1.1.................... moves to amend H.F. No. 2680, the first engrossment, as follows:
1.2Page 2, line 14, after "consultation." insert "(a)"
1.3Page 2, line 17, after "services," insert "mental health professionals,"
1.4Page 2, line 19, delete "include" and insert "be provided by a multidisciplinary team
1.5including, at a minimum, a" and delete "psychiatrists and" and insert "psychiatrist, an "
1.6and delete the second "psychiatrists;" and insert "psychiatrist, and a licensed clinical
1.7social worker;"
1.8Page 2, after line 19, insert: "(3) the service shall include a triage-level assessment
1.9to determine the most appropriate response to each request, including appropriate referrals
1.10to other mental health professionals, as well as provision of rapid psychiatric access when
1.11other appropriate services are not available; "
1.12Page 2, line 20, delete "(3)" and insert "(4)"
1.13Page 2, line 22, delete "(4)" and insert "(5)"
1.14Page 2, after line 23 insert "(b) The commissioner shall appoint an interdisciplinary
1.15work group to establish appropriate medication and psychotherapy protocols to guide the
1.16consultative process, including consultation with the Drug Utilization Review Board, as
1.17provided in section 256B.0625, subdivision 13j."
1.18Page 8, line 20, before the period insert ", and prepaid health plans are not required to
1.19increase rates to providers under contract to reflect payments provided in this paragraph"
1.20Page 9, line 11, delete "$50,000,000" and insert "$40,000,000"
1.21Page 9, line 15, before the period insert ", and prepaid health plans are not required to
1.22increase rates to providers under contract to reflect payments provided in this paragraph"
1.23Page 10, line 19, before the period insert ", and prepaid health plans are not required
1.24to increase rates to providers under contract to reflect payments provided in this paragraph"
1.25Page 10, after line 23, insert:

1.26    "Sec. 8. Minnesota Statutes 2008, section 256.969, is amended by adding a subdivision
1.27to read:
2.1    Subd. 26a. Psychiatric and burn services payment adjustment on or after July
2.21, 2010. (a) For admissions occurring on or after July 1, 2010, the commissioner shall
2.3increase the total payment for medical assistance fee-for-service inpatient admissions
2.4for the diagnosis-related groups specified in paragraph (b) at any hospital that is a
2.5nonstate public Minnesota hospital and a Level I trauma center. The rate increases
2.6shall be established for each hospital by the commissioner at a level that uses each
2.7hospital's voluntary payments under paragraph (c) as the state share. For purposes of this
2.8subdivision, medical assistance does not include general assistance medical care.
2.9    (b) The rate increases provided in paragraph (a) apply to the following
2.10diagnosis-related groups or subgroups, or any subsequent designations of such groups
2.11or subgroups: 424 to 431, 433, 504 to 511, 521, and 523. These increases are only
2.12available to the extent that revenue is available from the counties under paragraph (c)
2.13for the nonfederal share.
2.14    (c) Effective July 15, 2010, in addition to any payment otherwise required under
2.15sections 256B.19, 256B.195, 256B.196, and 256B.199, the following government entities
2.16may make the following voluntary payments to the commissioner on an annual basis:
2.17    (1) Hennepin County, $7,000,000; and
2.18    (2) Ramsey County, $3,500,000.
2.19The amounts in this paragraph shall be part of the designated governmental unit's portion
2.20of the nonfederal share of medical assistance costs.
2.21    (d) The commissioner may adjust the intergovernmental transfers under paragraph
2.22(c) and the payments under paragraph (a) based on the commissioner's determination of
2.23Medicare upper payment limits and hospital-specific charge limits."
