1.1.................... moves to amend H.F. No. 802, as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 144.7065, subdivision 8, is amended to
1.4read:
1.5    Subd. 8. Root cause analysis; corrective action plan. (a) Following the occurrence
1.6of an adverse health care event, the facility must conduct a root cause analysis of the
1.7event. Following the analysis, the facility must: (1) implement a corrective action plan
1.8to implement the findings of the analysis or (2) report to the commissioner any reasons
1.9for not taking corrective action. If the root cause analysis and the implementation of a
1.10corrective action plan are complete at the time an event must be reported, the findings of
1.11the analysis and the corrective action plan must be included in the report of the event. The
1.12findings of the root cause analysis and a copy of the corrective action plan must otherwise
1.13be filed with the commissioner within 60 days of the event.
1.14(b) In conducting the root cause analysis of the event, the facility must consider as
1.15a factor the staffing levels and the impact of those staffing levels on the event. Factors
1.16that must be examined when considering staffing levels include, but are not limited to,
1.17the following:
1.18(1) number of patients assigned to each registered nurse in the unit or department
1.19where the patient was receiving care at the time of the event;
1.20(2) skill mix and the level of experience of the nursing staff, including registered
1.21nurses, licensed practical nurses, nursing assistants, and the temporary or pool staff,
1.22available at the time the event occurred;
1.23(3) acuity of patients in the unit or department where the event occurred; and
1.24(4) nursing intensity as a measure of nursing care resources needed in the unit or
1.25department where the event occurred. For purposes of this subdivision, "nursing intensity"
1.26means a patient-specific, not diagnosis-specific, measurement of nursing care resources
1.27expended during a patient's hospitalization. A measurement of nursing intensity includes
2.1the complexity of care required for a patient and the knowledge and skill needed by
2.2a nurse for surveillance of patients in order to make continuous, appropriate clinical
2.3decisions in the care of the patients.

2.4    Sec. 2. Minnesota Statutes 2008, section 144.7065, subdivision 10, is amended to read:
2.5    Subd. 10. Relation to other law; data classification. (a) Adverse health events
2.6described in subdivisions 2 to 6 do not constitute "maltreatment," "neglect," or "a physical
2.7injury that is not reasonably explained" under section 626.556 or 626.557 and are excluded
2.8from the reporting requirements of sections 626.556 and 626.557, provided the facility
2.9makes a determination within 24 hours of the discovery of the event that this section is
2.10applicable and the facility files the reports required under this section in a timely fashion.
2.11(b) A facility that has determined that an event described in subdivisions 2 to 6
2.12has occurred must inform persons who are mandated reporters under section 626.556,
2.13subdivision 3 , or 626.5572, subdivision 16, of that determination. A mandated reporter
2.14otherwise required to report under section 626.556, subdivision 3, or 626.557, subdivision
2.153 , paragraph (e), is relieved of the duty to report an event that the facility determines under
2.16paragraph (a) to be reportable under subdivisions 2 to 6.
2.17(c) The protections and immunities applicable to voluntary reports under sections
2.18626.556 and 626.557 are not affected by this section.
2.19(d) Notwithstanding section 626.556, 626.557, or any other provision of Minnesota
2.20statute or rule to the contrary, neither a lead agency under section 626.556, subdivision 3c,
2.21or 626.5572, subdivision 13, the commissioner of health, nor the director of the Office of
2.22Health Facility Complaints is required to conduct an investigation of or obtain or create
2.23investigative data or reports regarding an event described in subdivisions 2 to 6. If the
2.24facility satisfies the requirements described in paragraph (a), the review or investigation
2.25shall be conducted and data or reports shall be obtained or created only under sections
2.26144.706 to 144.7069, except as permitted or required under sections 144.50 to 144.564,
2.27or as necessary to carry out the state's certification responsibility under the provisions of
2.28sections 1864 and 1867 of the Social Security Act. If, acting in good faith, a registered
2.29nurse reports an event required to be reported under subdivisions 2 to 6, in a timely
2.30manner, the Minnesota Board of Nursing is not required to conduct an investigation of
2.31or obtain or create investigative data or reports regarding the individual reporting of the
2.32events described in subdivisions 2 to 6.
2.33(e) Data contained in the following records are nonpublic and, to the extent they
2.34contain data on individuals, confidential data on individuals, as defined in section 13.02:
3.1(1) reports provided to the commissioner under sections 147.155, 147A.155,
3.2148.267 , 151.301, and 153.255;
3.3(2) event reports, findings of root cause analyses, and corrective action plans filed by
3.4a facility under this section; and
3.5(3) records created or obtained by the commissioner in reviewing or investigating
3.6the reports, findings, and plans described in clause (2).
3.7For purposes of the nonpublic data classification contained in this paragraph, the
3.8reporting facility shall be deemed the subject of the data.

