1.1                          A bill for an act 
  1.2             relating to health; modifying summer health intern 
  1.3             provisions; modifying provisions for grants to rural 
  1.4             hospitals; funding the rural hospital, planning, and 
  1.5             transition grant program; modifying student loan 
  1.6             repayment provisions for health professionals; 
  1.7             creating a health care technician loan forgiveness 
  1.8             program; creating a rural hospital nurse loan 
  1.9             forgiveness program; eliminating the sunset for 
  1.10            medical assistance coverage of telemedicine 
  1.11            consultations; funding rural health initiatives 
  1.12            through the general fund; appropriating money; 
  1.13            amending Minnesota Statutes 2000, sections 144.1464, 
  1.14            subdivision 2; 144.147, subdivision 2; 144.148, 
  1.15            subdivision 8; and 256B.0625, subdivision 3b; 
  1.16            proposing coding for new law in Minnesota Statutes, 
  1.17            chapter 144. 
  1.18  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.19     Section 1.  Minnesota Statutes 2000, section 144.1464, 
  1.20  subdivision 2, is amended to read: 
  1.21     Subd. 2.  [CRITERIA.] (a) The commissioner, through the 
  1.22  organization under contract, shall award grants to hospitals and 
  1.23  clinics that agree to:  
  1.24     (1) provide secondary and post-secondary summer health care 
  1.25  interns with formal exposure to the health care profession; 
  1.26     (2) provide an orientation for the secondary and 
  1.27  post-secondary summer health care interns; 
  1.28     (3) pay one-half the costs of employing the secondary and 
  1.29  post-secondary summer health care intern, based on an overall 
  1.30  hourly wage that is at least the minimum wage but does not 
  1.31  exceed $6 an hour; 
  2.1      (4) interview and hire secondary and post-secondary pupils 
  2.2   for a minimum of six weeks and a maximum of 12 weeks; and 
  2.3      (5) employ at least one secondary student for each 
  2.4   post-secondary student employed, to the extent that there are 
  2.5   sufficient qualifying secondary student applicants. 
  2.6      (b) In order to be eligible to be hired as a secondary 
  2.7   summer health intern by a hospital or clinic, a pupil must: 
  2.8      (1) intend to complete high school graduation requirements 
  2.9   and be between the junior and senior year of high school; 
  2.10     (2) be from a school district in proximity to the facility; 
  2.11  and 
  2.12     (3) provide the facility with a letter of recommendation 
  2.13  from a health occupations or science educator. 
  2.14     (c) In order to be eligible to be hired as a post-secondary 
  2.15  summer health care intern by a hospital or clinic, a pupil must: 
  2.16     (1) intend to complete a two-year or four-year degree 
  2.17  program and be planning on enrolling in or be enrolled in that 
  2.18  degree program; 
  2.19     (2) be enrolled in a Minnesota educational institution or 
  2.20  be a resident of the state of Minnesota; priority must be given 
  2.21  to applicants from a school district or an educational 
  2.22  institution in proximity to the facility; and 
  2.23     (3) provide the facility with a letter of recommendation 
  2.24  from a health occupations or science educator. 
  2.25     (d) Hospitals and clinics awarded grants may employ pupils 
  2.26  as secondary and post-secondary summer health care interns 
  2.27  beginning on or after June 15, 1993, if they agree to pay the 
  2.28  intern, during the period before disbursement of state grant 
  2.29  money, with money designated as the facility's 50 percent 
  2.30  contribution towards internship costs.  
  2.31     Sec. 2.  Minnesota Statutes 2000, section 144.147, 
  2.32  subdivision 2, is amended to read: 
  2.33     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner shall 
  2.34  establish a program of grants to assist eligible rural 
  2.35  hospitals.  The commissioner shall award grants to hospitals and 
  2.36  communities for the purposes set forth in paragraphs (a) and (b).
  3.1      (a) Grants may be used by hospitals and their communities 
  3.2   to develop strategic plans for preserving or enhancing access to 
  3.3   health services.  At a minimum, a strategic plan must consist of:
  3.4      (1) a needs assessment to determine what health services 
  3.5   are needed and desired by the community.  The assessment must 
  3.6   include interviews with or surveys of area health professionals, 
  3.7   local community leaders, and public hearings; 
  3.8      (2) an assessment of the feasibility of providing needed 
  3.9   health services that identifies priorities and timeliness for 
  3.10  potential changes; and 
  3.11     (3) an implementation plan.  
