1.1    .................... moves to amend H. F. No. 842 as follows:
1.2Page 2, line 13, delete "4,642,982,000" and insert "4,710,491,000" and delete
1.3"4,981,113,000" and insert "5,056,002,000" and delete "9,624,095,000" and insert
1.4"9,766,493,000"
1.5Page 2, line 16, delete "493,981,000" and insert "451,911,000" and delete
1.6"517,213,000" and insert "477,532,000" and delete "1,1011,194,000" and insert
1.7"929,443,000"
1.8Page 2, line 17, delete "286,354,000" and insert "284,409,000" and delete
1.9"283,434,000" and insert "281,082,000" and delete "569,788,000" and insert
1.10"565,491,000"
1.11Page 2, line 19, delete "5,480,498,000" and insert "5,503,992,000" and delete
1.12"5,839,650,000" and insert "5,872,506,000" and delete "11,320,148,000" and insert
1.13"11,376,498,000"
1.14Page 3, line 1, delete "4,509,596,000" and insert "4,577,115,000" and delete
1.15"4,850,114,000" and insert "4,925,022,000"
1.16Page 3, line 4, delete "459,823,000" and insert "417,753,000" and delete
1.17"485,715,000" and insert "446,034,000"
1.18Page 3, line 5, delete "277,354,000" and insert "275,409,000" and delete
1.19"271,434,000" and insert "269,082,000"
1.20Page 7, line 11, delete "53,758,000" and insert "53,656,000"
1.21Page 7, line 12, delete "52,943,000" and insert "52,771,000"
1.22Page 7, line 13, delete "26,472,000" and insert "26,343,000"
1.23Page 7, line 14, delete "26,464,000" and insert "26,329,000"
1.24Page 7, line 23, delete "40,378,000" and insert "40,379,000"
1.25Page 7, line 24, delete "33,918,000" and insert "33,922,000"
1.26Page 7, line 25, delete "11,726,000" and insert "11,730,000"
1.27Page 7, line 26, delete "11,470,000" and insert "11,744,000"
2.1Page 8, line 17, delete "4,744,000" and insert "6,416,000"
2.2Page 8, line 18, delete "9,710,000" and insert "9,687,000"
2.3Page 8, line 19, delete "15,669,000" and insert "15,705,000"
2.4Page 8, line 20, delete "18,280,000" and insert "19,197,000"
2.5Page 9, line 19, delete "96,463,000" and insert "96,888,000" and delete "90,492,000"
2.6and insert "90,819,000"
2.7Page 9, line 20, delete "96,463,000" and insert "96,888,000" and delete "90,492,000"
2.8and insert "90,819,000"
2.9Page 9, line 22, delete "684,906,000" and insert "608,355,000" and delete
2.10"675,939,000" and insert "670,426,000"
2.11Page 9, line 24, delete "495,858,000" and insert "493,677,000" and delete
2.12"476,765,000" and insert "473,931,000"
2.13Page 9, line 25, delete "179,473,000" and insert "177,103,000" and delete
2.14"179,524,000" and insert "176,845,000"
2.15Page 9, line 31, delete "61,180,000" and insert "62,000,000" and delete "60,983,000"
2.16and insert "61,911,000"
2.17Page 9, line 32, delete "76,141,000" and insert "73,521,000" and delete "75,242,000"
2.18and insert "72,563,000"
2.19Page 10, line 3, delete "103,332,000" and insert "103,582,000"
2.20Page 10, line 18, delete "36,232,000" and insert "35,216,000" and delete
2.21"42,002,000" and insert "40,970,000"
2.22Page 10, line 21, delete "41,665,000" and insert "41,666,000" and delete
2.23"43,095,000" and insert "43,096,000"
2.24Page 10, line 23, delete "21,000" and insert "11,000"
2.25Page 10, line 24, delete "34,000" and insert "24,000"
2.26Page 10, line 32, delete "56,473,000" and insert "55,772,000" and delete
2.27"62,761,000" and insert "61,390,000"
2.28Page 13, line 6, delete "37,885,000" and insert "37,876,000" and delete "38,262,000"