3.9    Sec. 3. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
3.10to read:
3.11    Subd. 3b. Nonpayment for hospital-acquired conditions. (a) The commissioner
3.12must not make medical assistance payments to a hospital for any costs of care that result
3.13from a condition listed in paragraph (c), if the condition was hospital-acquired.
3.14    (b) For purposes of this subdivision, a condition is hospital-acquired if it is not
3.15identified by the hospital as present on admission. For purposes of this subdivision,
3.16medical assistance includes general assistance medical care and MinnesotaCare.
3.17(c) The prohibition in paragraph (a) applies to payment for:
3.18(1) any hospital-acquired condition resulting from an adverse health care event
3.19reportable under section 144.7065, subdivision 2, clauses (1), (2), and (3);
3.20(2) any hospital-acquired condition listed in this clause that is represented by an
3.21ICD-9-CM diagnosis code and is designated as a complicating condition or a major
3.22complicating condition:
3.23(i) foreign object retained after surgery (ICD-9-CM codes 998.4 or 998.7);
3.24(ii) air embolism (ICD-9-CM code 999.1);
3.25(iii) blood incompatibility (ICD-9-CM code 999.6);
3.26(iv) pressure ulcers stage III or IV (ICD-9-CM codes 707.23 or 707.24);
3.27(v) falls and trauma, including fracture, dislocation, intracranial injury, crushing
3.28injury, burn, and electric shock (ICD-9-CM codes with these ranges on the complicating
3.29condition and major complicating condition list: 800-829; 830-839; 850-854; 925-929;
3.30940-949; and 991-994);
3.31(vi) catheter-associated urinary tract infection (ICD-9-CM code 996.64);
3.32(vii) vascular catheter-associated infection (ICD-9-CM code 999.31);
3.33(viii) manifestations of poor glycemic control (ICD-9-CM codes 249.10; 249.11;
3.34249.20; 249.21; 250.10; 250.11; 250.12; 250.13; 250.20; 250.21; 250.22; 250.23; and
3.35251.0);
4.1(ix) surgical site infection (ICD-9-CM codes 996.67 or 998.59) following certain
4.2orthopedic procedures (procedure codes 81.01; 81.02; 81.03; 81.04; 81.05; 81.06; 81.07;
4.381.08; 81.23; 81.24; 81.31; 81.32; 81.33; 81.34; 81.35; 81.36; 81.37; 81.38; 81.83; and
4.481.85);
4.5(x) surgical site infection (ICD-9-CM code 998.59) following bariatric surgery
4.6(procedure codes 44.38; 44.39; or 44.95) for a principal diagnosis of morbid obesity
4.7(ICD-9-CM code 278.01);
4.8(xi) surgical site infection, mediastinitis (ICD-9-CM code 519.2) following coronary
4.9artery bypass graft (procedure codes 36.10 to 36.19); and
4.10(xii) deep vein thrombosis (ICD-9-CM codes 453.40 to 453.42) or pulmonary
4.11embolism (ICD-9-CM codes 415.11 or 415.91) following total knee replacement
4.12(procedure code 81.54) or hip replacement (procedure codes 00.85 to 00.87 or 81.51
4.13to 81.52); and
4.14(3) any hospital acquired condition identified as nonpayable by the Medicare
4.15program, including but not limited to conditions identified in current and future rules
4.16adopted by the Centers for Medicare and Medicaid Services in compliance with section
4.175001(c) of the Deficit Reduction Act of 2005.
4.18(d) The prohibition in paragraph (a) applies to any additional payments that result
4.19from a hospital-acquired condition listed in paragraph (c), including, but not limited to,
4.20additional treatment or procedures, readmission to the facility after discharge, increased
4.21length of stay, change to a higher diagnostic category, or transfer to another hospital. In
4.22the event of a transfer to another hospital, the hospital where the condition listed under
4.23paragraph (c) was acquired is responsible for any costs incurred at the hospital to which
4.24the patient is transferred.
4.25(e) A hospital shall not bill a recipient of services for any payment disallowed under
4.26this subdivision.

4.27    Sec. 4. IMPACT OF ECONOMIC ENVIRONMENT ON STAFFING LEVELS.
4.28In the event that state funding to hospitals is reduced for the biennium beginning
4.29July 1, 2009, hospitals, licensed under Minnesota Statutes, sections 144.50 to 144.56,
4.30must submit to the legislature a report on the number of direct care employees, including
4.31registered nurses, licensed practical nurses, and nursing assistants, who where laid-off
4.32by the hospital and the number of direct care positions that where cut or left unfilled as
4.33a result of the reduction in state funding. Hospitals must report these numbers to the
4.34legislature by December 31, 2009, and by December 31, 2010."
4.35Renumber the sections in sequence and correct the internal references
4.36Amend the title accordingly