2.24Page 10, line 31, before the semicolon, insert:", except that Hennepin County
2.25Medical Center and Regions Hospital shall not receive a payment under this subdivision"
2.26Page 13, lines 2 and 3, delete "388, 390,"
2.27Page 13, line 5, delete "$42,000,000" and insert "$35,000,000"
2.28Page 13, line 9, before the period insert ", and prepaid health plans are not required to
2.29increase rates to providers under contract to reflect payments provided in this paragraph"
2.30Page 13, after line 13, insert:

2.31    "Sec. 10. Minnesota Statutes 2008, section 256.969, is amended by adding a
2.32subdivision to read:
2.33    Subd. 31. Rate increase for hospitals in cities of the third class and fourth class.
2.34    Effective for services rendered on or after March 1, 2010, to June 30, 2011, payment rates
2.35for medical assistance admissions, excluding general assistance medical care admissions,
2.36at Minnesota hospitals with fewer than 500 medical assistance admissions during fiscal
3.1year 2008 and located in cities of the third class or of the fourth class, as defined in
3.2section 410.01, shall be increased by 27 percent. This increase shall be paid from the
3.3account established in section 256D.032. The commissioner shall not adjust rates paid to a
3.4prepaid health plan under contract with the commissioner to reflect payments provided
3.5in this paragraph. The commissioner may utilize a settlement process to adjust rates in
3.6excess of the Medicare upper limits on payments. The commissioner may ratably reduce
3.7payments under this paragraph in order to comply with section 256B.195, subdivision 3,
3.8paragraph (f).
3.9EFFECTIVE DATE.This section is effective March 1, 2010."
3.10Page 17, after line 24, insert:

3.11    "Sec. 13. Minnesota Statutes 2009 Supplement, section 256B.196, subdivision 2,
3.12is amended to read:
3.13    Subd. 2. Commissioner's duties. (a) For the purposes of this subdivision and
3.14subdivision 3, the commissioner shall determine the fee-for-service outpatient hospital
3.15services upper payment limit for nonstate government hospitals. The commissioner shall
3.16then determine the amount of a supplemental payment to Hennepin County Medical
3.17Center and Regions Hospital for these services that would increase medical assistance
3.18spending in this category to the aggregate upper payment limit for all nonstate government
3.19hospitals in Minnesota. In making this determination, the commissioner shall allot the
3.20available increases between Hennepin County Medical Center and Regions Hospital
3.21based on the ratio of medical assistance fee-for-service outpatient hospital payments to
3.22the two facilities. The commissioner shall adjust this allotment as necessary based on
3.23federal approvals, the amount of intergovernmental transfers received from Hennepin and
3.24Ramsey Counties, and other factors, in order to maximize the additional total payments.
3.25The commissioner shall inform Hennepin County and Ramsey County of the periodic
3.26intergovernmental transfers necessary to match federal Medicaid payments available
3.27under this subdivision in order to make supplementary medical assistance payments to
3.28Hennepin County Medical Center and Regions Hospital equal to an amount that when
3.29combined with existing medical assistance payments to nonstate governmental hospitals
3.30would increase total payments to hospitals in this category for outpatient services to
3.31the aggregate upper payment limit for all hospitals in this category in Minnesota. Upon
3.32receipt of these periodic transfers, the commissioner shall make supplementary payments
3.33to Hennepin County Medical Center and Regions Hospital.
3.34    (b) For the purposes of this subdivision and subdivision 3, the commissioner shall
3.35determine an upper payment limit for physicians affiliated with Hennepin County Medical
4.1Center and with Regions Hospital. The upper payment limit shall be based on the average
4.2commercial rate or be determined using another method acceptable to the Centers for
4.3Medicare and Medicaid Services. The commissioner shall inform Hennepin County and
4.4Ramsey County of the periodic intergovernmental transfers necessary to match the federal
4.5Medicaid payments available under this subdivision in order to make supplementary
4.6payments to physicians affiliated with Hennepin County Medical Center and Regions
4.7Hospital equal to the difference between the established medical assistance payment for
4.8physician services and the upper payment limit. Upon receipt of these periodic transfers,
4.9the commissioner shall make supplementary payments to physicians of Hennepin Faculty
4.10Associates and HealthPartners.
