1.1.................... moves to amend H.F. No. 1795 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. INTENT.
1.4Nothing in this act requires a pregnant woman enrolled in medical assistance to
1.5deliver at a birthing center.

1.6    Sec. 2. Minnesota Statutes 2008, section 62Q.19, subdivision 1, is amended to read:
1.7    Subdivision 1. Designation. (a) The commissioner shall designate essential
1.8community providers. The criteria for essential community provider designation shall be
1.9the following:
1.10(1) a demonstrated ability to integrate applicable supportive and stabilizing services
1.11with medical care for uninsured persons and high-risk and special needs populations,
1.12underserved, and other special needs populations; and
1.13(2) a commitment to serve low-income and underserved populations by meeting the
1.14following requirements:
1.15(i) has nonprofit status in accordance with chapter 317A;
1.16(ii) has tax exempt status in accordance with the Internal Revenue Service Code,
1.17section 501(c)(3);
1.18(iii) charges for services on a sliding fee schedule based on current poverty income
1.19guidelines; and
1.20(iv) does not restrict access or services because of a client's financial limitation;
1.21(3) status as a local government unit as defined in section 62D.02, subdivision 11, a
1.22hospital district created or reorganized under sections 447.31 to 447.37, an Indian tribal
1.23government, an Indian health service unit, or a community health board as defined in
1.24chapter 145A;
2.1(4) a former state hospital that specializes in the treatment of cerebral palsy, spina
2.2bifida, epilepsy, closed head injuries, specialized orthopedic problems, and other disabling
2.3conditions; or
2.4(5) a sole community hospital. For these rural hospitals, the essential community
2.5provider designation applies to all health services provided, including both inpatient and
2.6outpatient services. For purposes of this section, "sole community hospital" means a
2.7rural hospital that:
2.8(i) is eligible to be classified as a sole community hospital according to Code
2.9of Federal Regulations, title 42, section 412.92, or is located in a community with a
2.10population of less than 5,000 and located more than 25 miles from a like hospital currently
2.11providing acute short-term services;
2.12(ii) has experienced net operating income losses in two of the previous three
2.13most recent consecutive hospital fiscal years for which audited financial information is
2.14available; and
2.15(iii) consists of 40 or fewer licensed beds; or
2.16(6) a birthing center licensed under section 144.566.
2.17(b) Prior to designation, the commissioner shall publish the names of all applicants
2.18in the State Register. The public shall have 30 days from the date of publication to submit
2.19written comments to the commissioner on the application. No designation shall be made
2.20by the commissioner until the 30-day period has expired.
2.21(c) The commissioner may designate an eligible provider as an essential community
2.22provider for all the services offered by that provider or for specific services designated by
2.23the commissioner.
2.24(d) For the purpose of this subdivision, supportive and stabilizing services include at
2.25a minimum, transportation, child care, cultural, and linguistic services where appropriate.

2.26    Sec. 3. [144.566] BIRTHING CENTERS.
2.27    Subdivision 1. Definitions. (a) For purposes of this section, the following definitions
2.28have the meanings given to them.
2.29(b) "Birthing center" means a health care facility licensed for the primary purpose
2.30of performing low-risk deliveries that is not a hospital or in a hospital and where
2.31births are planned to occur away from the mother's usual residence following a normal
2.32uncomplicated pregnancy.
2.33    Subd. 2. License required. (a) No person may establish, conduct, or maintain a
2.34birthing center without first obtaining a license from the commissioner of health according
2.35to this section. The license is effective for one year following the date of issuance.
3.1(b) A license issued under this section is not transferable or assignable and is subject
3.2to suspension or revocation at any time for failure to comply with this section.
3.3(c) A birthing center licensed under this section shall not assert, represent, offer,
3.4provide, or imply that the center is, or may, render care or services other than the services
3.5it is permitted to render within the scope of the license issued.
3.6(d) The license must be conspicuously posted in an area where patients are admitted.
3.7    Subd. 3. Application. An application for a license to operate a birthing center and
3.8the applicable fee under subdivision 6 must be submitted to the commissioner on a form
3.9provided by the commissioner and must contain:
3.10(1) the name of the applicant;
3.11(2) the location of the birthing center;
3.12(3) the name of the person in charge of the center;
3.13(4) documentation that the standards described under subdivision 5 have been
3.14met; and
3.15(5) any other information the commissioner deems necessary.
3.16    Subd. 4. Suspension, revocation, and refusal to renew. The commissioner may
3.17refuse to grant or renew, or may suspend or revoke, a license on any of the grounds
3.18described under section 144.55, subdivision 6, and the applicant or licensee is entitled to
3.19notice and a hearing as described under section 144.55, subdivision 7.
3.20    Subd. 5. Standards for licensure. (a) To be eligible for licensure under this section,
3.21a birthing center must meet the following requirements:
3.22(1) a governing body or person must be clearly identified as being legally responsible
3.23for setting policies and procedures and ensuring that they are implemented;
3.24(2) care must be provided by a physician, advanced practice registered nurse, or
3.25licensed traditional midwife during labor, birth, and puerperium; and
3.26(3) all standards for a licensed birthing center set out by the commissioner in
3.27Minnesota Rules.
3.28    Subd. 6. Fees. The annual license fee for a birthing center is $....... and shall be
3.29collected and deposited according to section 144.122. The commissioner may adjust the
3.30annual license fee for the first four years of this licensing program to include the costs
3.31of rulemaking required under this section.
3.32    Subd. 7. Inspections. The commissioner shall annually conduct an inspection of
3.33each licensed birthing center for the purpose of determining compliance with this section
3.34and any rules promulgated under subdivision 8.
4.1    Subd. 8. Rules. (a) The commissioner must promulgate rules to establish standards
4.2for licensing birthing centers by July 1, 2010, and may promulgate any other rules
4.3necessary to implement this section.
4.4(b) In adopting rules for birthing centers, the commissioner must consider the
4.5American Association of Birth Centers' Standards for Freestanding Birth Centers; the
4.6American Academy of Pediatrics/American College of Obstetricians and Gynecologists
4.7Guidelines for Perinatal Care; the American College of Nurse-Midwives Standards; and
4.8the American Public Health Association guidelines.

4.10Birthing centers licensed under section 144.566 must have in place an interoperable
4.11electronic health records system that is complaint with the requirements of section 62J.495.

4.13    Subdivision 1. Hospital liability is limited. A hospital, licensed under section
4.14144.55, that receives a patient transferred from a birthing center, as defined in section
4.15144.566, due to complications of labor or delivery is not liable for acts or omissions
4.16that occurred at the birthing center prior to the transfer of the patient to the hospital. A
4.17hospital is liable to a patient who is transferred from a birthing center for damages not to
4.18exceed $1,000,000.
4.19    Subd. 2. Physician liability is limited. A licensed physician who receives a patient
4.20transferred to a hospital from a birthing center, as defined in section 144.566, due to
4.21complications of labor or delivery is not liable for acts or omissions that occurred at the
4.22birthing center prior to the transfer of the patient to the physician's care.
4.23    Subd. 3. Birthing center liability. Nothing in this section limits the liability of a
4.24birthing center, as defined in section 144.566.

4.25    Sec. 6. Minnesota Statutes 2008, section 256B.0625, is amended by adding a
4.26subdivision to read:
4.27    Subd. 53. Services provided in birthing centers. Medical assistance covers
4.28services provided by a birthing center, licensed under section 144.566. The commissioner
4.29of human services shall apply for any necessary waiver from the Centers for Medicare and
4.30Medicaid Services to allow birthing centers to be reimbursed."
4.31Amend the title accordingly