2.29and insert "38,253,000"
2.30Page 13, line 26, delete "30,468,000" and insert "30,505,000" and delete
2.31"30,829,000" and insert "30,812,000"
2.32Page 14, line 4, delete "91,385,000" and insert "90,072,000" and delete "98,257,000"
2.33and insert "96,923,000"
2.34Page 15, line 25, delete "2,371,510,000" and insert "2,380,875,000" and delete
2.35"2,600,451,000" and insert "2,662,109,000"
3.1Page 15, line 27, delete "1,955,762,000" and insert "2,006,797,000" and delete
3.2"2,172,815,000" and insert "2,233,417,000"
3.3Page 15, line 28, delete "415,748,000" and insert "374,078,000" and delete
3.4"427,636,000" and insert "388,692,000"
3.5Page 15, line 32, delete "414,076,000" and insert "374,087,000" and delete
3.6"427,636,000" and insert "388,692,000"
3.7Page 16, line 17, delete "717,176,000" and insert "761,004,000" and delete
3.8"813,792,000" and insert "870,312,000"
3.9Page 16, delete line 18
3.10Page 16, line 21, delete "1,014,783,000" and insert "1,006,706,000" and delete
3.11"1,120,250,000" and insert "1,111,791,000"
3.12Page 16, line 33, delete "223,594,000" and insert "238,878,000" and delete
3.13"238,564,000" and insert "251,105,000"
3.14Page 17, line 2, delete "50,675,000" and insert "50,664,000"
3.15Page 17, line 5, delete "21,081,000" and insert "21,070,000"
3.16Page 17, line 27, delete "1,618,000" and insert "1,594,000"
3.17Page 17, line 28, delete "1,708,000" and insert "1,684,000"
3.18Page 17, line 33, delete "18,351,000" and insert "18,340,000"
3.19Page 18, line 2, delete "134,000" and insert "123,000"
3.20Page 18, line 3, delete "300,000" and insert "289,000"
3.21Page 18, line 5, delete "7,757,386" and insert "1,673,759,000" and delete
3.22"11,699,194" and insert "1,817,602,000"
3.23Page 18, line 7, delete "1,649,386," and insert "1,668,051,000" and delete
3.24"1,791,194" and insert "1,808,334,000"
3.25Page 18, line 8, delete "4,800,000" and insert "4,400,000" and delete "8,600,000"
3.26and insert "7,960,000"
3.27Page 18, line 27, delete "49,883,000" and insert "49,858,000" and delete
3.28"51,828,000" and insert "51,758,000"
3.29Page 18, line 34, delete "335,000" and insert "362,000"
3.30Page 19, line 1, delete "375,000" and insert "519,000"
3.31Page 19, line 5, delete "486,505,000" and insert "493,814,000" and delete
3.32"493,980,000" and insert "499,330,000"
3.33Page 19, line 33, delete "945,875,000" and insert "958,251,000" and delete
3.34"1,063,622,000" and insert "1,076,928,000"
3.35Page 20, line 28, delete "56,694,000" and insert "56,354,000" and delete
3.36"59,849,000" and insert "59,129,000"
4.1Page 20, line 29, delete "6,750,000" and insert "6,810,000"
4.2Page 20, line 32, delete "5,109,000" and insert "5,060,000"
4.3Page 20, line 33, delete "5,110,000" and insert "5,060,000"
4.4Page 21, line 8, delete "78,880,000" and insert "78,225,000" and delete "88,867,000"
4.5and insert "88,138,000"
4.6Page 21, line 14, delete "15,204,000" and insert "15,207,000"
4.7Page 21, line 15, delete "1,550,000" and insert "1,150,000" and delete "1,850,000"
4.8and insert "1,150,000"
4.9Page 21, line 20, delete "18,494,000" and insert "18,408,000"
4.10Page 21, line 25, delete "419,000" and insert "333,000"
4.11Page 21, after line 26, insert:
4.12"Base adjustment. The health care access
4.13fund base is decreased by $59,000 in each of
4.14the fiscal years 2010 and 2011 for continuing
4.15care management."