4.11    (c) Beginning January 1, 2010, Hennepin County and Ramsey County shall may
4.12make monthly intergovernmental transfers to the commissioner in the following amounts:
4.13$133,333 by Hennepin County and $100,000 by Ramsey County order to increase
4.14medical assistance capitation payments to licensed health care plans in Minnesota that
4.15pay enhanced amounts to Hennepin County Medical Center and Regions Hospital for the
4.16provision of services to Minnesota health care program enrollees. The commissioner
4.17shall increase the medical assistance capitation payments to Metropolitan Health Plan
4.18and HealthPartners each licensed health plan that agrees to provide enhanced payments
4.19to Hennepin County Medical Center or Regions Hospital for the provision of services to
4.20Minnesota health care program enrollees by an amount in total equal to the annual value of
4.21the monthly transfers plus federal financial participation health plan's increase in capitation
4.22payments as a result of the monthly intergovernmental transfers. The commissioner shall
4.23annually set the amount of the capitation rate increase for each plan, and the corresponding
4.24intergovernmental transfer amount, based on information submitted by Hennepin County
4.25Medical Center and Regions Hospital and actuarial soundness data for the licensed health
4.26plans. Upon the request of the commissioner, health plans shall submit individual-level
4.27cost data for verification purposes. The commissioner may ratably reduce these payments
4.28on a pro rata basis in order to satisfy federal requirements for actuarial soundness. If
4.29payments are reduced, transfers shall be reduced accordingly.
4.30    (d) The commissioner shall inform Hennepin County and Ramsey County on an
4.31ongoing basis of the need for any changes needed in the intergovernmental transfers
4.32in order to continue the payments under paragraphs (a) to (c), at their maximum level,
4.33including increases in upper payment limits, changes in the federal Medicaid match, and
4.34other factors.
4.35    (e) The payments in paragraphs (a) to (c) shall be implemented independently of
4.36each other, subject to federal approval and to the receipt of transfers under subdivision 3.
5.1EFFECTIVE DATE.This section is effective the day following final enactment.

5.2    Sec. 14. Minnesota Statutes 2009 Supplement, section 256B.199, is amended to read:
5.3256B.199 PAYMENTS REPORTED BY GOVERNMENTAL ENTITIES.
5.4    (a) Effective July 1, 2007, the commissioner shall apply for federal matching funds
5.5for the expenditures in paragraphs (b) and (c).
5.6    (b) The commissioner shall apply for federal matching funds for certified public
5.7expenditures as follows:
5.8    (1) Hennepin County, Hennepin County Medical Center, Ramsey County, and
5.9Regions Hospital, the University of Minnesota, and Fairview-University Medical Center
5.10shall report quarterly to the commissioner beginning June 1, 2007, payments made during
5.11the second previous quarter that may qualify for reimbursement under federal law;
5.12     (2) based on these reports, the commissioner shall apply for federal matching
5.13funds. These funds are appropriated to the commissioner for the payments under section
5.14256.969, subdivision 27 ; and
5.15     (3) by May 1 of each year, beginning May 1, 2007, the commissioner shall inform
5.16the nonstate entities listed in paragraph (a) of the amount of federal disproportionate share
5.17hospital payment money expected to be available in the current federal fiscal year.
5.18    (c) The commissioner shall apply for federal matching funds for general assistance
5.19medical care expenditures as follows:
5.20    (1) for hospital services occurring on or after July 1, 2007, general assistance medical
5.21care expenditures for fee-for-service inpatient and outpatient hospital payments made by
5.22the department shall be used to apply for federal matching funds, except as limited below:
5.23    (i) only those general assistance medical care expenditures made to an individual
5.24hospital that would not cause the hospital to exceed its individual hospital limits under
5.25section 1923 of the Social Security Act may be considered; and
5.26    (ii) general assistance medical care expenditures may be considered only to the extent
5.27of Minnesota's aggregate allotment under section 1923 of the Social Security Act; and
5.28    (2) all hospitals must provide any necessary expenditure, cost, and revenue
5.29information required by the commissioner as necessary for purposes of obtaining federal
5.30Medicaid matching funds for general assistance medical care expenditures.
