House Journal 57th Day Wednesday April 26 2023

A quorum was present.

Davids, Kiel and Nadeau were excused.

The Chief Clerk proceeded to read the Journal of the preceding day. There being no objection, further reading of the Journal was dispensed with and the Journal was approved as corrected by the Chief Clerk.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7072

PETITIONS AND COMMUNICATIONS

The following communications were received:

STATE OF MINNESOTA

OFFICE OF THE GOVERNOR

SAINT PAUL 55155

April 17, 2023

The Honorable Melissa Hortman

Speaker of the House of Representatives

The State of Minnesota

Dear Speaker Hortman:

Please be advised that I have received, approved, signed, and deposited in the Office of the Secretary of State the following House File:

H. F. No. 1278, relating to public safety; transferring money for the disaster assistance contingency account.

Sincerely,

Tim Walz

Governor

STATE OF MINNESOTA

OFFICE OF THE SECRETARY OF STATE

ST. PAUL 55155

The Honorable Melissa Hortman

Speaker of the House of Representatives

The Honorable Bobby Joe Champion

President of the Senate

I have the honor to inform you that the following enrolled Act of the 2023 Session of the State Legislature has been received from the Office of the Governor and is deposited in the Office of the Secretary of State for preservation, pursuant to the State Constitution, Article IV, Section 23:

S. F.

No.

H. F.

No.

Session Laws

Chapter No.

Time and

Date Approved

2023

Date Filed

2023

1278 26 11:41 a.m. April 17 April 17

Sincerely,

Steve Simon

Secretary of State

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7073

STATE OF MINNESOTA

OFFICE OF THE GOVERNOR

SAINT PAUL 55155

April 18, 2023

The Honorable Melissa Hortman

Speaker of the House of Representatives

The State of Minnesota

Dear Speaker Hortman:

Please be advised that I have received, approved, signed, and deposited in the Office of the Secretary of State the following House Files:

H. F. No. 1656, relating to energy; establishing grant programs to enhance the competitiveness of Minnesota entities in obtaining federal money for energy projects; creating an account; requiring a report; appropriating money.

H. F. No. 1581, relating to legislative enactments; making miscellaneous technical corrections to laws and statutes; correcting erroneous, obsolete, and omitted text and references; removing redundant, conflicting, and superseded provisions.

Sincerely,

Tim Walz

Governor

STATE OF MINNESOTA

OFFICE OF THE SECRETARY OF STATE

ST. PAUL 55155

The Honorable Melissa Hortman

Speaker of the House of Representatives

The Honorable Bobby Joe Champion

President of the Senate

I have the honor to inform you that the following enrolled Acts of the 2023 Session of the State Legislature have been received from the Office of the Governor and are deposited in the Office of the Secretary of State for preservation, pursuant to the State Constitution, Article IV, Section 23:

S. F.

No.

H. F.

No.

Session Laws

Chapter No.

Time and

Date Approved

2023

Date Filed

2023

1656 24 10:52 a.m. April 18 April 18

1581 25 10:52 a.m. April 18 April 18

Sincerely,

Steve Simon

Secretary of State

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7074

STATE OF MINNESOTA

OFFICE OF THE GOVERNOR

SAINT PAUL 55155

April 25, 2023

The Honorable Melissa Hortman

Speaker of the House of Representatives

The State of Minnesota

Dear Speaker Hortman:

Please be advised that I have received, approved, signed, and deposited in the Office of the Secretary of State the following House File:

H. F. No. 42, relating to public safety; amending definitions of labor trafficking; establishing enhanced penalties for labor trafficking when the trafficking occurs over an extended period of time or when a victim dies or suffers great bodily harm; making conforming changes related to the statewide human trafficking assessment; requiring the Sentencing Guidelines Commission to consider assigning a severity level ranking to the labor trafficking crime.

Sincerely,

Tim Walz

Governor

STATE OF MINNESOTA

OFFICE OF THE SECRETARY OF STATE

ST. PAUL 55155

The Honorable Melissa Hortman

Speaker of the House of Representatives

The Honorable Bobby Joe Champion

President of the Senate

S. F.

No.

H. F.

No.

Session Laws

Chapter No.

Time and

Date Approved

2023

Date Filed

2023

42 27 3:36 p.m. April 25 April 25

Sincerely,

Steve Simon

Secretary of State

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7075

REPORTS OF STANDING COMMITTEES AND DIVISIONS

Liebling from the Committee on Health Finance and Policy to which was referred:

H. F. No. 402, A bill for an act relating to health; establishing requirements for certain health care entity transactions; changing the expiration date on moratorium conversion transactions; requiring a health system to return charitable assets received from the state to the general fund in certain circumstances; requiring a study on the regulation of certain transactions; requiring a report; appropriating money; amending Laws 2017, First Special Session chapter 6, article 5, section 11, as amended; proposing coding for new law in Minnesota Statutes, chapter 144.

Reported the same back with the following amendments:

Delete everything after the enacting clause and insert:

"Section 1. Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:

Subd. 11. Restricted uses of the all-payer claims data. (a) Notwithstanding subdivision 4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's designee shall only use the data submitted under subdivisions 4 and 5 for the following purposes:

(1) to evaluate the performance of the health care home program as authorized under section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively (RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments of Health and Human Services, including the analysis of health care cost, quality, and utilization baseline and trend information for targeted populations and communities; ~~and~~

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such as the dates of the data contained in the files, the absence of costs of care for uninsured patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under this section as of June 30, 2015.; and

(6) to conduct analyses of the impact of health care transactions on health care costs, market consolidation, and quality under section 145D.01, subdivision 6.

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(b) The commissioner may publish the results of the authorized uses identified in paragraph (a) so long as the data released publicly do not contain information or descriptions in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from using the data collected under subdivision 4 to complete the state-based risk adjustment system assessment due to the legislature on October 1, 2015.

(d) The commissioner or the commissioner's designee may use the data submitted under subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1, 2023.

(e) The commissioner shall consult with the all-payer claims database work group established under subdivision 12 regarding the technical considerations necessary to create the public use files of summary data described in paragraph (a), clause (5).

Sec. 2. [145D.01] REQUIREMENTS FOR CERTAIN HEALTH CARE ENTITY TRANSACTIONS.

Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given.

(b) "Captive professional entity" means a professional corporation, limited liability company, or other entity formed to render professional services in which a beneficial owner is a health care provider employed by, controlled by, or subject to the direction of a hospital or hospital system.

(d) "Health care entity" means:

(1) a hospital;

(2) a hospital system;

(3) a captive professional entity;

(4) a medical foundation;

(5) a health care provider group practice;

(6) an entity organized or controlled by an entity listed in clauses (1) to (5); or

(7) an entity that owns or exercises substantial control over an entity listed in clauses (1) to (5).

(e) "Health care provider" means a physician licensed under chapter 147, a physician assistant licensed under chapter 147A, or an advanced practice registered nurse as defined in section 148.171, subdivision 3, who provides health care services, including but not limited to medical care, consultation, diagnosis, or treatment.

(f) "Health care provider group practice" means two or more health care providers legally organized in a partnership, professional corporation, limited liability company, medical foundation, nonprofit corporation, faculty practice plan, or other similar entity:

(1) in which each health care provider who is a member of the group provides substantially the full range of services that a health care provider routinely provides, including but not limited to medical care, consultation, diagnosis, and treatment, through the joint use of shared office space, facilities, equipment, or personnel;

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(2) for which substantially all services of the health care providers who are group members are provided through the group and are billed in the name of the group practice and amounts so received are treated as receipts of the group; or

(3) in which the overhead expenses of, and the income from, the group are distributed in accordance with methods previously determined by members of the group.

An entity that otherwise meets the definition of health care provider group practice in this paragraph shall be considered a health care provider group practice even if its shareholders, partners, or owners include single health care provider professional corporations, limited liability companies formed to render professional services, or other entities in which beneficial owners are individual health care providers.

(g) "Hospital" means a health care facility licensed as a hospital under sections 144.50 to 144.56.

(h) "Medical foundation" means a nonprofit legal entity through which physicians or other health care providers perform research or provide medical services.

(i)(1) "Transaction" means a single action, or a series of actions within a five-year period, that constitutes:

(i) a merger or exchange of a health care entity with another entity;

(ii) the sale, lease, or transfer of 40 percent or more of the assets of a health care entity to another entity;

(iii) the granting of a security interest of 40 percent or more of the property and assets of a health care entity to another entity;

(iv) the transfer of 40 percent or more of the shares or other ownership of a health care entity to another entity;

(v) a transfer of control, responsibility for, or governance of a health care entity, including any transfer of membership interests that effectively constitutes such a transfer;

(vi) the creation of a new health care entity; or

(vii) substantial investment of 40 percent or more in a health care entity that results in sharing of revenues without a change in ownership or voting shares.

