.................... moves to amend H. F. No. 297, the delete everything amendment
(A07-0645), as follows:
Page 146, after line 26, insert:
"Section 1. Minnesota Statutes 2006, section 62J.17, subdivision 2, is amended to read:
Subd. 2. Definitions.
For purposes of this section, the terms defined in this
subdivision have the meanings given.
(a) "Access" means the financial, temporal, and geographic availability of health
1.8 care to individuals who need it.
1.9 (b) (a)
"Capital expenditure" means an expenditure which, under generally accepted
accounting principles, is not properly chargeable as an expense of operation and
(c) "Cost" means the amount paid by consumers or third party payers for health
1.13 care services or products.
1.14 (d) "Date of the major spending commitment" means the date the provider formally
1.15 obligated itself to the major spending commitment. The obligation may be incurred
1.16 by entering into a contract, making a down payment, issuing bonds or entering a loan
1.17 agreement to provide financing for the major spending commitment, or taking some other
1.18 formal, tangible action evidencing the provider's intention to make the major spending
1.20 (e) (b)
"Health care service" means:
(1) a service or item that would be covered by the medical assistance program
under chapter 256B if provided in accordance with medical assistance requirements to an
eligible medical assistance recipient; and
(2) a service or item that would be covered by medical assistance except that it is
characterized as experimental, cosmetic, or voluntary.
"Health care service" does not include retail, over-the-counter sales of
nonprescription drugs and other retail sales of health-related products that are not generally
paid for by medical assistance and other third-party coverage.
"Major spending commitment" means an expenditure in excess of $1,000,000
(1) acquisition of a unit of medical equipment;
(2) a capital expenditure for a single project for the purposes of providing health
care services, other than for the acquisition of medical equipment;
(3) offering a new specialized service not offered before;
(4) planning for an activity that would qualify as a major spending commitment
under this paragraph; or
(5) a project involving a combination of two or more of the activities in clauses
(1) to (4).
The cost of acquisition of medical equipment, and the amount of a capital
expenditure, is the total cost to the provider regardless of whether the cost is distributed
over time through a lease arrangement or other financing or payment mechanism.
"Medical equipment" means fixed and movable equipment that is used by
a provider in the provision of a health care service. "Medical equipment" includes, but
is not limited to, the following:
(1) an extracorporeal shock wave lithotripter;
(2) a computerized axial tomography (CAT) scanner;
(3) a magnetic resonance imaging (MRI) unit;
(4) a positron emission tomography (PET) scanner; and
(5) emergency and nonemergency medical transportation equipment and vehicles.
"New specialized service" means a specialized health care procedure or
treatment regimen offered by a provider that was not previously offered by the provider,
including, but not limited to:
(1) cardiac catheterization services involving high-risk patients as defined in the
Guidelines for Coronary Angiography established by the American Heart Association
and the American College of Cardiology;
(2) heart, heart-lung, liver, kidney, bowel, or pancreas transplantation service, or
any other service for transplantation of any other organ;
(3) megavoltage radiation therapy;
(4) open heart surgery;
(5) neonatal intensive care services; and
(6) any new medical technology for which premarket approval has been granted by
the United States Food and Drug Administration, excluding implantable and wearable
3.4 (f) "Specialty care" includes but is not limited to cardiac, neurology, orthopedic,
3.5obstetrics, mental health, chemical dependency, and emergency services.
Sec. 2. Minnesota Statutes 2006, section 62J.17, subdivision 4a, is amended to read:
Subd. 4a. Expenditure reporting.
(a) A provider making a major spending
3.8 commitment after April 1, 1992, shall submit notification of the expenditure to the
3.9 commissioner and provide the commissioner with any relevant background information.