  3.12     The strategic plan must be developed by a committee that 
  3.13  includes representatives from the hospital, local public health 
  3.14  agencies, other health providers, and consumers from the 
  3.15  community.  
  3.16     (b) The grants may also be used by eligible rural hospitals 
  3.17  that have developed strategic plans to implement transition 
  3.18  projects to modify the type and extent of services provided, in 
  3.19  order to reflect the needs of that plan.  Grants may be used by 
  3.20  hospitals under this paragraph: 
  3.21     (1) to develop hospital-based physician practices that 
  3.22  integrate hospital and existing medical practice facilities that 
  3.23  agree to transfer their practices, equipment, staffing, and 
  3.24  administration to the hospital.  The grants may also be used by 
  3.25  the hospital; 
  3.26     (2) to establish a health provider cooperative, a 
  3.27  telemedicine system, or a rural health care system or; 
  3.28     (3) to cover expenses associated with being designated as a 
  3.29  critical access hospital for the Medicare rural hospital 
  3.30  flexibility program; or 
  3.31     (4) to cover expenses associated with addressing the health 
  3.32  care work force shortage. 
  3.33  Not more than one-third of any grant shall be used to offset 
  3.34  losses incurred by physicians agreeing to transfer their 
  3.35  practices to hospitals.  
  3.36     Sec. 3.  Minnesota Statutes 2000, section 144.148, 
  4.1   subdivision 8, is amended to read: 
  4.2      Subd. 8.  [EXPIRATION.] This section expires June 30, 
  4.3   2001 2003. 
  4.4      Sec. 4.  [144.1498] [HEALTH CARE TECHNICIANS IN RURAL 
  4.5   HOSPITALS.] 
  4.6      Subdivision 1.  [DEFINITIONS.] For purposes of this 
  4.7   section, the following definitions apply: 
  4.8      (a) "Clinical laboratory scientist" means a person who, 
  4.9   using independent judgment and responsibility, performs and 
  4.10  interprets results of medical laboratory tests with minimal 
  4.11  supervision by the director or supervisor, in only those 
  4.12  specialties or subspecialties in which the person is qualified 
  4.13  by education, training, and experience, and has demonstrated 
  4.14  ongoing competency by certification or other means.  A clinical 
  4.15  laboratory scientist may also be called a medical technologist. 
  4.16     (b) "Clinical laboratory technician" means any person other 
  4.17  than a medical laboratory director, clinical laboratory 
  4.18  scientist, or trainee who functions under the supervision of a 
  4.19  medical laboratory director or clinical laboratory scientist and 
  4.20  performs diagnostic and analytical laboratory tests in only 
  4.21  those specialties or subspecialties in which the person is 
  4.22  qualified by education, training, and experience, and has 
  4.23  demonstrated ongoing competency by certification or other 
  4.24  means.  A clinical laboratory technician may also be called a 
  4.25  medical technician. 
  4.26     (c) "Health care technician" means a radiologic 
  4.27  technologist, clinical laboratory scientist, or clinical 
  4.28  laboratory technician. 
  4.29     (d) "Qualified loans" means government, commercial, and 
  4.30  foundation loans for actual costs paid for tuition, reasonable 
  4.31  education expenses, and reasonable living expenses related to 
  4.32  the graduate or undergraduate education of a health care 
  4.33  technician. 
  4.34     (e) "Radiologic technologist" means a person, other than a 
  4.35  licensed physician, who has demonstrated competency by 
  4.36  certification, registration, or other means for administering 
  5.1   medical imaging or radiation therapy procedures to other persons 
  5.2   for medical purposes.  Radiologic technologist includes, but is 
  5.3   not limited to, radiographers, radiation therapists, and nuclear 
  5.4   medicine technologists. 
  5.5      (f) "Designated rural area" means: 
  5.6      (1) an area in Minnesota outside the counties of Anoka, 
  5.7   Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
  5.8   excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
  5.9   and St. Cloud; or 
  5.10     (2) a municipal corporation, as defined by section 471.634, 
  5.11  that is physically located, in whole or in part, in an area that 
  5.12  meets the criteria under clause (1). 