(2) "Transaction" does not include:

(i) a mortgage or other secured loan for business improvement purposes entered into by a health care entity that does not directly affect delivery of health care or governance of the health care entity;

(ii) a clinical affiliation of health care entities formed solely for the purpose of collaborating on clinical trials or providing graduate medical education;

(iii) the mere offer of employment to, or hiring of, a physician or other individual provider by a health care entity;

(iv) a transaction between entities under common ownership or control, either directly or indirectly through one or more intermediaries; or

(v) a single action or series of actions within a five-year period involving only entities that operate solely as a nursing home licensed under chapter 144A; a boarding care home licensed under sections 144.50 to 144.56; a supervised living facility licensed under sections 144.50 to 144.56; an assisted living facility licensed under chapter

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144G; a foster care setting licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, for a physical location that is not the primary residence of the license holder; a community residential setting as defined in section 245D.02, subdivision 4a; or a home care provider licensed under sections 144A.471 to 144A.483.

Subd. 2. Notice required. (a) This subdivision applies to all transactions where:

(1) the health care entity involved in the transaction has average revenue of at least $40,000,000 per year; or

(2) an entity created by the transaction is projected to have average revenue of at least $40,000,000 per year once the entity is operating at full capacity.

(b) A health care entity must provide notice to the attorney general and the commissioner and comply with this subdivision before entering into a transaction. Notice must be provided at least 90 days before the proposed completion date of the transaction.

(c) As part of the notice required under this subdivision, at least 90 days before the proposed completion date of the transaction, a health care entity must affirmatively disclose the following to the attorney general and the commissioner:

(1) the entities involved in the transaction;

(2) the leadership of the entities involved in the transaction, including all directors, board members, and officers;

(3) the services provided by each entity and the attributed revenue for each entity by location;

(4) the primary service area for each location;

(5) the proposed service area for each location;

(6) the current relationships between the entities and the affected health care providers and practices, the locations of affected health care providers and practices, the services provided by affected health care providers and practices, and the proposed relationships between the entities and the affected health care providers and practices;

(7) the terms of the transaction agreement or agreements;

(8) the acquisition price;

(9) markets in which the entities expect postmerger synergies to produce a competitive advantage;

(10) potential areas of expansion, whether in existing markets or new markets;

(11) plans to close facilities, reduce workforce, or reduce or eliminate services;

(12) the experts and consultants used to evaluate the transaction;

(13) the number of full-time equivalent positions at each location before and after the transaction by job category, including administrative and contract positions; and

(14) any other information requested by the attorney general or commissioner.

(d) As part of the notice required under this subdivision, at least 90 days before the proposed completion date of the transaction, a health care entity must affirmatively submit the following to the attorney general and the commissioner:

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(1) the current governing documents for all entities involved in the transaction and any amendments to these documents;

(2) the transaction agreement or agreements and all related agreements;

(3) any collateral agreements related to the principal transaction, including leases, management contracts, and service contracts;

(4) all expert or consultant reports or valuations conducted in evaluating the transaction, including any valuation of the assets that are subject to the transaction prepared within three years preceding the anticipated transaction completion date and any reports of financial or economic analysis conducted in anticipation of the transaction;

(5) the results of any projections or modeling of health care utilization or financial impacts related to the transaction, including but not limited to copies of reports by appraisers, accountants, investment bankers, actuaries, and other experts;

(6) for a transaction as defined in subdivision 1, paragraph (i), clause (1), item (i) or (v), a financial and economic analysis and report prepared by an independent expert or consultant on the effects of the transaction;

(7) for a transaction as defined in subdivision 1, paragraph (i), clause (1), item (i) or (v), an impact analysis report prepared by an independent expert or consultant on the effects of the transaction on communities and the workforce, including any changes in availability or accessibility of services;

(8) all documents reflecting the purposes of or restrictions on any related nonprofit entity's charitable assets;

(9) copies of all filings submitted to federal regulators, including any Hart-Scott-Rodino filing the entities submitted to the Federal Trade Commission in connection with the transaction;

(10) a certification sworn under oath by each board member and chief executive officer for any nonprofit entity involved in the transaction containing the following: an explanation of how the completed transaction is in the public interest, addressing the factors in subdivision 5, paragraph (a); a disclosure of each declarant's compensation and benefits relating to the transaction for the three years following the transaction's anticipated completion date; and a disclosure of any conflicts of interest;

(11) audited and unaudited financial statements from all entities involved in the transaction and tax filings for all entities involved in the transaction covering the preceding five fiscal years; and

(12) any other information or documents requested by the attorney general or commissioner.

(e) The attorney general may extend the notice and waiting period required under paragraph (b) for an additional 90 days by notifying the health care entity in writing of the extension.

(f) The attorney general may waive all or any part of the notice and waiting period required under paragraph (b).

(g) The attorney general or the commissioner may hold public listening sessions or forums to obtain input on the transaction from providers or community members who may be impacted by the transaction.

(h) The attorney general or the commissioner may bring an action in district court to compel compliance with the notice requirements in this subdivision.

Subd. 3. Prohibited transactions. No health care entity may enter into a transaction that will:

(1) substantially lessen competition; or

(2) tend to create a monopoly or monopsony.

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Subd. 4. Additional requirements for nonprofit health care entities. A health care entity that is incorporated under chapter 317A or organized under section 322C.1101, or that is a subsidiary of any such entity, must, before entering into a transaction, ensure that:

(1) the transaction complies with chapters 317A and 501B and other applicable laws;

(2) the transaction does not involve or constitute a breach of charitable trust;

(3) the nonprofit health care entity will receive full and fair value for its public benefit assets. This clause does not apply to a transaction with a public entity or an organization that is exempt under section 501(c)(3) of the Internal Revenue Code of 1986, or any successor section, where the discount between the fair value of the assets and the transaction price will further the charitable purposes of the nonprofit health care entity;

(4) the value of the public benefit assets to be transferred has not been manipulated in a manner that causes or has caused the value of the assets to decrease;

(5) the proceeds of the transaction will be used in a manner consistent with the public benefit for which the assets are held by the nonprofit health care entity;

(6) the transaction will not result in a breach of fiduciary duty; and

(7) there are procedures and policies in place to prohibit any officer, director, trustee, or other executive of the nonprofit health care entity from directly or indirectly benefiting from the transaction.

Subd. 5. Attorney general enforcement and supplemental authority. (a) The attorney general may bring an action in district court to enjoin or unwind a transaction or seek other equitable relief necessary to protect the public interest if a health care entity or transaction violates this section, if the transaction is contrary to the public interest, or if both a health care entity or transaction violates this section and the transaction is contrary to the public interest. Factors informing whether a transaction is contrary to the public interest include but are not limited to whether the transaction:

(1) will harm public health;

(2) will reduce the affected community's continued access to affordable and quality care and to the range of services historically provided by the entities or will prevent members of the affected community from receiving a comparable or better patient experience;

(3) will have a detrimental impact on competing health care options within primary and dispersed service areas;

(4) will have a negative impact on wages paid by, or the number of employees employed by, a health care entity involved in a transaction;

(5) will reduce delivery of health care to disadvantaged, uninsured, underinsured, and underserved populations and to populations enrolled in public health care programs;

(6) will have a substantial negative impact on medical education and teaching programs, health care workforce training, or medical research;

(7) will have a negative impact on the market for health care services, health insurance services, or skilled health care workers;

(8) will have a negative impact on wages, collective bargaining units, and collective bargaining agreements of existing or future workers employed by a health care entity involved in a transaction;

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(9) will increase health care costs for patients; or

(10) will adversely impact provider cost trends and containment of total health care spending.

(b) The attorney general may enforce this section under section 8.31.

(c) Failure of the entities involved in a transaction to provide timely information as required by the attorney general or the commissioner shall be an independent and sufficient ground for a court to enjoin the transaction or provide other equitable relief, provided the attorney general notified the entities of the inadequacy of the information provided and provided the entities with a reasonable opportunity to remedy the inadequacy.

(d) The commissioner shall provide to the attorney general, upon request, data and research on broader market trends, impacts on prices and outcomes, public health and population health considerations, and health care access, for the attorney general to use when evaluating whether a transaction is contrary to the public interest.

Subd. 6. Supplemental authority of commissioner. (a) Notwithstanding any law to the contrary, the commissioner may use data or information submitted under this section, section 62U.04, and sections 144.695 to 144.703 to conduct analyses of the aggregate impact of health care transactions on access to or the cost of health care services, health care market consolidation, and health care quality.

(b) The commissioner shall issue periodic public reports on the number and types of transactions subject to this section and on the aggregate impact of transactions on health care cost, quality, and competition in Minnesota.

Subd. 7. Classification of data. (a) Data provided by a health care entity to the attorney general and the commissioner under this section is classified as protected nonpublic data as defined in section 13.02, subdivision 13, in the case of data not on individuals or confidential data on individuals as defined in section 13.02, subdivision 3, in the case of data on individuals. The attorney general or the commissioner may make any data classified as confidential or protected nonpublic under this paragraph accessible to any person, agency, or the public if the attorney general or the commissioner determines that the access will aid the law enforcement process, promote public health or safety, or dispel widespread rumor or unrest.

(b) Any information exchanged between the attorney general and the commissioner according to subdivision 5 is classified as confidential data on individuals as defined in section 13.02, subdivision 3, or protected nonpublic data as defined in section 13.02, subdivision 13. The commissioner may share with the attorney general, according to section 13.05, subdivision 9, any not public data, as defined in section 13.02, subdivision 8a, held by the Department of Health to aid in the investigation and review of the transaction, and the attorney general must maintain this data with the same classification according to section 13.03, subdivision 4, paragraph (d).