3.10 (b) Notification must include a report, submitted within 60 days after the date of the
3.11 major spending commitment, using terms conforming to the definitions in section
3.12 and this section. Each report is subject to retrospective review and must contain:
3.13 (1) a detailed description of the major spending commitment, including the specific
3.14 dollar amount of each expenditure, and its purpose;
3.15 (2) the date of the major spending commitment;
3.16 (3) a statement of the expected impact that the major spending commitment will
3.17 have on charges by the provider to patients and third party payers;
3.18 (4) a statement of the expected impact on the clinical effectiveness or quality of care
3.19 received by the patients that the provider expects to serve;
3.20 (5) a statement of the extent to which equivalent services or technology are already
3.21 available to the provider's actual and potential patient population;
3.22 (6) a statement of the distance from which the nearest equivalent services or
3.23 technology are already available to the provider's actual and potential population;
3.24 (7) a statement describing the pursuit of any lawful collaborative arrangements; and
3.25 (8) a statement of assurance that the provider will not use, purchase, or perform
3.26 health care technologies and procedures that are not clinically effective and cost-effective,
3.27 unless the technology is used for experimental or research purposes to determine whether
3.28 a technology or procedure is clinically effective and cost-effective.
3.29 The provider may submit any additional information that it deems relevant.
3.30 (c) The commissioner may request additional information from a provider for the
3.31 purpose of review of a report submitted by that provider, and may consider relevant
3.32 information from other sources. A provider shall provide any information requested by
3.33 the commissioner within the time period stated in the request, or within 30 days after the
3.34 date of the request if the request does not state a time.
3.35 (d) If the provider fails to submit a complete and timely expenditure report, including
3.36 any additional information requested by the commissioner, the commissioner may make
4.1 the provider's subsequent major spending commitments subject to the procedures of
4.2 prospective review and approval under subdivision 6a.
4.3 Each hospital, outpatient surgical center, diagnostic imaging center, and physician
4.4clinic shall report annually to the commissioner on all major spending commitments,
4.5in the form and manner specified by the commissioner. The report shall include the
4.7 (a) a description of major spending commitments made during the previous year,
4.8including the total dollar amount of major spending commitments and purpose of the
4.10 (b) the cost of land acquisition, construction of new facilities, and renovation of
4.12 (c) the cost of purchased or leased medical equipment, by type of equipment;
4.13 (d) expenditures by type for specialty care and new specialized services;
4.14 (e) information on the amount and types of added capacity for diagnostic imaging
4.15services, outpatient surgical services, and new specialized services; and
4.16 (f) information on investments in electronic medical records systems.
4.17For hospitals and outpatient surgical centers, this information shall be included in reports
4.18to the commissioner that are required under section 144.698. For diagnostic imaging
4.19centers, this information shall be included in reports to the commissioner that are required
4.20under section 144.565. For physician clinics, this information shall be included in reports
4.21to the commissioner that are required under section 62J.41. For all other health care
4.22providers that are subject to this reporting requirement, reports must be submitted to the
4.23commissioner by March 1 each year for the preceding calendar year.
Sec. 3. Minnesota Statutes 2006, section 62J.17, subdivision 7, is amended to read:
Subd. 7. Exceptions.
retrospective review process as described in
4.26 subdivision 5a and the prospective review and approval process as described in subdivision
4.27 6a reporting requirement in subdivision 4a do does
not apply to:
(1) a major spending commitment to replace existing equipment with comparable
4.29 equipment used for direct patient care, upgrades of equipment beyond the current model,
4.30 or comparable model must be reported;
4.31 (2) (1)
a major spending commitment made by a research and teaching institution
for purposes of conducting medical education, medical research supported or sponsored
by a medical school, or by a federal or foundation grant or clinical trials;
(3) a major spending commitment to repair, remodel, or replace existing buildings or
4.35 fixtures if, in the judgment of the commissioner, the project does not involve a substantial
5.1 expansion of service capacity or a substantial change in the nature of health care services
5.3 (4) (2)
a major spending commitment for building maintenance including heating,
water, electricity, and other maintenance-related expenditures; and
a major spending commitment for activities, not directly related to the
delivery of patient care services, including food service, laundry, housekeeping, and
other service-related activities
5.8 (6) a major spending commitment for computer equipment or data systems not
5.9 directly related to the delivery of patient care services, including computer equipment or
5.10 data systems related to medical record automation.
