Updated 5:41 p.m.

Officials at Mayo Clinic are threatening to pull their investments from the state if lawmakers don’t make significant changes to key provisions of a health omnibus bill at the Capitol — exempting Mayo from one possible requirement, and eliminating another proposal entirely.

According to emails obtained by MPR News, and first reported by the Minnesota Reformer, the health care organization told DFL leaders, as well as the governor’s office on Wednesday that unless there are major changes to the Keeping Nurses at the Bedside Act and the Health Care Affordability Board, it will move its investments — which could total billions — elsewhere.

Mayo Clinic is currently pursuing several investments in the state, including the development of a “Destination Medical Center” — a multi-billion-dollar project aimed at revamping the city of Rochester, where the health giant is located.

“Our Board was set to move forward to consider this investment next week. Because these bills continue to proceed without meaningful and necessary changes to avert their harms to Minnesotans, we cannot proceed with seeking approval to make this investment in Minnesota. We will need to direct this enormous investment to other states,” said Kate Johansen, vice chair of external engagement at Mayo, in the email.

The Keeping Nurses by the Bedside Act would require hospitals to create committees made up of nurses and other staff to determine staffing plans and workload requirements. In the email, Mayo proposed a significant amendment to the bill that would make it exempt from those requirements.

“For Mayo to move forward with the investment above, the bill must include a path to full exemption from the bill’s requirements for systems, including Mayo’s full system in Minnesota, that meet high standards as demonstrated by use of a software-based acuity tool incorporating nurse input, achievement of Magnet designation and/or critical access hospital designation,” the email said.

The bill has been a major focus for the Minnesota Nurses Association, which called Mayo’s email “blackmail tactics.”

“This desperate move by executives at Mayo Clinic Health System makes clear exactly why this bill is needed at Mayo facilities, and at every hospital in the state,” said MNA President Mary Turner.

Meanwhile, Mayo said the Health Care Affordability Board bill should be removed in its entirety, calling it “extremely problematic.”

The Health Care Affordability Board, and an accompanying advisory council, would monitor health care market trends and provide recommendations and oversight.

The legislation says the board would aim “to protect consumers, state and local governments, health plan companies, providers, and other health care system stakeholders from unaffordable health care costs.”

“It must be removed from the HHS omnibus bill and consideration for Mayo to move forward with the previously stated investment,” per the Mayo email.

House Speaker Melissa Hortman, DFL-Brooklyn Park, told MPR News that bill authors were still working with health systems on a version of the Keep the Nurses at the Bedside Act that could satisfy hospital leaders, patients and medical providers.

“Really what it gets down to is what is a safe level of staffing in a hospital and can we as a state make sure that there’s not a profit motive getting in the way of providing safe staffing?” Hortman said.  “I think we all want that when our loved ones are being taken care of in a hospital setting to know that there’s a safe level of staff there to take care of them.” 

Gov. Tim Walz on Friday told reporters that he’d spoken with Mayo Clinic leaders about their concerns. And he said negotiations would continue over the health omnibus bill.

“We’ve always supported making sure that our nurses are supported, have what they need. We also understand that Mayo Clinic’s a unique entity where it’s focusing globally on it,” Walz said. “So I know that’s being worked on right now. We’ve been talking about them, I think we can get a compromise that works for everyone.”

Lawmakers from the House and Senate are working in a conference committee to iron out differences between health bills that cleared each chamber. A compromise bill will have to pass both chambers and get signed into law by the governor before it could take effect.

“Like any responsible organization, we must evaluate the legislative and regulatory environment in the places we operate,” said Dr. Amy Williams, chair of Midwest clinical practice at Mayo in a statement. “Mayo has been working to address these concerns for months and is committed to transparently sharing the impacts of these policy decisions.”

Williams also said that they would continue working with leaders on a bill “that is in the best interest of patients, the State and Mayo Clinic.”

Sen. Erin Murphy, a St. Paul Democrat and nurse who proposed forming committees to set safe staffing levels in hospitals, said Friday that lawmakers had already made many compromises with health care systems on the legislation.

“It is time for us to find a path forward on this for the people of Minnesota and their care,” she said.

Republican lawmakers on Friday said the response from Mayo Clinic spoke to a broader level of concern about changes that DFLers were trying to make.

“When our signature institutions tell us they are worried about what one-party rule is going to do to their futures, we should listen to them,” Sen. Paul Utke, R-Park Rapids, said. “The Mayo Clinic, along with many other businesses, school districts, and even the Wall Street Journal are raising alarm bells about the sweeping changes Democrats are rushing to implement.” 

MPR News reporter Catharine Richert contributed to this story.