Subd. 8. Relation to other law. (a) The powers and authority under this section are in addition to, and do not affect or limit, all other rights, powers, and authority of the attorney general or the commissioner under chapters 8, 309, 317A, 325D, and 501B, or other law.

(b) Nothing in this section shall suspend any obligation imposed under chapters 8, 309, 317A, 325D, and 501B, or other law on the entities involved in a transaction.

EFFECTIVE DATE. This section is effective the day following final enactment and applies to transactions completed on or after that date. In determining whether a transaction was completed on or after the effective date, any actions or series of actions necessary to the completion of the transaction must be considered.

Sec. 3. [309.715] CHARITABLE ASSETS; RETURN TO GENERAL FUND; OWNERSHIP OR CONTROL OF UNIVERSITY OF MINNESOTA HEALTH CARE FACILITIES.

Subdivision 1. Return of charitable assets. If a nonprofit health maintenance organization licensed under chapter 62D, or a health system organized as a charitable organization, sells or transfers control to an out-of-state, nonprofit entity or to any for-profit entity, the health maintenance organization or health system must return to the

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general fund an amount equal to the value of any charitable assets the health maintenance organization or health system received from the state.

Subd. 2. University of Minnesota health care facilities; ownership or control. The importance of the University of Minnesota health care facilities, which are the academic health care facilities licensed by the commissioner of health as M Health Fairview University, or any successor name, to the state of Minnesota shall be recognized based on their status as publicly supported academic health care facilities; their relationship with the University of Minnesota Medical School, a public entity dedicated to medical education, research, and public service; the status of the University of Minnesota as a constitutionally autonomous state entity; and the university's mission as a land grant institution. The University of Minnesota health care facilities, as charitable assets, must remain dedicated to the university's public health care mission. As such, the University of Minnesota health care facilities shall not be owned or controlled, directly or indirectly, in whole or in part, by a for-profit entity or an out‑of-state entity, unless the attorney general determines that ownership or control by a for-profit entity or out‑of‑state entity is in the public interest. A determination under this subdivision must be made using the procedures and authority in section 145D.01 and in consultation with the commissioner of health and the Board of Regents of the University of Minnesota.

EFFECTIVE DATE. This section is effective the day following final enactment and applies to transactions by a health maintenance organization or health system related to selling or transferring control to an out-of-state nonprofit entity or for-profit entity, and to transactions related to transferring ownership or control of the University of Minnesota health care facilities, that are completed on or after that date.

Sec. 4. Laws 2017, First Special Session chapter 6, article 5, section 11, as amended by Laws 2019, First Special Session chapter 9, article 8, section 20, is amended to read:

Sec. 11. MORATORIUM ON CONVERSION TRANSACTIONS.

(a) Notwithstanding Laws 2017, chapter 2, article 2, a nonprofit health service plan corporation operating under Minnesota Statutes, chapter 62C, or a nonprofit health maintenance organization operating under Minnesota Statutes, chapter 62D, as of January 1, 2017, may only merge or consolidate with; convert; or transfer, as part of a single transaction or a series of transactions within a 24-month period, all or a material amount of its assets to an entity that is a corporation organized under Minnesota Statutes, chapter 317A; or to a Minnesota nonprofit hospital within the same integrated health system as the health maintenance organization. For purposes of this section, "material amount" means the lesser of ten percent of such an entity's total admitted net assets as of December 31 of the previous year, or $50,000,000.

(b) Paragraph (a) does not apply if the nonprofit service plan corporation or nonprofit health maintenance organization files an intent to dissolve due to insolvency of the corporation in accordance with Minnesota Statutes, chapter 317A, or insolvency proceedings are commenced under Minnesota Statutes, chapter 60B.

(c) Nothing in this section shall be construed to authorize a nonprofit health maintenance organization or a nonprofit service plan corporation to engage in any transaction or activities not otherwise permitted under state law.

(d) This section expires July 1, ~~2023~~ 2026.

EFFECTIVE DATE. This section is effective the day following final enactment.

Sec. 5. STUDY AND RECOMMENDATIONS; NONPROFIT HEALTH MAINTENANCE ORGANIZATION CONVERSIONS AND OTHER TRANSACTIONS.

(a) The commissioner of health shall study and develop recommendations on the regulation of conversions, mergers, transfers of assets, and other transactions affecting Minnesota-domiciled nonprofit health maintenance organizations and for-profit health maintenance organizations. The recommendations must at least address:

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(1) monitoring and regulation of Minnesota-domiciled for-profit health maintenance organizations;

(2) issues related to public benefit assets held by a nonprofit health maintenance organization, including identifying the portion of the organization's assets that are considered public benefit assets to be protected, establishing a fair and independent process to value the assets, and determining how public benefit assets should be stewarded for the public good;

(3) providing a state agency or executive branch office with authority to review and approve or disapprove a nonprofit health maintenance organization's plan to convert to a for-profit organization; and

(4) establishing a process for the public to learn about and provide input on a nonprofit health maintenance organization's proposed conversion to a for-profit organization.

(b) To fulfill the requirements under this section, the commissioner:

(1) may consult with the commissioners of human services and commerce;

(2) may enter into one or more contracts for professional or technical services;

(3) notwithstanding any law to the contrary, may use data submitted under Minnesota Statutes, sections 62U.04 and 144.695 to 144.703, and other data held by the commissioner for purposes of regulating health maintenance organizations or data already submitted to the commissioner by health carriers; and

(4) may collect from health maintenance organizations and their parent or affiliated companies, financial data and other information, including nonpublic data and trade secret data, that are deemed necessary by the commissioner to conduct the study and develop the recommendations under this section. Health maintenance organizations must provide the commissioner with any information requested by the commissioner under this clause, in the form and manner specified by the commissioner. Any data collected by the commissioner under this clause is classified as confidential data on individuals as defined in Minnesota Statutes, section 13.02, subdivision 3, or protected nonpublic data as defined in Minnesota Statutes, section 13.02, subdivision 13.

(c) No later than October 1, 2023, the commissioner must seek public comments on the regulation of conversion transactions involving nonprofit health maintenance organizations.

(d) The commissioner may use the enforcement authority in Minnesota Statutes, section 62D.17, if a health maintenance organization fails to comply with a request for information under paragraph (b), clause (4).

(e) The commissioner shall submit preliminary findings from this study to the chairs of the legislative committees with jurisdiction over health and human services by January 15, 2024, and shall submit a final report and recommendations to the legislature by June 30, 2024.

Sec. 6. APPROPRIATIONS.

$....... in fiscal year 2024 and $....... in fiscal year 2025 are appropriated from the general fund to the commissioner of health for purposes of Minnesota Statutes, section 145D.01."

Correct the title numbers accordingly

With the recommendation that when so amended the bill be re-referred to the Committee on Ways and Means.

The report was adopted.

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Stephenson from the Committee on Commerce Finance and Policy to which was referred:

H. F. No. 2988, A bill for an act relating to commerce; modifying workers' compensation self-insurance provisions; amending Minnesota Statutes 2022, sections 79A.01, subdivision 4; 79A.04, subdivisions 7, 9, 10, 16, by adding a subdivision; 79A.08; 79A.13; 79A.24, subdivision 4; 79A.25, subdivisions 1, 2, 3, by adding a subdivision.

Reported the same back with the recommendation that the bill be re-referred to the Committee on Labor and Industry Finance and Policy.

The report was adopted.

Pursuant to Joint Rule 2.03 and in accordance with Senate Concurrent Resolution No. 3, H. F. No. 2988 was re‑referred to the Committee on Rules and Legislative Administration.

INTRODUCTION AND FIRST READING OF HOUSE BILLS

The following House Files were introduced:

Wiens; Anderson, P. E.; Murphy; Grossell; Fogelman; Joy and Perryman introduced:

H. F. No. 3287, A bill for an act relating to transportation; taxes; establishing a temporary reduction in the rates of the motor fuels tax; making transfers; appropriating money.

The bill was read for the first time and referred to the Committee on Transportation Finance and Policy.

Frederick, Quam and Feist introduced:

H. F. No. 3288, A bill for an act relating to claims against the state; providing for the settlement of certain claims; appropriating money.

The bill was read for the first time and referred to the Committee on Ways and Means.

MESSAGES FROM THE SENATE

The following message was received from the Senate:

Madam Speaker:

I hereby announce the passage by the Senate of the following House File, herewith returned, as amended by the Senate, in which amendments the concurrence of the House is respectfully requested:

H. F. No. 2292, A bill for an act relating to early childhood; modifying provisions for early learning scholarships, Head Start, and early education programs; providing for early childhood educator programs; requiring reports; appropriating money; amending Minnesota Statutes 2022, sections 119A.52; 121A.17, subdivision 3; 121A.19; 124D.13, by adding a subdivision; 124D.141, subdivision 2; 124D.162; 124D.165, subdivisions 2, 3, 4, 6; 125A.13; 179A.03, subdivision 18; proposing coding for new law in Minnesota Statutes, chapter 122A.