(b) In addition to the exceptions listed in paragraph (a), the
prospective review and
5.12 approval process described in subdivision 6a reporting requirement in subdivision 4a
not apply to mergers, acquisitions, and other changes in ownership or control that, in the
judgment of the commissioner, do not involve a substantial expansion of service capacity
or a substantial change in the nature of health care services provided.
Sec. 4. Minnesota Statutes 2006, section 62J.41, subdivision 1, is amended to read:
Subdivision 1. Cost containment data to be collected from providers.
commissioner shall require health care providers to collect and provide both patient
specific information and descriptive and financial aggregate data on:
(1) the total number of patients served;
(2) the total number of patients served by state of residence and Minnesota county;
(3) the site or sites where the health care provider provides services;
(4) the number of individuals employed, by type of employee, by the health care
(5) the services and their costs for which no payment was received;
(6) total revenue by type of payer or by groups of payers, including but not limited
to, revenue from Medicare, medical assistance, MinnesotaCare, nonprofit health service
plan corporations, commercial insurers, health maintenance organizations, and individual
(7) revenue from research activities;
(8) revenue from educational activities;
(9) revenue from out-of-pocket payments by patients;
(10) revenue from donations;
5.34 (11) a report on health care capital expenditures during the previous year, as required
5.35by section 62J.17; and
6.1 (11) (12)
any other data required by the commissioner, including data in
unaggregated form, for the purposes of developing spending estimates, setting spending
limits, monitoring actual spending, and monitoring costs.
The commissioner may, by rule, modify the data submission categories listed above if the
commissioner determines that this will reduce the reporting burden on providers without
having a significant negative effect on necessary data collection efforts.
Sec. 5. Minnesota Statutes 2006, section 62J.52, subdivision 1, is amended to read:
Subdivision 1. Uniform billing form CMS 1450.
(a) On and after January 1,
1996, all institutional inpatient hospital services, ancillary services, institutionally owned
or operated outpatient services rendered by providers in Minnesota, and institutional
or noninstitutional home health services that are not being billed using an equivalent
electronic billing format, must be billed using the uniform billing form CMS 1450, except
as provided in subdivision 5.
(b) The instructions and definitions for the use of the uniform billing form CMS
1450 shall be in accordance with the uniform billing form manual specified by the
commissioner. In promulgating these instructions, the commissioner may utilize the
manual developed by the National Uniform Billing Committee, as adopted and finalized
by the Minnesota Uniform Billing Committee.
(c) Services to be billed using the uniform billing form CMS 1450 include:
institutional inpatient hospital services and distinct units in the hospital such as psychiatric
unit services, physical therapy unit services, swing bed (SNF) services, inpatient state
psychiatric hospital services, inpatient skilled nursing facility services, home health
services (Medicare part A), and hospice services; ancillary services, where benefits are
exhausted or patient has no Medicare part A, from hospitals, state psychiatric hospitals,
skilled nursing facilities, and home health (Medicare part B); institutional owned or
operated outpatient services such as waivered services, hospital outpatient services,
including ambulatory surgical center services, hospital referred laboratory services,
hospital-based ambulance services, and other hospital outpatient services, skilled nursing
facilities, home health, freestanding renal dialysis centers, comprehensive outpatient
rehabilitation facilities (CORF), outpatient rehabilitation facilities (ORF), rural health
clinics, and community mental health centers; home health services such as home health
intravenous therapy providers, waivered services, personal care attendants, and hospice;
and any other health care provider certified by the Medicare program to use this form.
(d) On and after January 1, 1996, a mother and newborn child must be billed
separately, and must not be combined on one claim form.
7.1 (e) Services provided by Medicare Critical Access Hospitals electing Method
7.2II billing will be allowed an exception to this provision to allow the inclusion of the
7.3professional fees on the CMS 1450.
