1.1.................... moves to amend H.F. No. 657 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 256B.441, is amended by adding a
1.4subdivision to read:
1.5    Subd. 59. Critical access nursing facilities. (a) The commissioner, in consultation
1.6with the commissioner of health, shall designate qualifying nursing facilities as critical
1.7access nursing facilities.
1.8(b) A nursing facility may apply to be designated a critical access nursing facility
1.9if it meets the following criteria:
1.10(1) it is located more than 20 miles, defined as official mileage as reported by the
1.11Minnesota Department of Transportation, from the nearest licensed and certified nursing
1.12facility or hospital with swing beds;
1.13(2) it is located in a county that would be in the lowest quartile of counties measured
1.14in terms of the number of licensed and certified nursing facility beds per 1,000 residents
1.15age 65 or older, if the nursing facility were to close; and
1.16(3) it agrees to permanently delicense all beds in layaway status under section
1.17144A.071, subdivision 4b, at the time of designation.
1.18(c) The operating payment rates for a nursing facility designated as a critical access
1.19nursing facility shall be the greater of:
1.20(1) rates determined by the commissioner under this section, beginning October
1.211, 2009, without application of the phase-in period in subdivision 55. For purposes of
1.22determining the operating payment rate limits in subdivision 50, the facility shall be
1.23included in peer group 1; or
1.24(2) operating payment rates determined by the commissioner for the rate year
1.25beginning October 1, 2009, that are equal for a RUGs rate level with a weight of 1.00 to
1.26the peer group 1 median operating payment rate for that RUGs level. The percentage
1.27of operating payment rate to be case-mix adjusted shall be equal to the percentage of
2.1allowable costs that are case-mix adjusted in the facility's most recent available and audited
2.2annual statistical and cost report. This paragraph applies only if it results in a rate increase.
2.3(d) The commissioner shall request applications from eligible nursing facilities for
2.4critical access nursing facility status designation within 60 days of enactment of this
2.5subdivision and may request additional applications at any time.
2.6(e) The commissioner of health shall give priority to a critical access nursing facility
2.7for approval of nursing home moratorium exception proposals under section 144A.073.

2.8    Sec. 2. Minnesota Statutes 2008, section 256B.441, is amended by adding a
2.9subdivision to read:
2.10    Subd. 60. Rate decrease for certain nursing facilities. Effective October 1, 2009,
2.11operating payment rates of all nursing facilities that are reimbursed under this section or
2.12section 256B.434, shall be decreased to be equal, for a RUG's rate with a weight of 1.00,
2.13to the peer group I median rate for the same RUG's weight, but no facility's rate shall be
2.14decreased more than five percent. The percentage of the operating payment rate for each
2.15facility to be case-mix adjusted shall be equal to the percentage that is case-mix adjusted
2.16in that facility's September 30, 2009 operating payment rate. This subdivision shall apply
2.17only if it results in a rate decrease. Decreases determined under this subdivision shall be
2.18subtracted from rates after the blending required by subdivision 55, paragraph (a).

2.19    Sec. 3. APPROPRIATIONS.
2.20All savings to the general fund resulting from implementation of Minnesota Statutes,
2.21section 256B.441, subdivision 60, are appropriated to the commissioner of human services
2.22for general fund costs related to funding critical access nursing facilities as described in
2.23Minnesota Statutes, section 256B.441, subdivision 59."
2.24Amend the title accordingly