Thomas S. Bottern, Secretary of the Senate

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Pinto moved that the House refuse to concur in the Senate amendments to H. F. No. 2292, that the Speaker appoint a Conference Committee of 3 members of the House, and that the House requests that a like committee be appointed by the Senate to confer on the disagreeing votes of the two houses. The motion prevailed.

Long moved that the House recess subject to the call of the Chair. The motion prevailed.

RECESS

RECONVENED

The House reconvened and was called to order by the Speaker.

MOTIONS AND RESOLUTIONS

TAKEN FROM THE TABLE

Long moved that S. F. No. 2909, the unofficial engrossment, as amended, be taken from the table. The motion prevailed.

S. F. No. 2909, the unofficial engrossment, as amended, was reported to the House.

Nash moved to amend S. F. No. 2909, the unofficial engrossment, as amended, as follows:

Page 11, delete lines 21 to 25

Reletter the paragraphs in sequence

Page 223, delete article 14

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

A roll call was requested and properly seconded.

The question was taken on the Nash amendment and the roll was called. There were 61 yeas and 70 nays as follows:

Those who voted in the affirmative were:

The motion did not prevail and the amendment was not adopted.

Demuth moved to amend S. F. No. 2909, the unofficial engrossment, as amended, as follows:

Page 58, after line 7, insert:

"Sec. 6. Minnesota Statutes 2022, section 609.065, is amended to read:

609.065 JUSTIFIABLE ~~TAKING OF LIFE~~ USE OF DEADLY FORCE IN DEFENSE OF HOME AND PERSON.

Subdivision 1. Definitions. The intentional taking of the life of another is not authorized by section 609.06, except when necessary in resisting or preventing an offense which the actor reasonably believes exposes the actor or another to great bodily harm or death, or preventing the commission of a felony in the actor's place of abode (a) For purposes of this section, the terms in this subdivision have the meanings given them.

(b) "Court order" means an order for protection issued under section 518B.01, a restraining order issued under section 609.748, a no contact order issued under section 629.75, or a substantively similar order issued by any court in this state, another state, the United States, or any subordinate jurisdiction of the United States.

(c) "Deadly force" means force used by an individual with the purpose of causing, or which the individual should reasonably know creates a substantial risk of causing, great bodily harm or death. The intentional discharge of a firearm by an individual at another person, or at a vehicle in which another person is believed to be, constitutes deadly force. A threat to cause great bodily harm or death, by the production of a weapon or otherwise, constitutes reasonable force and not deadly force, when the individual's objective is limited to creating an expectation that the individual will use deadly force only if authorized by law.

(d) "Dwelling" means a building defined under section 609.556, subdivision 3, an overnight stopping accommodation of any kind, or a place of abode, that an individual temporarily or permanently is occupying or intending to occupy as a habitation or home. A dwelling includes but is not limited to a building or conveyance and

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7088

that building's or conveyance's curtilage and any attached or adjacent deck, porch, appurtenance, or other structure, whether the building or conveyance is used temporarily or permanently for these purposes, is mobile or immobile, or is a motor vehicle, watercraft, motor home, tent, or the equivalent.

(e) "Forcible felony" means any crime punishable by imprisonment exceeding one year the elements of which include the use or threatened use of physical force or a deadly weapon against the person of another, including but not limited to: murder in the first degree under section 609.185; murder in the second degree under section 609.19; manslaughter in the first degree under section 609.20; assault in the first degree under section 609.221; assault in the second degree under section 609.222; assault in the third degree under section 609.223; criminal sexual conduct in the first degree under section 609.342; criminal sexual conduct in the second degree under section 609.343; arson in the first degree under section 609.561; burglary in the first, second, and third degrees under section 609.582; robbery under sections 609.24 and 609.245; and kidnapping under section 609.25.

(f) "Good faith" includes honesty in fact in the conduct of the act concerned.

(g) "Great bodily harm" has the meaning given in section 609.02, subdivision 8.

(h) "Imminent" means the actor infers from all the facts and circumstances that the course of conduct has commenced.

(i) "Substantial bodily harm" has the meaning given in section 609.02, subdivision 7a.

(j) "Vehicle" means a conveyance of any type.

Subd. 2. Circumstances when authorized. (a) The use of deadly force by an individual is justified under this section when the act is undertaken:

(1) to resist or prevent the commission of a felony in the individual's dwelling;

(2) to resist or prevent what the individual reasonably believes is an offense or attempted offense that imminently exposes the individual or another person to substantial bodily harm, great bodily harm, or death; or

(3) to resist or prevent what the individual reasonably believes is the commission or imminent commission of a forcible felony.

(b) The use of deadly force is not authorized under this section if the individual knows that the person against whom force is being used is a licensed peace officer from this state, another state, the United States, or any subordinate jurisdiction of the United States, who is acting lawfully.

Subd. 3. Degree of force; retreat. An individual taking defensive action pursuant to subdivision 2 may use all force and means, including deadly force, that the individual in good faith believes is required to succeed in defense. The individual may meet force with superior force when the individual's objective is defensive; the individual is not required to retreat; and the individual may continue defensive actions against an assailant until the danger has ended.

Subd. 4. Presumptions. (a) An individual using deadly force is presumed to possess a reasonable belief that there exists an imminent threat of substantial bodily harm, great bodily harm, or death to the individual or another person, if the individual knows or has reason to know that:

(1) the person against whom the defensive action is being taken is unlawfully entering or attempting to enter by force or by stealth, or has unlawfully entered by force or by stealth and remains within, the dwelling or occupied vehicle of the individual; or

(2) the person against whom the defensive action is being taken is in the process of removing, or attempting to remove, the individual or another person from the dwelling or occupied vehicle of the individual.

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(b) An individual is not entitled to the benefit of the presumption in paragraph (a) if the individual knows that the person against whom the defensive action is being taken:

(1) is a lawful resident of the dwelling or a lawful possessor of the vehicle, or is otherwise lawfully permitted to enter the dwelling or vehicle; or

(2) is a person who has lawful custody of the person being removed from the dwelling or vehicle or whose removal from the dwelling or vehicle is being attempted. A person who is prohibited by a court order from contacting another individual or from entering a dwelling or possessing a vehicle of another individual is not a lawful resident of that individual's dwelling and is not a lawful possessor of that individual's vehicle.

(c) An individual using defensive force is not entitled to the benefit of the presumption in paragraph (a) if the individual is presently engaged in a crime or attempting to escape from the scene of a crime, or is presently using the dwelling or occupied vehicle in furtherance of a crime.

(d) An individual is not entitled to the benefit of the presumption in paragraph (a) if the individual knows or has reason to know that the person against whom the defensive action is being taken is a licensed peace officer from this state, another state, the United States, or any subordinate jurisdiction of the United States, who is acting lawfully.

Subd. 5. Criminal investigation; immunity from prosecution. (a) An individual who uses force, including deadly force, according to this section or as otherwise provided by law in defense of the individual, the individual's dwelling, or another individual is justified in using such force and is immune from any criminal prosecution for that act.

(b) A law enforcement agency may arrest an individual using force under circumstances described in this section only after considering any claims or circumstances supporting self-defense or lawful defense of another individual.

Subd. 6. Justifiable use of force; burden of proof. In a criminal trial, when there is any evidence of justifiable use of force under this section or section 609.06, the state has the burden of proving beyond a reasonable doubt that the defendant's actions were not justifiable.

Subd. 7. Short title. This section may be cited as the "Defense of Dwelling and Person Act of 2023."

EFFECTIVE DATE. This section is effective August 1, 2023, and applies to uses of deadly force occurring on or after that date."

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

A roll call was requested and properly seconded.

The question was taken on the Demuth amendment and the roll was called. There were 62 yeas and 69 nays as follows:

Those who voted in the affirmative were:

The bill was passed, as amended, and its title agreed to.

There being no objection, the order of business reverted to Reports of Standing Committees and Divisions.

REPORTS OF STANDING COMMITTEES AND DIVISIONS

Long from the Committee on Rules and Legislative Administration to which was referred:

Reported the same back with the recommendation that the bill be re-referred to the Committee on Labor and Industry Finance and Policy.

Joint Rule 2.03 has been waived for any subsequent committee action on this bill.

The report was adopted.