4.16Page 22, delete lines 3 to 33
4.17Page 29, line 24, delete "4,220,000" and insert "3,310,000" and delete "4,264,000"
4.18and insert "3,345,000"
4.19Page 29, line 27, delete "2,633,000" and insert "2,623,000" and delete "2,660,000"
4.20and insert "2,641,000"
4.21Page 29, delete line 28
4.22Page 84, delete section 1 and insert:

4.23    "Section 1. Minnesota Statutes 2006, section 16A.724, subdivision 2, is amended to
4.24read:
4.25    Subd. 2. Transfers. (a) Notwithstanding section 295.581, to the extent available
4.26resources in the health care access fund exceed expenditures in that fund, effective with
4.27the biennium beginning July 1, 2007, the commissioner shall transfer funds from the
4.28health care access fund to the general fund to offset the costs of MinnesotaCare enrollees
4.29shifting to medical assistance due to the implementation of an automated eligibility
4.30determination system. The medical assistance costs shall be identified and updated in the
4.31November and February forecasts.
4.32    (b) In addition to the amounts in paragraph (a), the commissioner of finance shall
4.33transfer the excess funds from the health care access fund to the general fund on June
4.3430 of each year, provided that the amount transferred in any fiscal biennium shall not
4.35exceed $96,000,000. For the biennium ending June 30, 2011, the transfer shall not exceed
4.36$48,000,000.
5.1    (b) (c) For fiscal years 2006 to 2009, MinnesotaCare shall be a forecasted program,
5.2and, if necessary, the commissioner shall reduce these transfers from the health care access
5.3fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary,
5.4transfer sufficient funds from the general fund to the health care access fund to meet
5.5annual MinnesotaCare expenditures."
5.6Page 85, after line 13 insert:

5.7    "Sec. 4. Minnesota Statutes 2006, section 256.969, subdivision 9, is amended to read:
5.8    Subd. 9. Disproportionate numbers of low-income patients served. (a) For
5.9admissions occurring on or after October 1, 1992, through December 31, 1992, the
5.10medical assistance disproportionate population adjustment shall comply with federal law
5.11and shall be paid to a hospital, excluding regional treatment centers and facilities of the
5.12federal Indian Health Service, with a medical assistance inpatient utilization rate in excess
5.13of the arithmetic mean. The adjustment must be determined as follows:
5.14    (1) for a hospital with a medical assistance inpatient utilization rate above the
5.15arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
5.16federal Indian Health Service but less than or equal to one standard deviation above the
5.17mean, the adjustment must be determined by multiplying the total of the operating and
5.18property payment rates by the difference between the hospital's actual medical assistance
5.19inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
5.20treatment centers and facilities of the federal Indian Health Service; and
5.21    (2) for a hospital with a medical assistance inpatient utilization rate above one
5.22standard deviation above the mean, the adjustment must be determined by multiplying
5.23the adjustment that would be determined under clause (1) for that hospital by 1.1. If
5.24federal matching funds are not available for all adjustments under this subdivision, the
5.25commissioner shall reduce payments on a pro rata basis so that all adjustments qualify for
5.26federal match. The commissioner may establish a separate disproportionate population
5.27operating payment rate adjustment under the general assistance medical care program.
5.28For purposes of this subdivision medical assistance does not include general assistance
5.29medical care. The commissioner shall report annually on the number of hospitals likely to
5.30receive the adjustment authorized by this paragraph. The commissioner shall specifically
5.31report on the adjustments received by public hospitals and public hospital corporations
5.32located in cities of the first class.