Sec. 6. Minnesota Statutes 2006, section 62J.52, subdivision 2, is amended to read:
Subd. 2. Uniform billing form CMS 1500.
(a) On and after January 1, 1996, all
noninstitutional health care services rendered by providers in Minnesota except dental
or pharmacy providers, that are not currently being billed using an equivalent electronic
billing format, must be billed using the health insurance claim form CMS 1500, except as
provided in subdivision 5.
(b) The instructions and definitions for the use of the uniform billing form CMS
1500 shall be in accordance with the manual developed by the Administrative Uniformity
Committee entitled standards for the use of the CMS 1500 form, dated February 1994,
as further defined by the commissioner.
(c) Services to be billed using the uniform billing form CMS 1500 include physician
services and supplies, durable medical equipment, noninstitutional ambulance services,
independent ancillary services including occupational therapy, physical therapy, speech
therapy and audiology, home infusion therapy, podiatry services, optometry services,
mental health licensed professional services, substance abuse licensed professional
services, nursing practitioner professional services, certified registered nurse anesthetists,
chiropractors, physician assistants, laboratories, medical suppliers, and other health care
providers such as day activity centers and freestanding ambulatory surgical centers.
7.22 (d) Services provided by Medicare Critical Access Hospitals electing Method
7.23II billing will be allowed an exception to this provision to allow the inclusion of the
7.24professional fees on the CMS 1450.
Sec. 7. Minnesota Statutes 2006, section 62J.60, subdivision 2, is amended to read:
Subd. 2. General characteristics.
(a) The Minnesota uniform health care
identification card must be a preprinted card constructed of plastic, paper, or any other
medium that conforms with ANSI and ISO 7810 physical characteristics standards. The
card dimensions must also conform to ANSI and ISO 7810 physical characteristics
standard. The use of a signature panel is optional. The uniform prescription drug
information contained on the card must conform with the format adopted by the NCPDP
and, except as provided in subdivision 3, paragraph (a), clause (2), must include all of
the fields required to submit a claim in conformance with the most recent pharmacy
identification card implementation guide produced by the NCPDP. All information
required to submit a prescription drug claim, exclusive of information provided on a
prescription that is required by law, must be included on the card in a clear, readable, and
understandable manner. If a health benefit plan requires a conditional or situational field,
as defined by the NCPDP, the conditional or situational field must conform to the most
recent pharmacy information card implementation guide produced by the NCPDP.
(b) The Minnesota uniform health care identification card must have an essential
information window on the front side with the following data elements: card issuer name,
electronic transaction routing information, card issuer identification number, cardholder
(insured) identification number, and cardholder (insured) identification name. No optional
data may be interspersed between these data elements.
(c) Standardized labels are required next to human readable data elements and
8.10must come before the human data elements
Sec. 8. Minnesota Statutes 2006, section 62J.60, subdivision 3, is amended to read:
Subd. 3. Human readable data elements.
(a) The following are the minimum
human readable data elements that must be present on the front side of the Minnesota
uniform health care identification card:
(1) card issuer name or logo, which is the name or logo that identifies the card issuer.
The card issuer name or logo may be located at the top of the card. No standard label
is required for this data element;
(2) complete electronic transaction routing information including, at a minimum,
the international identification number. The standardized label of this data element
is "RxBIN." Processor control numbers and group numbers are required if needed to
electronically process a prescription drug claim. The standardized label for the process
control numbers data element is "RxPCN" and the standardized label for the group
numbers data element is "RxGrp," except that if the group number data element is a
universal element to be used by all health care providers, the standardized label may be
"Grp." To conserve vertical space on the card, the international identification number and
the processor control number may be printed on the same line;
(3) cardholder (insured) identification number, which is the unique identification
number of the individual card holder established and defined under this section. The
standardized label for the data element is "ID";
(4) cardholder (insured) identification name, which is the name of the individual
card holder. The identification name must be formatted as follows: first name, space,
optional middle initial, space, last name, optional space and name suffix. The standardized
label for this data element is "Name";
(5) care type, which is the description of the group purchaser's plan product under
which the beneficiary is covered. The description shall include the health plan company
name and the plan or product name. The standardized label for this data element is
(6) service type, which is the description of coverage provided such as hospital,
dental, vision, prescription, or mental health. The standard label for this data element
9.5is "Svc Type"
(7) provider/clinic name, which is the name of the primary care clinic the card
holder is assigned to by the health plan company. The standard label for this field is
"PCP." This information is mandatory only if the health plan company assigns a specific
primary care provider to the card holder.