MESSAGES FROM THE SENATE

The following messages were received from the Senate:

Madam Speaker:

I hereby announce the Senate refuses to concur in the House amendments to the following Senate File:

S. F. No. 2934, A bill for an act relating to human services; establishing an office of addiction and recovery; establishing the Minnesota board of recovery services; establishing title protection for sober homes; modifying provisions governing disability services, aging services, and behavioral health; modifying medical assistance eligibility requirements for certain populations; making technical and conforming changes; establishing certain grants; requiring reports; appropriating money; amending Minnesota Statutes 2022, sections 4.046, subdivisions 6, 7, by adding a subdivision; 179A.54, by adding a subdivision; 241.021, subdivision 1; 241.31, subdivision 5; 241.415; 245A.03, subdivision 7; 245A.11, subdivisions 7, 7a; 245D.04, subdivision 3; 245G.01, by adding subdivisions; 245G.02, subdivision 2; 245G.05, subdivision 1, by adding a subdivision; 245G.06, subdivisions 1, 3, 4, by adding subdivisions; 245G.08, subdivision 3; 245G.09, subdivision 3; 245G.22, subdivision 15; 245I.10, subdivision 6; 246.54, subdivisions 1a, 1b; 252.27, subdivision 2a; 254B.01, subdivision 8, by adding subdivisions; 254B.04, by adding a subdivision; 254B.05, subdivisions 1, 5; 256.043, subdivisions 3, 3a; 256.9754; 256B.04, by adding a subdivision; 256B.056, subdivision 3; 256B.057, subdivision 9; 256B.0625, subdivisions 17, 17a, 18h, 22,

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by adding a subdivision; 256B.0638, subdivisions 2, 4, 5; 256B.0659, subdivisions 1, 12, 19, 24; 256B.073, subdivision 3, by adding a subdivision; 256B.0759, subdivision 2; 256B.0911, subdivision 13; 256B.0913, subdivisions 4, 5; 256B.0917, subdivision 1b; 256B.0922, subdivision 1; 256B.0949, subdivision 15; 256B.14, subdivision 2; 256B.434, by adding a subdivision; 256B.49, subdivisions 11, 28; 256B.4905, subdivision 5a; 256B.4911, by adding a subdivision; 256B.4912, by adding subdivisions; 256B.4914, subdivisions 3, as amended, 4, 5, 5a, 5b, 5c, 5d, 5e, 8, 9, 10, 10a, 10c, 12, 14, by adding a subdivision; 256B.492; 256B.5012, by adding subdivisions; 256B.766; 256B.85, subdivision 7, by adding a subdivision; 256B.851, subdivisions 5, 6; 256I.05, by adding subdivisions; 256M.42; 256R.02, subdivision 19; 256R.17, subdivision 2; 256R.25; 256R.47; 256R.481; 256R.53, by adding subdivisions; 256S.15, subdivision 2; 256S.18, by adding a subdivision; 256S.19, subdivision 3; 256S.203, subdivisions 1, 2; 256S.205, subdivisions 3, 5; 256S.21; 256S.2101, subdivisions 1, 2, by adding subdivisions; 256S.211, by adding subdivisions; 256S.212; 256S.213; 256S.214; 256S.215, subdivisions 2, 3, 4, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17; Laws 2019, chapter 63, article 3, section 1, as amended; Laws 2021, First Special Session chapter 7, article 16, section 28, as amended; article 17, sections 16; 20; proposing coding for new law in Minnesota Statutes, chapters 121A; 144A; 245; 245D; 254B; 256; 256I; 256S; 325F; repealing Minnesota Statutes 2022, sections 245G.05, subdivision 2; 246.18, subdivisions 2, 2a; 256B.0638, subdivisions 1, 2, 3, 4, 5, 6; 256B.0759, subdivision 6; 256B.0917, subdivisions 1a, 6, 7a, 13; 256B.4914, subdivision 9a; 256S.19, subdivision 4.

The Senate respectfully requests that a Conference Committee be appointed thereon. The Senate has appointed as such committee:

Senators Hoffman, Abeler, and Fateh.

Said Senate File is herewith transmitted to the House with the request that the House appoint a like committee.

Thomas S. Bottern, Secretary of the Senate

Noor moved that the House accede to the request of the Senate and that the Speaker appoint a Conference Committee of 3 members of the House to meet with a like committee appointed by the Senate on the disagreeing votes of the two houses on S. F. No. 2934. The motion prevailed.

Madam Speaker:

I hereby announce the Senate refuses to concur in the House amendments to the following Senate File:

S. F. No. 3035, A bill for an act relating to state government; establishing the biennial budget for the Department of Employment and Economic Development, Explore Minnesota, Department of Labor and Industry, Workers' Compensation Court of Appeals, and Bureau of Mediation Services; modifying miscellaneous policy provisions; requiring reports; appropriating money; amending Minnesota Statutes 2022, sections 15.71, by adding subdivisions; 15.72, by adding a subdivision; 116J.5492, subdivisions 8, 10; 116J.55, subdivisions 1, 5, 6; 116J.871, subdivision 2; 116J.8748, subdivisions 3, 4, 6, by adding a subdivision; 116L.361, subdivision 7; 116L.362, subdivision 1; 116L.364, subdivision 3; 116L.56, subdivision 2; 116L.561, subdivision 5; 116L.562, subdivision 2; 116U.05; 116U.10; 116U.15; 116U.20; 116U.30; 116U.35; 175.16, subdivision 1; 177.26, subdivisions 1, 2; 177.27, subdivisions 4, 7; 178.01; 178.011, subdivision 7; 178.03, subdivision 1; 178.11; 179.86, subdivisions 1, 3, by adding subdivisions; 181.14, subdivision 1; 181.635, subdivisions 1, 2, 3, 4, 6; 181.85, subdivisions 2, 4; 181.86, subdivision 1; 181.87, subdivisions 2, 3, 7; 181.88; 181.89, subdivision 2, by adding a subdivision; 181.9435, subdivision 1; 181.9436; 182.654, subdivision 11; 182.666, subdivisions 1, 2, 3, 4, 5, by adding a subdivision; 326B.092, subdivision 6; 326B.096; 326B.103, subdivision 13, by adding subdivisions; 326B.106, subdivisions 1, 4, by adding a subdivision; 326B.802, subdivision 15; 337.01, subdivision 3; 337.05, subdivision 1; 341.21, subdivisions 2a, 2b, 2c, 4f, 7, by adding a subdivision; 341.221; 341.25; 341.27; 341.28, subdivisions 2, 3, by

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7100

adding subdivisions; 341.30, subdivision 4; 341.32, subdivision 2; 341.321; 341.33; 341.355; 469.40, subdivision 11; 469.47, subdivisions 1, 5, 6; Laws 2021, First Special Session chapter 10, article 2, section 24; proposing coding for new law in Minnesota Statutes, chapters 116J; 116L; 116U; 179; 181; 182; 341; repealing Minnesota Statutes 2022, section 177.26, subdivision 3.

The Senate respectfully requests that a Conference Committee be appointed thereon. The Senate has appointed as such committee:

Senators Champion, McEwen, Mohamed, Hauschild, and Gustafson.

Said Senate File is herewith transmitted to the House with the request that the House appoint a like committee.

Thomas S. Bottern, Secretary of the Senate

Hassan moved that the House accede to the request of the Senate and that the Speaker appoint a Conference Committee of 5 members of the House to meet with a like committee appointed by the Senate on the disagreeing votes of the two houses on S. F. No. 3035. The motion prevailed.

Madam Speaker:

I hereby announce the passage by the Senate of the following House File, herewith returned, as amended by the Senate, in which amendments the concurrence of the House is respectfully requested:

H. F. No. 366, A bill for an act relating to health care; limiting the release of health records in cases related to reproductive health; prohibiting certain acts by certain health-related licensing boards; prohibiting disqualification on background study for accessing or providing reproductive health care; preventing the enforcement of certain judgments related to reproductive health; restricting the enforcement of subpoenas issued in cases related to reproductive health; creating a cause of action for penalties and court costs for lawsuits related to reproductive health; prohibiting extradition of persons charged in another state for acts committed or services received in Minnesota related to reproductive health; amending Minnesota Statutes 2022, sections 147.091, by adding a subdivision; 147A.13, by adding a subdivision; 148.261, by adding a subdivision; 245C.15, by adding a subdivision; 629.01; 629.02; 629.05; 629.06; 629.13; 629.14; proposing coding for new law in Minnesota Statutes, chapters 144; 548; 604.

Thomas S. Bottern, Secretary of the Senate

CONCURRENCE AND REPASSAGE

Agbaje moved that the House concur in the Senate amendments to H. F. No. 366 and that the bill be repassed as amended by the Senate. The motion prevailed.

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judgments related to reproductive health; restricting the enforcement of subpoenas issued in cases related to reproductive health; creating a cause of action for penalties and court costs for lawsuits related to reproductive health; prohibiting extradition of persons charged in another state for acts committed or services received in Minnesota related to reproductive health; amending Minnesota Statutes 2022, sections 147.091, by adding a subdivision; 147A.13, by adding a subdivision; 148.261, by adding a subdivision; 151.071, by adding a subdivision; 245C.15, by adding a subdivision; 629.01; 629.02; 629.05; 629.06; 629.13; 629.14; proposing coding for new law in Minnesota Statutes, chapters 144; 548; 604.

The bill was read for the third time, as amended by the Senate, and placed upon its repassage.

The question was taken on the repassage of the bill and the roll was called. There were 70 yeas and 58 nays as follows:

Those who voted in the affirmative were:

The bill was passed, as amended, and its title agreed to.

Lislegard was excused for the remainder of today's session.

There being no objection, the order of business reverted to Calendar for the Day.

CALENDAR FOR THE DAY

S. F. No. 2995 was reported to the House.

Liebling moved to amend S. F. No. 2995, the unofficial engrossment.

Liebling requested a division of the Liebling amendment to S. F. No. 2995, the unofficial engrossment.

Liebling further requested that the second portion of the divided Liebling amendment be voted on first.