5.33    (b) For admissions occurring on or after July 1, 1993, the medical assistance
5.34disproportionate population adjustment shall comply with federal law and shall be paid to
5.35a hospital, excluding regional treatment centers and facilities of the federal Indian Health
6.1Service, with a medical assistance inpatient utilization rate in excess of the arithmetic
6.2mean. The adjustment must be determined as follows:
6.3    (1) for a hospital with a medical assistance inpatient utilization rate above the
6.4arithmetic mean for all hospitals excluding regional treatment centers and facilities of the
6.5federal Indian Health Service but less than or equal to one standard deviation above the
6.6mean, the adjustment must be determined by multiplying the total of the operating and
6.7property payment rates by the difference between the hospital's actual medical assistance
6.8inpatient utilization rate and the arithmetic mean for all hospitals excluding regional
6.9treatment centers and facilities of the federal Indian Health Service;
6.10    (2) for a hospital with a medical assistance inpatient utilization rate above one
6.11standard deviation above the mean, the adjustment must be determined by multiplying
6.12the adjustment that would be determined under clause (1) for that hospital by 1.1. The
6.13commissioner may establish a separate disproportionate population operating payment
6.14rate adjustment under the general assistance medical care program. For purposes of this
6.15subdivision, medical assistance does not include general assistance medical care. The
6.16commissioner shall report annually on the number of hospitals likely to receive the
6.17adjustment authorized by this paragraph. The commissioner shall specifically report on
6.18the adjustments received by public hospitals and public hospital corporations located
6.19in cities of the first class;
6.20    (3) for a hospital that had medical assistance fee-for-service payment volume during
6.21calendar year 1991 in excess of 13 percent of total medical assistance fee-for-service
6.22payment volume, a medical assistance disproportionate population adjustment shall be
6.23paid in addition to any other disproportionate payment due under this subdivision as
6.24follows: $1,515,000 due on the 15th of each month after noon, beginning July 15, 1995.
6.25For a hospital that had medical assistance fee-for-service payment volume during calendar
6.26year 1991 in excess of eight percent of total medical assistance fee-for-service payment
6.27volume and was the primary hospital affiliated with the University of Minnesota, a
6.28medical assistance disproportionate population adjustment shall be paid in addition to any
6.29other disproportionate payment due under this subdivision as follows: $505,000 due on
6.30the 15th of each month after noon, beginning July 15, 1995; and
6.31    (4) effective August 1, 2005, the payments in paragraph (b), clause (3), shall be
6.32reduced to zero.
6.33    (c) The commissioner shall adjust rates paid to a health maintenance organization
6.34under contract with the commissioner to reflect rate increases provided in paragraph (b),
6.35clauses (1) and (2), on a nondiscounted hospital-specific basis but shall not adjust those
6.36rates to reflect payments provided in clause (3).
7.1    (d) If federal matching funds are not available for all adjustments under paragraph
7.2(b), the commissioner shall reduce payments under paragraph (b), clauses (1) and (2), on a
7.3pro rata basis so that all adjustments under paragraph (b) qualify for federal match.
7.4    (e) For purposes of this subdivision, medical assistance does not include general
7.5assistance medical care.
7.6    (f) For hospital services occurring on or after July 1, 2005, to June 30, 2007, general
7.7assistance medical care expenditures for fee for service inpatient and outpatient hospital
7.8services made by the department and by prepaid health plans participating in general
7.9assistance medical care effective July 1, 2007, payments under section 256B.199 shall be
7.10considered Medicaid disproportionate share hospital payments, except as limited below:
7.11by clauses (1) to (5).
7.12    (1) only the portion of Minnesota's disproportionate share hospital allotment under
7.13section 1923(f) of the Social Security Act that is not spent on the disproportionate
7.14population adjustments in paragraph (b), clauses (1) and (2), may be used for general
7.15assistance medical care expenditures;
7.16    (2) only those general assistance medical care expenditures made to hospitals that
7.17qualify for disproportionate share payments under section 1923 of the Social Security Act
7.18and the Medicaid state plan may be considered disproportionate share hospital payments;
7.19    (3) only those general assistance medical care expenditures made to an individual
7.20hospital that would not cause the hospital to exceed its individual hospital limits under
7.21section 1923 of the Social Security Act may be considered; and
7.22    (4) general assistance medical care expenditures may be considered only to the
7.23extent of Minnesota's aggregate allotment under section 1923 of the Social Security Act.