(b) The following human readable data elements shall be present on the back side
of the Minnesota uniform health care identification card. These elements must be left
justified, and no optional data elements may be interspersed between them:
(1) claims submission names and addresses, which are the names and addresses of
the entity or entities to which claims should be submitted. If different destinations are
required for different types of claims, this must be labeled;
(2) telephone numbers and names that pharmacies and other health care providers
may call for assistance. These telephone numbers and names are required on the back
side of the card only if one of the contacts listed in clause (3) cannot provide pharmacies
or other providers with assistance or with the telephone numbers and names of contacts
for assistance; and
(3) telephone numbers and names; which are the telephone numbers and names of the
following contacts with a standardized label describing the service function as applicable:
(i) eligibility and benefit information;
(ii) utilization review;
(iii) precertification; or
(iv) customer services.
(c) The following human readable data elements are mandatory on the back
side of the Minnesota uniform health care identification card for health maintenance
(1) emergency care authorization telephone number or instruction on how to receive
authorization for emergency care. There is no standard label required for this information;
(2) one of the following:
(i) telephone number to call to appeal to or file a complaint with the commissioner of
(ii) for persons enrolled under section
, the telephone
number to call to file a complaint with the ombudsperson designated by the commissioner
of human services under section
and the address to appeal to the commissioner of
human services. There is no standard label required for this information.
(d) All human readable data elements not required under paragraphs (a) to (c) are
optional and may be used at the issuer's discretion."
Page 159, after line 15, insert:
"Sec. 15. Minnesota Statutes 2006, section 144.565, is amended to read:
10.9144.565 DIAGNOSTIC IMAGING FACILITIES.
Subdivision 1. Utilization and services data; economic and financial interests.
The commissioner shall require diagnostic imaging facilities and providers of diagnostic
10.12imaging services in Minnesota
report by March 1 each year for the preceding
to the commissioner, in the form and manner specified by the commissioner:
(1) utilization data for each health plan company and each public program,
including workers' compensation,
as follows: of diagnostic imaging services as defined
10.16in subdivision 4, paragraph (b);
10.17 (i) the number of computerized tomography (CT) procedures performed;
10.18 (ii) the number of magnetic resonance imaging (MRI) procedures performed; and
10.19 (iii) the number of positron emission tomography (PET) procedures performed; and
(2) the names of all physicians with any financial or economic interest and
individuals with a ten percent or greater
financial or economic interest in the facility
10.22 (3) the location where procedures were performed;
10.23 (4) the number of units of each type of fixed, portable, and mobile scanner used at
10.25 (5) the average number of hours per month each mobile scanner was operated at
10.27 (6) the number of hours per month each scanner was leased, if applicable;
10.28 (7) the total number of diagnostic imaging procedures billed for by the provider at
10.29each location, by type of diagnostic imaging service as defined in subdivision 4, paragraph
10.31 (8) a report on major health care capital expenditures during the previous year, as
10.32required by section 62J.17.
Subd. 2. Commissioner's right to inspect records.
If the report is not filed or
the commissioner of health has reason to believe the report is incomplete or false, the
commissioner shall have the right to inspect diagnostic imaging facility books, audits,
Subd. 3. Separate reports.