The second portion of the Liebling amendment to S. F. No. 2995, the unofficial engrossment, reads as follows:

Page 520, delete section 5

Page 528, after line 23, insert:

"Sec. 15. Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:

Subd. 5a. Managed care contracts. (a) Managed care contracts under this section and section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner may issue separate contracts with requirements specific to services to medical assistance recipients age 65 and older.

(b) A prepaid health plan providing covered health services for eligible persons pursuant to chapters 256B and 256L is responsible for complying with the terms of its contract with the commissioner. Requirements applicable to managed care programs under chapters 256B and 256L established after the effective date of a contract with the commissioner take effect when the contract is next issued or renewed.

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(c) The commissioner shall withhold five percent of managed care plan payments under this section and county‑based purchasing plan payments under section 256B.692 for the prepaid medical assistance program pending completion of performance targets. Each performance target must be quantifiable, objective, measurable, and reasonably attainable, except in the case of a performance target based on a federal or state law or rule. Criteria for assessment of each performance target must be outlined in writing prior to the contract effective date. Clinical or utilization performance targets and their related criteria must consider evidence-based research and reasonable interventions when available or applicable to the populations served, and must be developed with input from external clinical experts and stakeholders, including managed care plans, county-based purchasing plans, and providers. The managed care or county-based purchasing plan must demonstrate, to the commissioner's satisfaction, that the data submitted regarding attainment of the performance target is accurate. The commissioner shall periodically change the administrative measures used as performance targets in order to improve plan performance across a broader range of administrative services. The performance targets must include measurement of plan efforts to contain spending on health care services and administrative activities. The commissioner may adopt plan‑specific performance targets that take into account factors affecting only one plan, including characteristics of the plan's enrollee population. The withheld funds must be returned no sooner than July of the following year if performance targets in the contract are achieved. The commissioner may exclude special demonstration projects under subdivision 23.

(d) The commissioner shall require that managed care plans:

(1) use the assessment and authorization processes, forms, timelines, standards, documentation, and data reporting requirements, protocols, billing processes, and policies consistent with medical assistance fee-for-service or the Department of Human Services contract requirements for all personal care assistance services under section 256B.0659 and community first services and supports under section 256B.85; ~~and~~

(2) by January 30 of each year that follows a rate increase for any aspect of services under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking minority members of the legislative committees with jurisdiction over rates determined under section 256B.851 of the amount of the rate increase that is paid to each personal care assistance provider agency with which the plan has a contract.; and

(3) use a six-month timely filing standard and provide an exemption to the timely filing timelines for the resubmission of claims where there has been a denial, request for more information, or system issue.

(e) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the health plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. For 2012, the reduction shall be based on the health plan's utilization in 2009. To earn the return of the withhold each subsequent year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than ten percent of the plan's emergency department utilization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous measurement year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.

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The withhold described in this paragraph shall continue for each consecutive contract period until the plan's emergency room utilization rate for state health care program enrollees is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the health plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved.

(f) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of no less than five percent of the plan's hospital admission rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, compared to the previous calendar year until the final performance target is reached. When measuring performance, the commissioner must consider the difference in health risk in a managed care or county-based purchasing plan's membership in the baseline year compared to the measurement year, and work with the managed care or county-based purchasing plan to account for differences that they agree are significant.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph shall continue until there is a 25 percent reduction in the hospital admission rate compared to the hospital admission rates in calendar year 2011, as determined by the commissioner. The hospital admissions in this performance target do not include the admissions applicable to the subsequent hospital admission performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that may be returned to the hospitals if the performance target is achieved.

(g) Effective for services rendered on or after January 1, 2012, the commissioner shall include as part of the performance targets described in paragraph (c) a reduction in the plan's hospitalization admission rates for subsequent hospitalizations within 30 days of a previous hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare enrollees, as determined by the commissioner. To earn the return of the withhold each year, the managed care plan or county-based purchasing plan must achieve a qualifying reduction of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, of no less than five percent compared to the previous calendar year until the final performance target is reached.

The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following calendar year if the managed care plan or county-based purchasing plan demonstrates to the satisfaction of the commissioner that a qualifying reduction in the subsequent hospitalization rate was achieved. The commissioner shall structure the withhold so that the commissioner returns a portion of the withheld funds in amounts commensurate with achieved reductions in utilization less than the targeted amount.

The withhold described in this paragraph must continue for each consecutive contract period until the plan's subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and 28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year 2011. Hospitals shall cooperate with the plans in meeting this performance target and shall accept payment withholds that must be returned to the hospitals if the performance target is achieved.

(h) Effective for services rendered on or after January 1, 2013, through December 31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.

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(i) Effective for services rendered on or after January 1, 2014, the commissioner shall withhold three percent of managed care plan payments under this section and county-based purchasing plan payments under section 256B.692 for the prepaid medical assistance program. The withheld funds must be returned no sooner than July 1 and no later than July 31 of the following year. The commissioner may exclude special demonstration projects under subdivision 23.

(j) A managed care plan or a county-based purchasing plan under section 256B.692 may include as admitted assets under section 62D.044 any amount withheld under this section that is reasonably expected to be returned.

(k) Contracts between the commissioner and a prepaid health plan are exempt from the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and 7.

(l) The return of the withhold under paragraphs (h) and (i) is not subject to the requirements of paragraph (c).

(m) Managed care plans and county-based purchasing plans shall maintain current and fully executed agreements for all subcontractors, including bargaining groups, for administrative services that are expensed to the state's public health care programs. Subcontractor agreements determined to be material, as defined by the commissioner after taking into account state contracting and relevant statutory requirements, must be in the form of a written instrument or electronic document containing the elements of offer, acceptance, consideration, payment terms, scope, duration of the contract, and how the subcontractor services relate to state public health care programs. Upon request, the commissioner shall have access to all subcontractor documentation under this paragraph. Nothing in this paragraph shall allow release of information that is nonpublic data pursuant to section 13.02.

EFFECTIVE DATE. This section is effective January 1, 2024."

Page 553, line 22, delete "This appropriation" and insert "This is a onetime appropriation and"

Page 562, line 28, delete "22,373,000" and insert "12,428,000" and delete "34,810,000" and insert "19,195,000"

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

The motion prevailed and the second portion of the Liebling amendment was adopted.

Liebling withdrew the first portion of her amendment to S. F. No. 2995, the unofficial engrossment, as amended.

Backer moved to amend S. F. No. 2995, the unofficial engrossment, as amended, as follows:

Page 313, after line 7, insert:

"Sec. 5. Minnesota Statutes 2022, section 144E.101, subdivision 12, is amended to read:

Subd. 12. Mutual aid agreement. (a) A licensee shall have a written agreement with at least one neighboring licensed ambulance service for the preplanned and organized response of emergency medical services, and other emergency personnel and equipment, to a request for assistance in an emergency when local ambulance transport resources have been expended. The response is predicated upon formal agreements among participating ambulance services. A copy of each mutual aid agreement shall be maintained in the files of the licensee and shall be filed with the board for informational purposes only.

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(b) A licensee may have a written agreement with a neighboring licensed ambulance service, including a licensed ambulance service from a neighboring state if that service is currently and remains in compliance with its home state licensing requirements, to provide ~~part-time~~ support to the primary service area of the licensee upon the licensee's request. The agreement may allow the licensee to suspend ambulance services in its primary service area during the times the neighboring licensed ambulance service has agreed to provide all emergency services to the licensee's primary service area. The agreement may ~~not~~ permit the neighboring licensed ambulance service to serve the licensee's primary service area for ~~more than 12~~ up to 24 hours per day, provided service by the neighboring licensed ambulance does not exceed 108 hours per calendar week. This paragraph applies only to an ambulance service whose primary service area is mainly located outside the metropolitan counties listed in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud, or an ambulance based in a community with a population of less than 2,500 persons."

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

The motion prevailed and the amendment was adopted.

Quam moved to amend S. F. No. 2995, the unofficial engrossment, as amended, as follows:

Page 10, after line 21, insert:

"(j) Effective for discharges occurring on or after July 1, 2023, payment rates under this section must be rebased to reflect those changes in hospital costs between the existing base year or years and the rate year. In any year that inpatient claims volume falls below the threshold required to ensure a statistically valid sample of claims, the commissioner may combine claims data from two consecutive years to serve as the base year. Years in which inpatient claims volume is reduced or altered due to a pandemic or other public health emergency must not be used as a base year or part of a base year if the base year includes more than one year. Changes in costs between the base year or years and the rate year must be measured using the hospital cost index defined in subdivision 1, paragraph (a). The commissioner must establish the base year for each rebasing period considering the most recent year or years for which filed Medicare cost reports are available. The estimated change in the average payment per hospital discharge resulting from a scheduled rebasing must be calculated and made available to the legislature by January 15 of each year in which rebasing is scheduled to occur, and must include the differential in payment rates compared to the individual hospital's costs by hospital.

(k) Effective for discharges occurring on or after July 1, 2023, inpatient payment rates for critical access hospitals located in Minnesota or the local trade area must be a rate equal to 100 percent of their base year costs inflated to the rate year using the hospital cost index defined in subdivision 1, paragraph (a)."