  5.13     (g) "Rural hospital" means any nonfederal, general acute 
  5.14  care hospital that: 
  5.15     (1) is located in a designated rural area; 
  5.16     (2) has 50 or fewer beds; and 
  5.17     (3) is not for profit. 
  5.18     Subd. 2.  [CREATION OF ACCOUNT.] A rural health care 
  5.19  technician education account is established in the general 
  5.20  fund.  The commissioner shall use money from the account to 
  5.21  establish a loan forgiveness program for health care technicians 
  5.22  who agree to practice in a rural hospital.  The account consists 
  5.23  of money appropriated by the legislature and repayments and 
  5.24  penalties collected under subdivision 5.  Money from the account 
  5.25  must be used for the loan forgiveness program. 
  5.26     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  5.27  the program, a person enrolled in a program of study designed to 
  5.28  prepare the person to become a health care technician must 
  5.29  submit an application to the commissioner before completion of 
  5.30  the health care technician education program.  For fiscal year 
  5.31  2002, applicants may have graduated from a health care 
  5.32  technician program in calendar year 2001.  A health care 
  5.33  technician student who is selected to participate in the loan 
  5.34  forgiveness program must sign a contract to agree to serve a 
  5.35  minimum one-year service obligation in a rural hospital.  The 
  5.36  service obligation shall begin no later than March 31 of the 
  6.1   first year following completion of the education program. 
  6.2      Subd. 4.  [LOAN FORGIVENESS.] (a) The commissioner may 
  6.3   accept up to 25 applicants per year for participation in the 
  6.4   loan forgiveness program.  Applicants are responsible for 
  6.5   securing their own loans.  The commissioner shall select 
  6.6   participants based on their suitability for rural practice, as 
  6.7   indicated by rural experience or training.  The commissioner 
  6.8   shall give preference to applicants who are attending a 
  6.9   Minnesota educational institution and to those applicants 
  6.10  closest to completing their training.  For each year that a 
  6.11  participant serves as a health care technician in a rural 
  6.12  hospital, up to a maximum of two years, the commissioner shall 
  6.13  annually repay the participant $2,500 for each year of service, 
  6.14  not to exceed $5,000 or the balance of the qualified loans, 
  6.15  whichever is less. 
  6.16     (b) Before loan repayment is made, the participant must 
  6.17  complete and return to the commissioner an affidavit of practice 
  6.18  form verifying that the participant is practicing as required 
  6.19  under this section.  The participant must verify that the full 
  6.20  amount of loan repayment under this section was applied toward 
  6.21  the qualified loan, in order to receive additional loan 
  6.22  repayments.  Participants who move their practice from one rural 
  6.23  hospital to another remain eligible for loan repayment. 
  6.24     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
  6.25  does not fulfill the service commitment required under 
  6.26  subdivision 3, the commissioner shall collect from the 
  6.27  participant 100 percent of any payments made for qualified loans 
  6.28  and interest at a rate established according to section 270.75.  
  6.29  The commissioner shall deposit the money collected in the health 
  6.30  care technician account established in subdivision 2. 
  6.31     Subd. 6.  [WAIVER OF OBLIGATION.] Payment or service 
  6.32  obligations cancel in the event of a participant's death.  The 
  6.33  commissioner may waive or suspend payment or service obligations 
  6.34  if a participant becomes permanently disabled or is temporarily 
  6.35  disabled for more than two years.  The commissioner may grant a 
  6.36  waiver of all or part of the money owed as a result of a 
  7.1   nonfulfillment penalty if emergency circumstances prevented 
  7.2   fulfillment of the required service commitment. 
  7.3      Sec. 5.  [144.1499] [NURSES IN RURAL HOSPITALS.] 
  7.4      Subdivision 1.  [DEFINITION.] For purposes of this section, 
  7.5   the following definitions apply: 
  7.6      (a) "Designated rural area" means: 
  7.7      (1) an area in Minnesota outside the counties of Anoka, 
  7.8   Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
  7.9   excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
  7.10  and St. Cloud; or 
  7.11     (2) a municipal corporation, as defined by section 471.634, 
  7.12  that is physically located, in whole or in part, in an area that 
  7.13  meets the criteria in clause (1). 
