1.1                          A bill for an act
  1.2             relating to human services; adjusting inpatient 
  1.3             hospital rates for certain diagnosis related groups 
  1.4             for facilities located outside of the seven-county 
  1.5             metropolitan area; requiring adjustments in capitation 
  1.6             rates; amending Minnesota Statutes 2000, section 
  1.7             256.969, by adding a subdivision. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2000, section 256.969, is 
  1.10  amended by adding a subdivision to read: 
  1.11     Subd. 26.  [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 
  1.12  30, 2001.] (a) For admissions occurring after June 30, 2001, the 
  1.13  commissioner shall pay all medical assistance and MinnesotaCare 
  1.14  inpatient admissions for the diagnosis related groups specified 
  1.15  in paragraph (c) at hospitals located outside of the 
  1.16  seven-county metropolitan area at the higher of: 
  1.17     (1) the hospital's current payment rate for the diagnostic 
  1.18  category to which the diagnosis related group belongs, exclusive 
  1.19  of disproportionate population adjustments received under 
  1.20  subdivision 9 and hospital payment adjustments received under 
  1.21  subdivision 23; or 
  1.22     (2) the average payment rate for that diagnostic category 
  1.23  for hospitals located within the seven-county metropolitan area, 
  1.24  exclusive of disproportionate population adjustments received 
  1.25  under subdivision 9 and hospital payment adjustments received 
  1.26  under subdivision 23. 
  2.1      (b) The commissioner shall increase capitation rates to 
  2.2   prepaid health plans under section 256B.69 to reflect this 
  2.3   payment adjustment.  The commissioner shall require prepaid 
  2.4   health plans, effective July 1, 2001, to reimburse all medical 
  2.5   assistance, general assistance medical care, and MinnesotaCare 
  2.6   inpatient admissions for the diagnosis related groups specified 
  2.7   in paragraph (c) at hospitals located outside of the 
  2.8   seven-county metropolitan area at the higher of: 
  2.9      (1) the prepaid health plan's current payment rate for the 
  2.10  diagnostic category to which the diagnosis related group 
  2.11  belongs; or 
  2.12     (2) the average fee-for-service payment rate for that 
  2.13  diagnostic category for hospitals located within the 
  2.14  seven-county metropolitan area, exclusive of disproportionate 
  2.15  population adjustments received under subdivision 9 and hospital 
  2.16  payment adjustments received under subdivision 23. 
  2.17     (c) The payment increases provided in paragraphs (a) and 
  2.18  (b) apply to the following diagnosis related groups, as they 
  2.19  fall within the diagnostic categories: 
  2.20     (1) 370 C-section with complicating diagnosis; 
  2.21     (2) 371 C-section without complicating diagnosis; 
  2.22     (3) 372 vaginal delivery with complicating diagnosis; 
  2.23     (4) 373 vaginal delivery without complicating diagnosis; 
  2.24     (5) 386 extreme immaturity, weight greater than 1,500 
  2.25  grams; 
  2.26     (6) 388 full-term neonates with other problems; 
  2.27     (7) 390 prematurity without major problems; 
  2.28     (8) 391 normal newborn case; 
  2.29     (9) 385 neonate, died or transferred to another health care 
  2.30  facility; 
  2.31     (10) 425 acute adjustment reaction and psychosocial 
  2.32  dysfunctioning; 
  2.33     (11) 430 psychosis; 
  2.34     (12) 431 childhood mental disorders; and 
  2.35     (13) 164-167 appendectomy.