7.24All hospitals and prepaid health plans participating in general assistance medical care
7.25must provide any necessary expenditure, cost, and revenue information required by the
7.26commissioner as necessary for purposes of obtaining federal Medicaid matching funds for
7.27general assistance medical care expenditures Medicaid disproportionate share payments.
7.28    (5) expenditures under general assistance medical care shall be used to the fullest
7.29extent before payments under section 256B.199.
7.30    (g) Upon federal approval of the related state plan amendment, paragraph (f) is
7.31effective retroactively from July 1, 2005, or the earliest effective date approved by the
7.32Centers for Medicare and Medicaid Services."
7.33Page 85, after line 27 insert:

7.34    "Sec. 5. [256B.194] FEDERAL PAYMENTS.
7.35    Subdivision 1. Payments at actual cost. If the Centers for Medicare & Medicaid
7.36Services (CMS) promulgates a final rule consistent with its stated intent in the proposed
8.1rule published at 72 Federal Register, No. 11, January 18, 2007, regarding limiting
8.2payments to units of government, and notwithstanding Minnesota Statutes or Minnesota
8.3Rules to the contrary, for providers that are units of government, the commissioner may
8.4limit medical assistance and MinnesotaCare payments to a provider's actual cost of
8.5providing services, in accordance with the CMS final rule. If a final rule is promulgated,
8.6the commissioner may also require medical assistance and MinnesotaCare providers to
8.7provide any information necessary to determine Medicaid-related costs, and require the
8.8cooperation of providers in any audit or review necessary to ensure payments are limited
8.9to cost. This section does not apply to providers who are exempt from the provisions of
8.10the CMS final rule.
8.11    Subd. 2. Loss of federal financial participation. For all transfers, certified
8.12expenditures, and medical assistance payments listed below, if the commissioner
8.13determines that federal financial participation is no longer available for the medical
8.14assistance payments listed, then related obligations for the non-federal share of payments
8.15and the medical assistance payments shall terminate. The commissioner shall notify all
8.16affected parties of the loss of federal financial participation, and the resulting payments
8.17and obligations that are terminated. If the commissioner determines that federal financial
8.18participation is no longer available for any medical assistance payments or contributions
8.19to the nonfederal share of medical assistance payments that have already been made, the
8.20commissioner may collect the medical assistance payments from providers and return
8.21contributions of the nonfederal share to its source. The transfers, certified expenditures,
8.22and medical assistance payments subject to this section are those specified in: section
8.23256B.195; section 256B.19, subdivisions 1c and 1d; section 256B.431, subdivision 23;
8.24section 62J.692, subdivision 7, paragraphs (b) and (c); Laws of Minnesota 2005, First
8.25Special Session, chapter 4, article 9, section 2, subdivision 1; Laws of Minnesota 2002,
8.26chapter 220, article 17, section 2, subdivision 3; and section 256B.69, subdivision 5c,
8.27paragraph (a), clauses (2), (3), and (4).

8.28    Sec. 6. Minnesota Statutes 2006, section 256B.199, is amended to read:
8.29256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
8.30    (a) Hennepin County, and Hennepin County Medical Center, Ramsey County,
8.31Regions Hospital, the University of Minnesota, and Fairview-University Medical Center
8.32shall report quarterly to the commissioner beginning June 1, 2007, payments made during
8.33the second previous quarter that may qualify for reimbursement under federal law.
8.34    (b) Based on these reports, the commissioner shall apply for federal matching funds.
8.35These funds are appropriated to the commissioner for the payments under section 256.969,
8.36subdivision 27 to Hennepin County Medical Center.
9.1    (c) By May 1 of each year, beginning May 1, 2007, the commissioner shall inform
9.2the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
9.3hospital payment money expected to be available in the current federal fiscal year.
9.4    (d) This section sunsets on June 30, 2009. The commissioner shall report to
9.5the legislature by December 15, 2008, with recommendations for maximizing federal
9.6disproportionate share hospital payments after June 30, 2009."