Page 10, line 22, strike "(j)" and insert "(l)"

Page 536, line 25, delete "282,251,000" and insert "270,002,996" and delete "245,773,000" and insert "229,544,490"

Page 537, line 31, delete "$221,687,000" and insert "$204,174,494"

Page 537, line 32, delete "$238,595,000" and insert "$219,723,762"

Page 540, line 7, delete "1,066,045,000" and insert "1,078,293,004" and delete "748,577,000" and insert "764,805,510"

A roll call was requested and properly seconded.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7109

The question was taken on the Quam amendment and the roll was called. There were 56 yeas and 69 nays as follows:

Those who voted in the affirmative were:

The motion did not prevail and the amendment was not adopted.

Davis moved to amend S. F. No. 2995, the unofficial engrossment, as amended, as follows:

Page 183, delete section 79 and insert:

"Sec. 79. [144.6514] RIGHT OF PATIENTS TO SUPPORT PERSON.

Subdivision 1. Short title. This section may be cited as the "No Patient Left Alone Act."

Subd. 2. General rule. A provider must allow, at a minimum, one support person of the patient's or resident's choice to be physically present while the patient is receiving care services.

Subd. 3. Definitions. (a) For the purposes of this section, the following terms have the meanings given.

(b) "Minor" means an individual who has not attained the age of 18 years, notwithstanding any law to the contrary.

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(d) "Provider" means a licensed health care facility, nursing home, assisted living facility, residential care home, organization, or corporation that is licensed, certified, or otherwise authorized by the laws of this state to provide health care.

(e) "Resident" means an individual residing in a facility.

(f) "Support person" means an individual necessary to provide compassionate care to the patient or resident, including but not limited to:

(1) an individual requested to meet the physical or mental needs of the patient or resident;

(2) individuals requested in end-of-life situations;

(3) a clergy member or lay person offering religious or spiritual support; or

(4) an individual providing a service requested by the patient or resident, such as a hairdresser or barber.

Subd. 4. Notice of rights. (a) A provider must have written policies and procedures regarding a patient's or resident's right to have a support person present during treatment, including provisions describing any clinically necessary or reasonable restriction the provider may place on access to the patient or resident and the reason for the restriction. A provider must inform each patient, resident, or support person, as appropriate, of the patient's or resident's right to have a support person present, including any restriction on that right, and must ensure that a support person enjoys full and equal visitation privileges consistent with patient preferences and the provider's policies and procedures. A provider must have written policies and procedures regarding complaints and the contact information for the individuals tasked with investigating violations.

(b) For the purposes of this section, policies and procedures are subject to the following:

(1) the support person of a minor may not be subject to visitation hours, unless otherwise exempt under subdivision 8;

(2) maximum access to patients, including by offering evening and weekend visits, must be provided;

(3) in end-of-life or nearing end-of-life situations, every effort should be made for all immediate family to be accommodated, in reasonably sized groups, with no age restrictions;

(4) when the parent or legal guardian of a minor child is receiving care, the support person must be permitted to bring the minor or minors in the event no child care is available;

(5) if limitations are set on the number of support persons allowed to be present, a clergy member or lay person offering religious or spiritual support must be allowed to be physically present, in addition to the number of support persons allowed;

(6) in the event of a pandemic, one or more ways for compassionate care visitation, including personal contact, that minimize the risk of infection to patients and residents must be identified;

(7) when all feasible options for the physical presence of a support person have been exhausted, a virtual option must be required, unless otherwise exempt under subdivision 8; and

(8) requiring medical interventions that permanently alter the individual or penetrate the skin or mucosa, including but not limited to vaccination and presterilized single-use needles, of the support person or the patient or resident is prohibited.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7118

Subd. 5. Limitation of rights. (a) A patient or resident is not required to waive the rights provided under this section.

(b) A patient or resident is not required to consent to additional conditions, such as executing an advance directive or agreeing to a "do not resuscitate" or similar order as a condition of receiving visitation from a support person.

(c) In the event a patient or resident is incapacitated or otherwise unable to communicate the patient's or resident's wishes and an individual provides an advance medical directive designating the individual as the patient's or resident's support person, durable power of attorney, or other term indicating the individual is authorized to exercise rights covered by this section on behalf of the patient or resident, the provider must accept this designation and allow the individual to exercise the patient's or resident's support person rights on the patient's or resident's behalf.

(d) The rights specified in this section may not be terminated, suspended, or waived by the provider, the Department of Health, or any governmental entity, notwithstanding declarations of emergency declared by the governor or the legislature.

Subd. 6. Violations; penalties. Any provider who knowingly or willfully violates this section is subject to a civil penalty of $500 per day of violation.

Subd. 7. Liability of provider. Unless expressly required by federal law or regulation, no action shall be taken against a provider for:

(1) giving a support person access to a provider's facility;

(2) failing to protect or otherwise ensure the safety or comfort of a support person given access to a provider's facility;

(3) choosing not to follow the Centers for Disease Control and Prevention or other national guidelines that require or recommend restricting support person access; or

(4) the acts or omissions of any support person who is given access to a provider's facility.

Subd. 8. Exemption. (a) Facilities are not required to allow a support person to enter an operating room, isolation room, isolation unit, behavioral health setting, or other typically restricted area or to remain present during the administration of emergency care in critical situations.

(b) Facilities are not required to allow a support person access beyond the rooms, units, or wards in which the patient or resident the support person is visiting is receiving care or beyond general common areas in the provider's facility.

(1) at the request of the patient, resident, or a law enforcement agency;

(2) due to a court order;

(3) if the support person has symptoms of a transmissible infection;

(4) if the support person is determined to be a danger to the patient or in cases of suspected abuse;

(5) if support persons are engaging in disruptive, threatening, or violent behavior toward any staff member, patient, or other visitor; or

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7119

(6) if support persons are noncompliant with hospital policy."

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

A roll call was requested and properly seconded.

Schomacker moved to amend the Davis amendment to S. F. No. 2995, the unofficial engrossment, as amended, as follows:

Page 1, line 14, delete "residential care home, organization," and insert "or organization"

Page 2, line 15, delete "8" and insert "6"

Page 2, line 27, after the semicolon, insert "and"

Page 2, line 29, delete "8;" and insert "6."

Page 2, delete lines 30 to 33

Page 3, delete subdivisions 6 and 7

Page 3, line 26, delete "8" and insert "6"

The motion prevailed and the amendment to the amendment was adopted.

The question recurred on the Davis amendment, as amended, and the roll was called. There were 58 yeas and 68 nays as follows:

Those who voted in the affirmative were:

The motion did not prevail and the amendment was not adopted.

Demuth moved to amend S. F. No. 2995, the unofficial engrossment, as amended, as follows:

Page 159, after line 13, insert:

"Sec. 61. [144.3435] NOTICE TO PARENT OR GUARDIAN REGARDING ABORTION PERFORMED ON A MINOR.

Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given.

(b) "Abortion" has the meaning given in section 145.411, subdivision 5.

(c) "Health care provider" means a physician licensed to practice medicine in Minnesota or other health care professional authorized to practice that individual's profession in Minnesota and whose scope of practice and qualifications include the performance of abortions.

(d) "Medical emergency" means a condition that, in reasonable medical judgment, so complicates the medical condition of the pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions. A condition is not a medical emergency if it is based on a claim, diagnosis, or determination that the woman may engage in conduct which she intends to result in her death or in the substantial and irreversible physical impairment of a major bodily function.

Subd. 2. Notice to parent or guardian. If a health care provider did not obtain the consent of a parent or guardian of a pregnant minor before performing an abortion on the pregnant minor because of a medical emergency, the health care provider must notify the minor's parent or guardian within 24 hours after the abortion and must so certify in the minor's medical record."

Page 211, after line 15, insert:

"Sec. 116. [145.4161] LICENSURE OF ABORTION FACILITIES.

Subdivision 1. Definitions. (a) For purposes of this section, the following terms have the meanings given.

(b) "Abortion facility" means a clinic, health center, or other facility in which the pregnancies of ten or more women known to be pregnant are willfully terminated or aborted each month. A facility licensed as a hospital or outpatient surgical center under sections 144.50 to 144.56 shall not be considered an abortion facility.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7123

(c) "Accrediting or membership organization" means a national organization that establishes evidence-based clinical standards for abortion care and accredits abortion facilities or accepts as members abortion facilities following an application and inspection process.

(d) "Commissioner" means the commissioner of health.

Subd. 2. License required. (a) Beginning July 1, 2024, no abortion facility shall be established, operated, or maintained in the state without first obtaining a license from the commissioner according to this section.

(b) A license issued under this section is not transferable or assignable and is subject to suspension or revocation at any time for failure to comply with this section.

(c) If a single entity maintains abortion facilities on different premises, each facility must obtain a separate license.

(d) To be eligible for a license under this section, an abortion facility must be accredited by or a member of an accrediting or membership organization or must obtain accreditation from or membership in such an organization within six months after the date of the application for licensure. If the abortion facility loses its accreditation or membership, the abortion facility must immediately notify the commissioner.

(e) The commissioner, the attorney general, an appropriate county attorney, or a woman upon whom an abortion has been performed or attempted to be performed at an unlicensed facility may seek an injunction in district court against the continued operation of the facility. Proceedings for securing an injunction may be brought by the attorney general or by the appropriate county attorney.