5.31    (d) For the period from April 1, 2009, to September 30, 2010, the commissioner shall
5.32apply for additional federal matching funds available as disproportionate share hospital
5.33payments under the American Recovery and Reinvestment Act of 2009. These funds shall
5.34be made available as the state share of payments under section 256.969, subdivision 28.
6.1The entities required to report certified public expenditures under paragraph (b), clause
6.2(1), shall report additional certified public expenditures as necessary under this paragraph.
6.3    (e) Effective July 15, 2010, in addition to any payment otherwise required under
6.4sections 256B.19, 256B.195, and 256B.196, the following government entities may make
6.5the following voluntary payments on an annual basis:
6.6    (1) Hennepin County, $6,200,000; and
6.7    (2) Ramsey County, $4,000,000.
6.8    (f) The sums in paragraph (e) shall be part of the designated governmental unit's
6.9portion of the nonfederal share of medical assistance costs.
6.10    (g) Effective July 15, 2010, the commissioner shall make the following Medicaid
6.11disproportionate share hospital payments to the hospitals on a monthly basis:
6.12    (1) to Hennepin County Medical Center, any federal matching funds available to
6.13match the payments received by the medical center for contributions under paragraph (e),
6.14to increase payments for medical assistance admissions and to recognize higher medical
6.15assistance costs in institutions that provide high levels of charity care; and
6.16    (2) to Regions Hospital, any federal matching funds available to match the payments
6.17received by the hospital for contributions under paragraph (e), to increase payments
6.18for medical assistance admissions and to recognize higher medical assistance costs in
6.19institutions that provide high levels of charity care.
6.20    (h) Effective July 15, 2010, after making the payments provided in paragraph
6.21(g), the commissioner shall make the increased payments provided in section 256.969,
6.22subdivision 26a.
6.23    (i) The commissioner shall make the payments under paragraphs (g) and (h) prior
6.24to making any other payments under this section, section 256.969, subdivision 27, or
6.25256B.195."
6.26Page 22, line 9, after "any" insert "medical"
6.27Page 22, line 10, after the first "in" insert "or credited to"
6.28Page 23, line 2, after "any" insert "medical"
6.29Page 23, line 3, after the first "in" insert "or credited to"
6.30Page 29, line 6, delete "ensure and improve" and insert "monitor enrollment and
6.31ensure"
6.32Page 29, line 11, after "assessing" insert "enrollment"
6.33Page 29, line 35, delete "70" and insert "69"
6.34Page 30, line 6, delete "40" and insert "60"
6.35Page 31, delete lines 4 and 5
7.1Page 31, line 10, before the period insert ", and shall be used only for expenditures
7.2related to the general assistance medical care program or as provided in this act"
7.3Page 31, line 31, after "any" insert "medical"
7.4Page 31, line 32 after the first "in" insert "or credited to"
7.5Page 35, line 16, delete the first "$......." and insert "$21,875,000" and delete the
7.6second "$......." and insert "$13,125,000"
7.7Page 35, line 19, delete the first "$......." and insert "$21,875,000" and delete the
7.8second "$......." and insert "$13,125,000"
7.9Page 36, line 4, delete "$34,000,000" and insert "$44,000,000"
7.10Page 36, line 14, delete "$17,000,000" and insert "$9,560,500" and delete
7.11everything after the period and insert "The general fund base for children and community
7.12service grants is increased by $9,560,500 per year for fiscal years 2012 and 2013"
7.13Page 36, delete line 15
7.14Page 36, line 17, delete "the adult mental health integrated fund" and insert "adult
7.15mental health grants"
7.16Page 36, line 19, delete "$12,000,000" and insert "$9,560,500" and delete everything
7.17after the period and insert "The general fund base for adult mental health grants in
7.18increased by $9,560,500 per year in fiscal years 2012 and 2013."
7.19Page 36, delete line 20
7.20Page 36, line 21, delete "$29,000,000" and insert "$19,121,000"
7.21Page 37, line 1, before "rate" insert "medical assistance"
7.22Page 37, line 2, before the semicolon, insert ", and to the health care access fund and
7.23pay the MinnesotaCare rate increases from the health care access fund"