9.7Page 89, after line 14, insert:

9.8    "Sec. 7. REPEALER; HOSPITAL QUARTERLY PAYMENT ADJUSTMENTS.
9.9Minnesota Statutes 2006, section 256.969, subdivision 27, is repealed effective
9.10July 1, 2007."
9.11Page 89, after line 16 insert:

9.12    "Section 1. Minnesota Statutes 2006, section 144A.071, subdivision 3, is amended to
9.13read:
9.14    Subd. 3. Exceptions authorizing an increase in beds. The commissioner of health,
9.15in coordination with the commissioner of human services, may approve the addition
9.16of a new certified bed or the addition of a new licensed nursing home bed, under the
9.17following conditions:
9.18    (a) to license or certify a new bed in place of one decertified after July 1, 1993, as
9.19long as the number of certified plus newly certified or recertified beds does not exceed the
9.20number of beds licensed or certified on July 1, 1993, or to address an extreme hardship
9.21situation, in a particular county that, has fewer than 75 percent of the national average of
9.22nursing home beds per 1,000 elderly individuals, or that has fewer than 85 percent of the
9.23national average of nursing home beds per 1,000 elderly individuals and together with all
9.24of that county's contiguous Minnesota counties, has fewer nursing home beds per 1,000
9.25elderly than the number that is ten percent higher than 120 percent of the national average
9.26of nursing home beds per 1,000 elderly individuals. For the purposes of this section, the
9.27national average of nursing home beds shall be the most recent figure that can be supplied
9.28by the federal Centers for Medicare and Medicaid Services and the number of elderly in
9.29the county or the nation shall be determined by the most recent federal census or the
9.30most recent estimate of the state demographer as of July 1, of each year of persons age
9.3165 and older, whichever is the most recent at the time of the request for replacement. An
9.32extreme hardship situation can only be found after the county documents the existence of
9.33unmet medical needs for nursing home placement that cannot be addressed by any other
9.34alternatives. The number of new beds that the commissioner may authorize in the event of
9.35an extreme hardship situation shall not exceed the sum of: (1) the number necessary to
9.36increase the county's number of beds per thousand elderly to 90 percent of the national
10.1average; and (2) the number that are delicensed while the planned closure program in
10.2section 256B.437 is suspended. Operating payment rates of nursing facilities adding beds
10.3under this provision shall not change when the new beds are licensed. Adjustments to
10.4the property payment rate shall be determined in accordance with section 256B.434,
10.5subdivision 4f;
10.6    (b) to certify or license new beds in a new facility that is to be operated by the
10.7commissioner of veterans affairs or when the costs of constructing and operating the new
10.8beds are to be reimbursed by the commissioner of veterans affairs or the United States
10.9Veterans Administration;
10.10    (c) to license or certify beds in a facility that has been involuntarily delicensed
10.11or decertified for participation in the medical assistance program, provided that an
10.12application for relicensure or recertification is submitted to the commissioner within 120
10.13days after delicensure or decertification;
10.14    (d) to certify two existing beds in a facility with 66 licensed beds on January 1, 1994,
10.15that had an average occupancy rate of 98 percent or higher in both calendar years 1992 and
10.161993, and which began construction of four attached assisted living units in April 1993; or
10.17    (e) to certify four existing beds in a facility in Winona with 139 beds, of which
10.18129 beds are certified."
10.19Page 106, after line 35 insert:

10.20    "Sec. 25. Minnesota Statutes 2006, section 256B.437, is amended by adding a
10.21subdivision to read:
10.22    Subd. 10. Ensuring access to services. In order to address an access problem
10.23for long-term care services or to prevent an access problem from developing, the
10.24commissioner may suspend bed closure incentives under this section, layaway incentives
10.25under section 144A.071, subdivision 4b, or the single bed incentive under section
10.26256B.431, subdivision 42, on a local, regional or statewide basis. The commissioner may
10.27reinstate the incentives at such time as the access problem is alleviated."
10.28Renumber the sections in sequence and correct the internal references
10.29Amend the title accordingly