  7.14     (b) "Qualified loans" means government, commercial, and 
  7.15  foundation loans for actual costs paid for tuition, reasonable 
  7.16  education expenses, and reasonable living expenses related to 
  7.17  the graduate or undergraduate education of a health care 
  7.18  professional. 
  7.19     (c) "Rural hospital" means any nonfederal, general acute 
  7.20  care hospital that: 
  7.21     (1) is located in a designated rural area; 
  7.22     (2) has 50 or fewer beds; and 
  7.23     (3) is not for profit. 
  7.24     Subd. 2.  [CREATION OF ACCOUNT.] A rural hospital nurse 
  7.25  loan forgiveness account is established in the general fund.  
  7.26  The commissioner shall use money from the account to establish a 
  7.27  loan forgiveness program for nurses who agree to practice in a 
  7.28  rural hospital.  The account consists of money appropriated by 
  7.29  the legislature and repayments and penalties collected under 
  7.30  subdivision 5.  Money from the account must be used for the loan 
  7.31  forgiveness program. 
  7.32     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
  7.33  the program, a person enrolled in a program of study designed to 
  7.34  prepare the person to become a registered nurse or licensed 
  7.35  practical nurse must submit an application to the commissioner 
  7.36  before completion of a nursing education program.  For fiscal 
  8.1   year 2002, applicants may have graduated from a nursing 
  8.2   education program in calendar year 2001.  A nursing student who 
  8.3   is selected to participate in the loan forgiveness program must 
  8.4   sign a contract to agree to serve a minimum one-year service 
  8.5   obligation in a rural hospital.  The service obligation shall 
  8.6   begin no later than March 31 of the first year following 
  8.7   completion of the education program. 
  8.8      Subd. 4.  [LOAN FORGIVENESS.] (a) The commissioner may 
  8.9   accept up to 25 applicants per year for participation in the 
  8.10  loan forgiveness program.  Applicants are responsible for 
  8.11  securing their own loans.  The commissioner shall select 
  8.12  participants based on their suitability for rural practice, as 
  8.13  indicated by rural experience or training.  The commissioner 
  8.14  shall give preference to applicants who are attending a 
  8.15  Minnesota nursing educational program and to those applicants 
  8.16  closest to completing their training.  For each year that a 
  8.17  participant serves as a nurse in a rural hospital, up to a 
  8.18  maximum of two years, the commissioner shall annually repay the 
  8.19  participant $3,000 for each year of service, not to exceed 
  8.20  $6,000 or the balance of the qualified loans, whichever is less. 
  8.21     (b) Before loan repayment is made, the participant must 
  8.22  complete and return to the commissioner an affidavit of practice 
  8.23  form verifying that the participant is practicing as required 
  8.24  under this section.  The participant must verify that the full 
  8.25  amount of loan repayment under this section was applied toward 
  8.26  the qualified loan, in order to receive additional loan 
  8.27  repayments.  Participants who move their practice from one rural 
  8.28  hospital to another remain eligible for loan repayment. 
  8.29     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
  8.30  does not fulfill the service commitment required under 
  8.31  subdivision 3, the commissioner shall collect from the 
  8.32  participant 100 percent of any payments made for qualified loans 
  8.33  and interest at a rate established according to section 270.75.  
  8.34  The commissioner shall deposit the money collected in the nurse 
  8.35  loan forgiveness account established in subdivision 2. 
  8.36     Subd. 6.  [WAIVER OF OBLIGATION.] Payment or service 
  9.1   obligations cancel in the event of a participant's death.  The 
  9.2   commissioner may waive or suspend payment or service obligations 
  9.3   if a participant becomes permanently disabled or is temporarily 
  9.4   disabled for more than two years.  The commissioner may grant a 
  9.5   waiver of all or part of the money owed as a result of a 
  9.6   nonfulfillment penalty if emergency circumstances prevented 
  9.7   fulfillment of the required service commitment. 
