1.1 	A bill for an act
1.2 	relating to human services; providing a
1.3 	disproportionate population adjustment for certain
1.4 	hospitals; providing a hospital payment adjustment for
1.5 	certain hospitals under certain circumstances;
1.6 	changing hospital payment adjustment provisions for
1.7 	diagnostic-related group payments; increasing the
1.8 	surcharge on criminal and traffic offenders;
1.9 	appropriating money; amending Minnesota Statutes 2004,
1.10 	sections 256.969, subdivisions 9, 23, 26; 256B.195,
1.11 	subdivision 3; 357.021, subdivisions 6, 7.
1.12 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.13 	Section 1. Minnesota Statutes 2004, section 256.969,
1.14 	subdivision 9, is amended to read:
1.15 		Subd. 9.Disproportionate numbers of low-income patients
1.16 	served.  (a) For admissions occurring on or after October 1,
1.17 	1992, through December 31, 1992, the medical assistance
1.18 	disproportionate population adjustment shall comply with federal
1.19 	law and shall be paid to a hospital, excluding regional
1.20 	treatment centers and facilities of the federal Indian Health
1.21 	Service, with a medical assistance inpatient utilization rate in
1.22 	excess of the arithmetic mean.  The adjustment must be
1.23 	determined as follows:
1.24 	(1) for a hospital with a medical assistance inpatient
1.25 	utilization rate above the arithmetic mean for all hospitals
1.26 	excluding regional treatment centers and facilities of the
1.27 	federal Indian Health Service but less than or equal to one
1.28 	standard deviation above the mean, the adjustment must be
2.1 	determined by multiplying the total of the operating and
2.2 	property payment rates by the difference between the hospital's
2.3 	actual medical assistance inpatient utilization rate and the
2.4 	arithmetic mean for all hospitals excluding regional treatment
2.5 	centers and facilities of the federal Indian Health Service; and
2.6 	(2) for a hospital with a medical assistance inpatient
2.7 	utilization rate above one standard deviation above the mean,
2.8 	the adjustment must be determined by multiplying the adjustment
2.9 	that would be determined under clause (1) for that hospital by
2.10 	1.1.  If federal matching funds are not available for all
2.11 	adjustments under this subdivision, the commissioner shall
2.12 	reduce payments on a pro rata basis so that all adjustments
2.13 	qualify for federal match.  The commissioner may establish a
2.14 	separate disproportionate population operating payment rate
2.15 	adjustment under the general assistance medical care program.
2.16 	For purposes of this subdivision medical assistance does not
2.17 	include general assistance medical care.  The commissioner shall
2.18 	report annually on the number of hospitals likely to receive the
2.19 	adjustment authorized by this paragraph.  The commissioner shall
2.20 	specifically report on the adjustments received by public
2.21 	hospitals and public hospital corporations located in cities of
2.22 	the first class.
2.23 	(b) For admissions occurring on or after July 1, 1993, the
2.24 	medical assistance disproportionate population adjustment shall
2.25 	comply with federal law and shall be paid to a hospital,
2.26 	excluding regional treatment centers and facilities of the
2.27 	federal Indian Health Service, with a medical assistance
2.28 	inpatient utilization rate in excess of the arithmetic mean.
2.29 	The adjustment must be determined as follows:
2.30 	(1) for a hospital with a medical assistance inpatient
2.31 	utilization rate above the arithmetic mean for all hospitals
2.32 	excluding regional treatment centers and facilities of the
2.33 	federal Indian Health Service but less than or equal to one
2.34 	standard deviation above the mean, the adjustment must be
2.35 	determined by multiplying the total of the operating and
2.36 	property payment rates by the difference between the hospital's
3.1 	actual medical assistance inpatient utilization rate and the
3.2 	arithmetic mean for all hospitals excluding regional treatment
3.3 	centers and facilities of the federal Indian Health Service;
3.4 	(2) for a hospital with a medical assistance inpatient
3.5 	utilization rate above one standard deviation above the mean,
3.6 	the adjustment must be determined by multiplying the adjustment
3.7 	that would be determined under clause (1) for that hospital by
3.8 	1.1.  The commissioner may establish a separate disproportionate
3.9 	population operating payment rate adjustment under the general
3.10 	assistance medical care program.  For purposes of this
3.11 	subdivision, medical assistance does not include general
3.12 	assistance medical care.  The commissioner shall report annually
3.13 	on the number of hospitals likely to receive the adjustment
3.14 	authorized by this paragraph.  The commissioner shall
3.15 	specifically report on the adjustments received by public
3.16 	hospitals and public hospital corporations located in cities of
3.17 	the first class; ~~and~~ 
3.18 	(3) for a hospital that had medical assistance
3.19 	fee-for-service payment volume during calendar year 1991 in
3.20 	excess of 13 percent of total medical assistance fee-for-service
3.21 	payment volume, a medical assistance disproportionate population
3.22 	adjustment shall be paid in addition to any other
3.23 	disproportionate payment due under this subdivision as follows:
3.24 	$1,515,000 due on the 15th of each month after noon, beginning
3.25 	July 15, 1995.  For a hospital that had medical assistance
3.26 	fee-for-service payment volume during calendar year 1991 in
3.27 	excess of eight percent of total medical assistance
3.28 	fee-for-service payment volume and was the primary hospital
3.29 	affiliated with the University of Minnesota, a medical
3.30 	assistance disproportionate population adjustment shall be paid
3.31 	in addition to any other disproportionate payment due under this
3.32 	subdivision as follows:  $505,000 due on the 15th of each month
3.33 	after noon, beginning July 15, 1995;
3.34 	(4) for a hospital not eligible under clause (5) with
3.35 	medical assistance patient days greater than three percent of
3.36 	total patient days during the base year, a medical assistance
4.1 	disproportionate population adjustment shall be paid in addition
4.2 	to any other disproportionate payments due under this
4.3 	subdivision equal to 3.6 percent of the total of the operating
4.4 	and payment rates, effective for admissions occurring on or
4.5 	after July 1, 2005, and on or before June 30, 2006, and equal to
4.6 	2.8 percent of the total of the operating and payment rates
4.7 	effective for admissions occurring on or after July 1, 2006; and 
4.8 	(5) for a hospital with medical assistance patient days
4.9 	greater than 24 percent of total patient days during the base
4.10 	year that provides obstetrical services as defined in United
4.11 	States Code, title 42, section 1396r-4(d)(1), a medical
4.12 	assistance disproportionate population adjustment shall be paid
4.13 	in addition to any other disproportionate payment due under this
4.14 	subdivision equal to 10.3 percent of the total of the operating
4.15 	and property payment rates, effective for admissions occurring
4.16 	on or after July 1, 2005, and on or before June 30, 2005, and
4.17 	equal to 8.1 percent of the total of the operating and payment
4.18 	rates effective for admissions occurring on or after July 1,
4.19 	2006.
4.20 	(c) The commissioner shall adjust rates paid to a health
4.21 	maintenance organization under contract with the commissioner to
4.22 	reflect rate increases provided in paragraph (b), clauses (1)
4.23 	and (2), on a nondiscounted hospital-specific basis but shall
4.24 	not adjust those rates to reflect payments provided in ~~clause~~ 
4.25 	clauses (3), (4), and (5).
4.26 	(d) If federal matching funds are not available for all
4.27 	adjustments under paragraph (b), the commissioner shall reduce
4.28 	payments under paragraph (b), clauses (1) and (2), on a pro rata
4.29 	basis so that all adjustments under paragraph (b) qualify for
4.30 	federal match.
4.31 	(e) For purposes of this subdivision, medical assistance
4.32 	does not include general assistance medical care.

4.33 	Sec. 2. Minnesota Statutes 2004, section 256.969,
4.34 	subdivision 23, is amended to read:
4.35 		Subd. 23.Hospital payment adjustment after june 30,
4.36 	1993.  (a) For admissions occurring after June 30, 1993, the
5.1 	commissioner shall adjust the medical assistance payment paid to
5.2 	a hospital, excluding regional treatment centers and facilities
5.3 	of the federal Indian Health Service, with a medical assistance
5.4 	inpatient utilization rate in excess of the arithmetic mean.
5.5 	The adjustment must be determined as follows:
5.6 	(1) for a hospital with a medical assistance inpatient
5.7 	utilization rate above the arithmetic mean for all hospitals
5.8 	excluding regional treatment centers and facilities of the
5.9 	federal Indian Health Service, the adjustment must be determined
5.10 	by multiplying the total of the operating and property payment
5.11 	rates by the difference between the hospital's actual medical
5.12 	assistance inpatient utilization rate and the arithmetic mean
5.13 	for all hospitals excluding regional treatment centers and
5.14 	facilities of the federal Indian Health Service; ~~and~~ 
5.15 	(2) for a hospital with a medical assistance inpatient
5.16 	utilization rate above one standard deviation above the mean,
5.17 	the adjustment must be determined by multiplying the adjustment
5.18 	under clause (1) for that hospital by 1.1;
5.19 	(3) for a hospital not eligible under clause (4) with
5.20 	medical assistance patient days greater than three percent of
5.21 	total patient days during the base year, a medical assistance
5.22 	disproportionate population adjustment shall be paid in addition
5.23 	to any other disproportionate payments due under this
5.24 	subdivision equal to 3.6 percent of the total of the operating
5.25 	and payment rates, effective for admissions occurring on or
5.26 	after July 1, 2005, and on or before June 30, 2006, and equal to
5.27 	2.8 percent of the total of the operating and payment rates
5.28 	effective for admissions occurring on or after July 1, 2006; and 
5.29 	(4) for a hospital with medical assistance patient days
5.30 	greater than 24 percent of total patient days during the base
5.31 	year that provides obstetrical services as defined in United
5.32 	States Code, title 42, section 1396r-4(d)(1), a medical
5.33 	assistance disproportionate population adjustment shall be paid
5.34 	in addition to any other disproportionate payment due under this
5.35 	subdivision equal to 10.3 percent of the total of the operating
5.36 	and property payment rates, effective for admissions occurring
6.1 	on or after July 1, 2005, and on or before June 30, 2005, and
6.2 	equal to 8.1 percent of the total of the operating and payment
6.3 	rates effective for admissions occurring on or after July 1,
6.4 	2006.
6.5 	(b) Any payment under this subdivision must be reduced by
6.6 	the amount of any payment received under subdivision 9,
6.7 	paragraph (b), clause (1) ~~or~~ ,(2), (4), or (5).  For purposes of
6.8 	this subdivision, medical assistance does not include general
6.9 	assistance medical care.
6.10 	(c) The commissioner shall adjust rates paid to a health
6.11 	maintenance organization under contract with the commissioner to
6.12 	reflect rate increases provided in this section, excluding
6.13 	payments under paragraph (a), clauses (3) and (4).  The
6.14 	adjustment must be made on a nondiscounted hospital-specific
6.15 	basis.

6.16 	Sec. 3. Minnesota Statutes 2004, section 256.969,
6.17 	subdivision 26, is amended to read:
6.18 		Subd. 26.Greater minnesota payment adjustment after june
6.19 	30, 2001.  (a) For admissions occurring after June 30, 2001, the
6.20 	commissioner shall pay fee-for-service inpatient admissions for
6.21 	the diagnosis-related groups specified in paragraph (b) at
6.22 	hospitals located outside of the seven-county metropolitan area
6.23 	at the higher of:
6.24 	(1) the hospital's current payment rate for the diagnostic
6.25 	category to which the diagnosis-related group belongs, exclusive
6.26 	of disproportionate population adjustments received under
6.27 	subdivision 9 and hospital payment adjustments received under
6.28 	subdivision 23; or
6.29 	(2) 90 percent of the average payment rate for that
6.30 	diagnostic category for hospitals located within the
6.31 	seven-county metropolitan area, exclusive of disproportionate
6.32 	population adjustments received under subdivision 9 and hospital
6.33 	payment adjustments received under subdivisions 20 and 23. ~~The~~
6.34 	~~commissioner may adjust this percentage each year so that the~~
6.35 	~~estimated payment increases under this paragraph are equal to~~
6.36 	~~the funding provided under section 256B.195 for this purpose.~~
7.1 	(b) The payment increases provided in paragraph (a) apply
7.2 	to the following diagnosis-related groups, as they fall within
7.3 	the diagnostic categories:
7.4 	(1) 370 cesarean section with complicating diagnosis;
7.5 	(2) 371 cesarean section without complicating diagnosis;
7.6 	(3) 372 vaginal delivery with complicating diagnosis;
7.7 	(4) 373 vaginal delivery without complicating diagnosis;
7.8 	(5) 386 extreme immaturity and respiratory distress
7.9 	syndrome, neonate;
7.10 	(6) 388 full-term neonates with other problems;
7.11 	(7) 390 prematurity without major problems;
7.12 	(8) 391 normal newborn;
7.13 	(9) 385 neonate, died or transferred to another acute care
7.14 	facility;
7.15 	(10) 425 acute adjustment reaction and psychosocial
7.16 	dysfunction;
7.17 	(11) 430 psychoses;
7.18 	(12) 431 childhood mental disorders; and
7.19 	(13) 164-167 appendectomy.

7.20 	Sec. 4. Minnesota Statutes 2004, section 256B.195,
7.21 	subdivision 3, is amended to read:
7.22 		Subd. 3.Payments to certain safety net providers.  (a)
7.23 	Effective July 15, 2001, the commissioner shall make the
7.24 	following payments to the hospitals indicated after noon on the
7.25 	15th of each month:
7.26 	(1) to Hennepin County Medical Center, any federal matching
7.27 	funds available to match the payments received by the medical
7.28 	center under subdivision 2, to increase payments for medical
7.29 	assistance admissions and to recognize higher medical assistance
7.30 	costs in institutions that provide high levels of charity care;
7.31 	and
7.32 	(2) to Regions Hospital, any federal matching funds
7.33 	available to match the payments received by the hospital under
7.34 	subdivision 2, to increase payments for medical assistance
7.35 	admissions and to recognize higher medical assistance costs in
7.36 	institutions that provide high levels of charity care.
8.1 	(b) Effective July 15, 2001, the following percentages of
8.2 	the transfers under subdivision 2 shall be retained by the
8.3 	commissioner for deposit each month into the general fund:
8.4 	(1) 18 percent, plus any federal matching funds, shall be
8.5 	allocated for the following purposes:
8.6 	(i) during the fiscal year beginning July 1, 2001, of the
8.7 	amount available under this clause, 39.7 percent shall be
8.8 	allocated to make increased hospital payments under section
8.9 	256.969, subdivision 26; 34.2 percent shall be allocated to fund
8.10 	the amounts due from small rural hospitals, as defined in
8.11 	section 144.148, for overpayments under section 256.969,
8.12 	subdivision 5a, resulting from a determination that medical
8.13 	assistance and general assistance payments exceeded the charge
8.14 	limit during the period from 1994 to 1997; and 26.1 percent
8.15 	shall be allocated to the commissioner of health for rural
8.16 	hospital capital improvement grants under section 144.148; and
8.17 	(ii) during fiscal years beginning on or after July 1,
8.18 	2002, of the amount available under this clause, 55 percent
8.19 	shall be allocated to make increased hospital payments under
8.20 	section 256.969, subdivision 26, and 45 percent shall be
8.21 	allocated to the commissioner of health for rural hospital
8.22 	capital improvement grants under section 144.148; and
8.23 	(2) 11 percent shall be allocated to the commissioner of
8.24 	health to fund community clinic grants under section 145.9268.
8.25 	(c) This subdivision shall apply to fee-for-service
8.26 	payments only and shall not increase capitation payments or
8.27 	payments made based on average rates. The allocation in
8.28 	paragraph (b), clause (1), item (ii), to increase hospital
8.29 	payments under section 256.969, subdivision 26, shall not limit
8.30 	payments under that section.
8.31 	(d) Medical assistance rate or payment changes, including
8.32 	those required to obtain federal financial participation under
8.33 	section 62J.692, subdivision 8, shall precede the determination
8.34 	of intergovernmental transfer amounts determined in this
8.35 	subdivision.  Participation in the intergovernmental transfer
8.36 	program shall not result in the offset of any health care
9.1 	provider's receipt of medical assistance payment increases other
9.2 	than limits resulting from hospital-specific charge limits and
9.3 	limits on disproportionate share hospital payments.
9.4 	(e) Effective July 1, 2003, if the amount available for
9.5 	allocation under paragraph (b) is greater than the amounts
9.6 	available during March 2003, after any increase in
9.7 	intergovernmental transfers and payments that result from
9.8 	section 256.969, subdivision 3a, paragraph (c), are paid to the
9.9 	general fund, any additional amounts available under this
9.10 	subdivision after reimbursement of the transfers under
9.11 	subdivision 2 shall be allocated to increase medical assistance
9.12 	payments, subject to hospital-specific charge limits and limits
9.13 	on disproportionate share hospital payments, as follows:
9.14 	(1) if the payments under subdivision 5 are approved, the
9.15 	amount shall be paid to the largest ten percent of hospitals as
9.16 	measured by 2001 payments for medical assistance, general
9.17 	assistance medical care, and MinnesotaCare in the nonstate
9.18 	government hospital category.  Payments shall be allocated
9.19 	according to each hospital's proportionate share of the 2001
9.20 	payments; or
9.21 	(2) if the payments under subdivision 5 are not approved,
9.22 	the amount shall be paid to the largest ten percent of hospitals
9.23 	as measured by 2001 payments for medical assistance, general
9.24 	assistance medical care, and MinnesotaCare in the nonstate
9.25 	government category and to the largest ten percent of hospitals
9.26 	as measured by payments for medical assistance, general
9.27 	assistance medical care, and MinnesotaCare in the nongovernment
9.28 	hospital category.  Payments shall be allocated according to
9.29 	each hospital's proportionate share of the 2001 payments in
9.30 	their respective category of nonstate government and
9.31 	nongovernment.  The commissioner shall determine which hospitals
9.32 	are in the nonstate government and nongovernment hospital
9.33 	categories.

9.34 	Sec. 5. Minnesota Statutes 2004, section 357.021,
9.35 	subdivision 6, is amended to read:
9.36 		Subd. 6.Surcharges on criminal and traffic offenders.
 10.1 	(a) The court shall impose and the court administrator shall
10.2 	collect a ~~$60~~ $70 surcharge on every person convicted of any
10.3 	felony, gross misdemeanor, misdemeanor, or petty misdemeanor
10.4 	offense, other than a violation of a law or ordinance relating
10.5 	to vehicle parking, for which there shall be a $3 surcharge.  In
10.6 	the Second Judicial District, the court shall impose, and the
10.7 	court administrator shall collect, an additional $1 surcharge on
10.8 	every person convicted of any felony, gross misdemeanor, or
10.9 	petty misdemeanor offense, other than a violation of a law or
10.10 	ordinance relating to vehicle parking, if the Ramsey County
10.11 	Board of Commissioners authorizes the $1 surcharge.  The
10.12 	surcharge shall be imposed whether or not the person is
10.13 	sentenced to imprisonment or the sentence is stayed.
10.14 	(b) If the court fails to impose a surcharge as required by
10.15 	this subdivision, the court administrator shall show the
10.16 	imposition of the surcharge, collect the surcharge and correct
10.17 	the record.
10.18 	(c) The court may not waive payment of the surcharge
10.19 	required under this subdivision.  Upon a showing of indigency or
10.20 	undue hardship upon the convicted person or the convicted
10.21 	person's immediate family, the sentencing court may authorize
10.22 	payment of the surcharge in installments.
10.23 	(d) The court administrator or other entity collecting a
10.24 	surcharge shall forward it to the commissioner of finance.
10.25 	(e) If the convicted person is sentenced to imprisonment
10.26 	and has not paid the surcharge before the term of imprisonment
10.27 	begins, the chief executive officer of the correctional facility
10.28 	in which the convicted person is incarcerated shall collect the
10.29 	surcharge from any earnings the inmate accrues from work
10.30 	performed in the facility or while on conditional release.  The
10.31 	chief executive officer shall forward the amount collected to
10.32 	the commissioner of finance.
10.33 	(f) The $10 surcharge increase in paragraph (a) is in
10.34 	addition to any other increase in this surcharge enacted by the
10.35 	2005 legislature.

10.36 	Sec. 6. Minnesota Statutes 2004, section 357.021,
11.1 	subdivision 7, is amended to read:
11.2 		Subd. 7.Disbursement of surcharges by commissioner of
11.3 	finance.  (a) Except as provided in paragraphs (b), (c), and
11.4 	(d), the commissioner of finance shall disburse surcharges
11.5 	received under subdivision 6 and section 97A.065, subdivision 2,
11.6 	as follows:
11.7 	(1) one percent shall be credited to the game and fish fund
11.8 	to provide peace officer training for employees of the
11.9 	Department of Natural Resources who are licensed under sections
11.10 	626.84 to 626.863, and who possess peace officer authority for
11.11 	the purpose of enforcing game and fish laws;
11.12 	(2) 39 percent shall be credited to the peace officers
11.13 	training account in the special revenue fund; and
11.14 	(3) 60 percent shall be credited to the general fund.
11.15 	(b) The commissioner of finance shall credit $3 of each
11.16 	surcharge received under subdivision 6 and section 97A.065,
11.17 	subdivision 2, to the general fund.
11.18 	(c) In addition to any amounts credited under paragraph
11.19 	(a), the commissioner of finance shall credit ~~$32~~ $42 of each
11.20 	surcharge received under subdivision 6 and section 97A.065,
11.21 	subdivision 2, and the $3 parking surcharge, to the general fund.
11.22 	(d) If the Ramsey County Board of Commissioners authorizes
11.23 	imposition of the additional $1 surcharge provided for in
11.24 	subdivision 6, paragraph (a), the court administrator in the
11.25 	Second Judicial District shall withhold $1 from each surcharge
11.26 	collected under subdivision 6.  The court administrator must use
11.27 	the withheld funds solely to fund the petty misdemeanor
11.28 	diversion program administered by the Ramsey County Violations
11.29 	Bureau.  The court administrator must transfer any unencumbered
11.30 	portion of the funds received under this subdivision to the
11.31 	commissioner of finance for distribution according to paragraphs
11.32 	(a) to (c).

11.33 	Sec. 7. APPROPRIATION.
 11.34 	$4,900,000 in fiscal year 2006 and $6,500,000 in fiscal
11.35 	year 2007 is appropriated from the general fund to the
11.36 	commissioner of human services for the purposes of sections 1 to
12.1 	3.