For a diagnostic imaging facility that is not attached
11.2 or not contiguous to a hospital or a hospital affiliate, the commissioner shall require
11.3 the information in subdivision 1 be reported separately for each detached diagnostic
11.4 imaging facility as part of the report required under section
If any entity owns
more than one diagnostic imaging facility, that entity must report by individual facility.
11.6Reports must include only services that were billed by the provider of diagnostic imaging
11.7services submitting the report. If a diagnostic imaging facility leases capacity, technical
11.8services, or professional services to one or more other providers of diagnostic imaging
11.9services, each provider must submit a separate annual report to the commissioner for all
11.10diagnostic imaging services that it provided and billed. The owner of the leased capacity
11.11must provide a report listing the names and addresses of providers to whom the diagnostic
11.12imaging services and equipment were leased.
Subd. 4. Definitions.
For purposes of this section, the following terms have the
(a) "Diagnostic imaging facility" means a health care facility that
provides is not
11.16a hospital or location licensed as a hospital which offers
diagnostic imaging services
through the use of ionizing radiation or other imaging technique including, but not limited
11.18 to magnetic resonance imaging (MRI) or computerized tomography (CT) scan on a
11.19 freestanding or mobile basis in Minnesota, regardless of whether the equipment used
11.20to provide the service is owned or leased. For the purposes of this section, diagnostic
11.21imaging facility includes, but is not limited to, facilities such as a physician's office, clinic,
11.22mobile transport vehicle, outpatient imaging center, or surgical center
11.23 (b) "Diagnostic imaging service" means the use of ionizing radiation or other
11.24imaging technique on a human patient including, but not limited to, magnetic resonance
11.25imaging (MRI) or computerized tomography (CT), positron emission tomography (PET),
11.26or single photon emission computerized tomography (SPECT) scans using fixed, portable,
11.27or mobile equipment.
"Financial or economic interest" means a direct or indirect:
(1) equity or debt security issued by an entity, including, but not limited to, shares of
stock in a corporation, membership in a limited liability company, beneficial interest in
a trust, units or other interests in a partnership, bonds, debentures, notes or other equity
interests or debt instruments, or any contractual arrangements;
(2) membership, proprietary interest, or co-ownership with an individual, group, or
organization to which patients, clients, or customers are referred to; or
(3) employer-employee or independent contractor relationship, including, but not
limited to, those that may occur in a limited partnership, profit-sharing arrangement, or
other similar arrangement with any facility to which patients are referred, including any
compensation between a facility and a health care provider, the group practice of which
the provider is a member or employee or a related party with respect to any of them.
Freestanding Fixed equipment
" means a stationary
facility that is not located within a: machine installed in a permanent location.
12.6 (1) hospital;
12.7 (2) location licensed as a hospital; or
12.8 (3) physician's office or clinic where the professional practice of medicine by
12.9 licensed physicians is the primary purpose and not the provision of ancillary services
12.10 such as diagnostic imaging.
12.11 (d) (e)
" means a diagnostic imaging
facility that is transported to
12.12 various sites not including movement within a hospital or a physician's office or clinic
12.13machine in a self-contained transport vehicle designed to be brought to a temporary offsite
12.14location to perform diagnostic imaging services
12.15 (f) "Portable equipment" means a diagnostic imaging machine designed to be
12.16temporarily transported within a permanent location to perform diagnostic imaging
12.18 (g) "Provider of diagnostic imaging services" means a diagnostic imaging facility
12.19or an entity that offers and bills for diagnostic imaging services at a facility owned or
12.20leased by the entity.
12.21 Subd. 5. Reports open to public inspection. All reports filed pursuant to this
12.22section shall be open to public inspection.
Page 163, delete section 22 and insert:
"Sec. .... REPEALER.
12.25(a) Minnesota Statutes 2006, section 144.335, is repealed.
12.26(b) Minnesota Statutes 2006, section 62J.17, subdivisions 1, 5a, 6a, and 8, are
12.27repealed, effective the day following final enactment.
Renumber the sections in sequence and correct the internal references
Amend the title accordingly