  9.8      Sec. 6.  Minnesota Statutes 2000, section 256B.0625, 
  9.9   subdivision 3b, is amended to read: 
  9.10     Subd. 3b.  [TELEMEDICINE CONSULTATIONS.] (a) Medical 
  9.11  assistance covers telemedicine consultations.  Telemedicine 
  9.12  consultations must be made via two-way, interactive video or 
  9.13  store-and-forward technology.  Store-and-forward technology 
  9.14  includes telemedicine consultations that do not occur in real 
  9.15  time via synchronous transmissions, and that do not require a 
  9.16  face-to-face encounter with the patient for all or any part of 
  9.17  any such telemedicine consultation.  The patient record must 
  9.18  include a written opinion from the consulting physician 
  9.19  providing the telemedicine consultation.  A communication 
  9.20  between two physicians that consists solely of a telephone 
  9.21  conversation is not a telemedicine consultation.  Coverage is 
  9.22  limited to three telemedicine consultations per recipient per 
  9.23  calendar week.  Telemedicine consultations shall be paid at the 
  9.24  full allowable rate. 
  9.25     (b) This subdivision expires July 1, 2001.  
  9.26     Sec. 7.  [APPROPRIATIONS.] 
  9.27     Subdivision 1.  [SUMMER HEALTH CARE INTERN 
  9.28  PROGRAM.] $400,000 is appropriated from the general fund to the 
  9.29  commissioner of health for the biennium ending June 30, 2003, to 
  9.30  fund the summer health care intern program under Minnesota 
  9.31  Statutes, section 144.1464.  Effective July 1, 2001, funding for 
  9.32  the summer health care intern program shall be provided through 
  9.33  the general fund rather than the health care access fund. 
  9.34     Subd. 2.  [RURAL HOSPITAL PLANNING AND TRANSITION GRANT 
  9.35  PROGRAM.] $500,000 is appropriated from the general fund to the 
  9.36  commissioner of health for the biennium ending June 30, 2003, to 
 10.1   fund the rural hospital planning and transition grant program 
 10.2   under Minnesota Statutes, section 144.147.  Effective July 1, 
 10.3   2001, funding for the rural hospital planning and transition 
 10.4   grant program shall be provided through the general fund rather 
 10.5   than the health care access fund. 
 10.6      Subd. 3.  [RURAL HOSPITAL CAPITAL IMPROVEMENT GRANT 
 10.7   PROGRAM.] $10,000,000 is appropriated from the general fund to 
 10.8   the commissioner of health for the biennium ending June 30, 
 10.9   2003, to fund the rural hospital capital improvement grant 
 10.10  program under Minnesota Statutes, section 144.148.  Effective 
 10.11  July 1, 2001, funding for the rural hospital capital improvement 
 10.12  grant program shall be provided through the general fund rather 
 10.13  than the health care access fund.  This is a one-time 
 10.14  appropriation and shall not become part of the base level 
 10.15  funding for this activity for the 2004-2005 biennium. 
 10.16     Subd. 4.  [RURAL HOSPITAL FINANCIAL ASSISTANCE 
 10.17  GRANTS.] $400,000 is appropriated from the general fund to the 
 10.18  commissioner of health for the biennium ending June 30, 2003, to 
 10.19  fund rural hospital financial assistance grants under Minnesota 
 10.20  Statutes, section 144.1484.  Effective July 1, 2001, funding for 
 10.21  the rural hospital financial assistance grants shall be provided 
 10.22  through the general fund rather than the health care access fund.
 10.23     Subd. 5.  [HEALTH CARE TECHNICIAN LOAN FORGIVENESS 
 10.24  PROGRAM.] $187,500 is appropriated from the general fund to the 
 10.25  commissioner of health for the biennium ending June 30, 2003, to 
 10.26  fund the health care technician loan forgiveness program under 
 10.27  Minnesota Statutes, section 144.1498. 
 10.28     Subd. 6.  [RURAL HOSPITAL NURSE LOAN FORGIVENESS 
 10.29  PROGRAM.] $225,000 is appropriated from the general fund to the 
 10.30  commissioner of health for the biennium ending June 30, 2003, to 
 10.31  fund the rural hospital nurse loan forgiveness program under 
 10.32  Minnesota Statutes, section 144.1499. 
 10.33     Sec. 8.  [EFFECTIVE DATE.] 
 10.34     Sections 3 and 6 are effective the day following final 
 10.35  enactment.