(f) Sanctions provided in this subdivision do not restrict other available sanctions.

Subd. 3. Temporary license. For new abortion facilities planning to begin operations on or after July 1, 2024, the commissioner may issue a temporary license to the abortion facility that is valid for a period of six months from the date of issuance. The abortion facility must submit to the commissioner an application and applicable fee for licensure as required under subdivisions 4 and 7. The application must include the information required under subdivision 4, clauses (1), (2), (3), (5), and (6), and provide documentation that the abortion facility has submitted the application for accreditation or membership from an accrediting or membership organization. Upon receipt of accreditation or membership verification, the abortion facility must submit to the commissioner the information required in subdivision 4, clause (4), and the applicable fee under subdivision 7. The commissioner shall then issue a new license.

Subd. 4. Application. An application for a license to operate an abortion facility and the applicable fee under subdivision 7 must be submitted to the commissioner on a form provided by the commissioner and must contain:

(1) the name of the applicant;

(2) the site location of the abortion facility;

(3) the name of the person in charge of the abortion facility;

(4) documentation that the abortion facility is accredited by or a member of an accrediting or membership organization, including the effective date and the expiration date of the accreditation or membership and the date of the last site visit by the accrediting or membership organization;

(5) the names and license numbers, if applicable, of the health care professionals on staff at the abortion facility; and

(6) any other information the commissioner deems necessary.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7124

Subd. 5. Inspections. Prior to initial licensure and at least once every two years thereafter, the commissioner shall perform a routine and comprehensive inspection of each abortion facility. Facilities shall be open at all reasonable times to an inspection authorized in writing by the commissioner. No notice need be given to any person prior to an inspection authorized by the commissioner.

Subd. 6. Suspension, revocation, and refusal to grant or renew. The commissioner may refuse to grant or renew, or may suspend or revoke, a license on any of the grounds described under section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or upon the loss of accreditation or membership described in subdivision 4, clause (4). The applicant or licensee is entitled to a notice and a hearing as described under section 144.55, subdivision 7, and a new license may be issued after proper inspection of an abortion facility has been conducted.

Subd. 7. Fees. (a) The biennial license fee for abortion facilities is $365.

(b) The temporary license fee is $365.

Subd. 8. Renewal. (a) A license issued under this section expires two years from the date of issuance.

(b) A temporary license issued under this section expires six months from the date of issuance and may be renewed for one additional six-month period.

Subd. 9. Records. All health records maintained on each client by an abortion facility are subject to sections 144.292 to 144.298.

Subd. 10. Severability. If any one or more provisions, sections, subdivisions, sentences, clauses, phrases, or words of this section or the application of them to any person or circumstance is found to be unconstitutional, they are declared to be severable and the balance of this section shall remain effective notwithstanding such unconstitutionality. The legislature intends that it would have passed this section, and each provision, section, subdivision, sentence, clause, phrase, or word, regardless of the fact that any one provision, section, subdivision, sentence, clause, phrase, or word is declared unconstitutional."

Page 266, after line 30, insert:

"Sec. 180. Laws 2023, chapter 4, section 1, is amended to read:

Section 1. 145.409 REPRODUCTIVE HEALTH RIGHTS.

Subdivision 1. Short title. This section may be cited as the "Protect Reproductive Options Act."

Subd. 2. ~~Definition~~ Definitions. (a) For purposes of this section, the following definitions have the meanings given.

(b) "Abortion" has the meaning given in section 145.411, subdivision 5.

(c) "Abortion facility" means a clinic, health center, or other facility in which the pregnancies of ten or more women known to be pregnant are willfully terminated or aborted each month. A facility licensed as a hospital or outpatient surgical center under sections 144.50 to 144.56 shall not be considered an abortion facility.

(d) "Commissioner" means the commissioner of health.

(e) "Health care provider" means a physician licensed to practice medicine in Minnesota or other health care professional authorized to practice that individual's profession in Minnesota and whose scope of practice and qualifications include the performance of abortions.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7125

(f) "Medical emergency" means a condition that, in reasonable medical judgment, so complicates the medical condition of the pregnant woman as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible physical impairment of a major bodily function, not including psychological or emotional conditions. A condition is not a medical emergency if it is based on a claim, diagnosis, or determination that the woman may engage in conduct which she intends to result in her death or in the substantial and irreversible physical impairment of a major bodily function.

(g) "Partial-birth abortion" means an abortion in which the individual performing the abortion:

(1) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the individual knows will kill the partially delivered fetus; and

(2) performs the overt act, other than completion of delivery, that kills the partially delivered fetus.

(h) "Reproductive health care" means health care offered, arranged, or furnished for the purpose of preventing pregnancy, terminating a pregnancy, managing pregnancy loss, or improving maternal health and birth outcomes. Reproductive health care includes, but is not limited to, contraception; sterilization; preconception care; maternity care; abortion care; family planning and fertility services; and counseling regarding reproductive health care.

(i) "Third trimester" means the stage of pregnancy that begins at the end of the 26th week from the beginning of the pregnant woman's last menstrual period.

Subd. 3. Reproductive freedom. (a) Every individual has a fundamental right to make autonomous decisions about the individual's own reproductive health, including the fundamental right to use or refuse reproductive health care.

(b) Every individual who becomes pregnant has a fundamental right to continue the pregnancy and give birth, or obtain an abortion, and to make autonomous decisions about how to exercise this fundamental right.

(1) authorize the performance of partial-birth abortions in a manner that is prohibited under subdivision 6;

(2) authorize the performance of abortions in the third trimester of pregnancy in a manner that is prohibited under subdivision 7;

(3) limit the authority of the commissioner to license abortion facilities under section 145.4161;

(4) prohibit notice, as required under section 144.3435, from being provided to a parent or guardian of a minor on whom an abortion is performed in a medical emergency; or

(5) prohibit an unborn child who is born alive following an attempted abortion from being treated as a person under the law under subdivision 9.

Subd. 4. Right to reproductive freedom recognized. The Minnesota Constitution establishes the principles of individual liberty, personal privacy, and equality. Such principles ensure the fundamental right to reproductive freedom.

Subd. 5. Local unit of government limitation. A local unit of government may not regulate an individual's ability to freely exercise the fundamental rights set forth in this section in a manner that is more restrictive than that set forth in this section.

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7126

Subd. 6. Partial-birth abortions prohibited; exception. (a) It is prohibited for any individual to knowingly perform a partial-birth abortion that causes the death of a human fetus.

(b) Paragraph (a) does not apply to a partial-birth abortion that is necessary to save the life of a mother whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy itself.

Subd. 7. Abortion in the third trimester prohibited; exceptions. (a) Except as provided in paragraphs (b) and (c), it is prohibited for any individual to knowingly or intentionally cause an abortion in the third trimester of pregnancy that results in the death of the unborn child.

(b) Medical treatment provided to a pregnant woman that results in the accidental death of, or unintentional injury to, the unborn child is not a violation of paragraph (a).

(1) if the pregnancy is the result of conduct that would constitute a violation of section 609.342, 609.343, 609.344, 609.345, or 609.3451, provided documentation is presented to the attending health care provider that the conduct was reported to law enforcement within the first 15 weeks of pregnancy;

(2) if the pregnancy is the result of conduct that would constitute a violation of section 609.365, provided documentation is presented to the attending health care provider that the conduct was reported to law enforcement within the first 15 weeks of pregnancy; or

(3) to avert the death of the pregnant woman or to prevent a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman, not including psychological or emotional conditions.

Subd. 8. Pregnant woman not subject to criminal penalties. A pregnant woman who sought or obtained an abortion that violates subdivision 6 or 7 shall not be subject to criminal penalties for violating subdivision 6 or 7.

Subd. 9. Born alive child. Any unborn child who is born alive following an attempted abortion shall be treated as a person under the law, and a birth certificate shall be issued certifying the child's birth. If the child later dies, a death certificate shall be issued.

Subd. 10. Severability. If any one or more provision, section, subdivision, sentence, clause, phrase, or word of this section or the application of it to any person or circumstance is found to be unconstitutional, it is declared to be severable and the balance of this section shall remain effective notwithstanding such unconstitutionality. The legislature intends that it would have passed this section, and each provision, section, subdivision, sentence, clause, phrase, or word, regardless of the fact that any one provision, section, subdivision, sentence, clause, phrase, or word is declared unconstitutional."

Page 556, line 15, delete "70,981,000" and insert "71,036,000" and delete "73,220,000" and insert "73,228,000"

Page 557, after line 26, insert:

"(g) Licensure of Abortion Facilities. $55,000 in fiscal year 2024 and $8,000 in fiscal year 2025 are from the state government special revenue fund for the licensure of abortion facilities under Minnesota Statutes, section 145.4161. The base for this appropriation is $42,000 in fiscal year 2026 and $8,000 in fiscal year 2027."

Journal of the House - 57th Day - Wednesday, April 26, 2023 - Top of Page 7127

Adjust amounts accordingly

Reletter the paragraphs in sequence

Renumber the sections in sequence and correct the internal references

Amend the title accordingly

A roll call was requested and properly seconded.

The question was taken on the Demuth amendment and the roll was called. There were 59 yeas and 67 nays as follows:

Those who voted in the affirmative were: