HF 1831

as introduced - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:55am

A bill for an act
relating to human services; modifying performance withholds for managed care
plans serving state health care program enrollees; amending Minnesota Statutes
2008, section 256L.12, subdivision 9.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 256L.12, subdivision 9, is amended to read:

Subd. 9.

Rate setting; performance withholds.

(a) Rates will be prospective,
per capita, where possible. The commissioner may allow health plans to arrange for
inpatient hospital services on a risk or nonrisk basis. The commissioner shall consult with
an independent actuary to determine appropriate rates.

(b) For services rendered on or after January 1, 2003, to December 31, 2003, the
commissioner shall withhold .5 percent of managed care plan payments under this section
pending completion of performance targets. The withheld funds must be returned no
sooner than July 1 and no later than July 31 of the following year if performance targets
in the contract are achieved. A managed care plan may include as admitted assets under
section 62D.044 any amount withheld under this paragraph that is reasonably expected
to be returned.

(c) For services rendered on or after January 1, 2004, the commissioner shall
withhold five percent of managed care plan payments under this section pending
completion of performance targets. Each performance target must be quantifiable,
objective, measurable, and reasonably attainable, except in the case of a performance target
based on a federal or state law or rule. Criteria for assessment of each performance target
must be outlined in writing prior to the contract effective date. The managed care plan
must demonstrate, to the commissioner's satisfaction, that the data submitted regarding
attainment of the performance target is accurate. The commissioner shall periodically
change the administrative measures used as performance targets in order to improve plan
performance across a broader range of administrative services. The performance targets
must include measurement of plan efforts to contain spending on health care services and
administrative activities. The commissioner may adopt plan-specific performance targets
that take into account factors affecting only one plan, such as characteristics of the plan's
enrollee population. The withheld funds must be returned no sooner than July 1 and no
later than July 31 of the following calendar year if performance targets in the contract are
achieved. A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
paragraph that is reasonably expected to be returned.

new text begin (d) For services rendered on or after January 1, 2010, the commissioner shall
establish additional performance targets based on the Healthcare Effectiveness Data and
Information Set (HEDIS), as developed by the National Committee for Quality Assurance.
These performance targets shall be subject to the withhold of five percent of managed care
plan payments established under paragraph (c). Any managed care plan that fails to meet a
HEDIS-based performance target in any single year shall receive a compounded penalty
for failing to meet the same target in subsequent, consecutive years. The commissioner
shall annually notify the chairs of the house of representatives and senate committees with
jurisdiction over health and human services of any updates to HEDIS-based performance
targets necessary to remain as closely aligned with HEDIS standards as possible. Unless
otherwise indicated by clinical evidence, HEDIS-based performance targets must include
the following categories of measurement:
new text end

new text begin (1) public health measures, including lead testing and comprehensive diabetes care;
new text end

new text begin (2) administrative measures, including timeliness of payments to providers and
identifying treating providers on 100 percent of claims;
new text end

new text begin (3) patient care measures, including patient satisfaction, compliance with the health
care reform requirements described in chapter 62U, and reductions in the utilization of
high-cost, low-effectiveness surgeries, procedures, and services; and
new text end

new text begin (4) cost of care measures, including cholesterol management for patients with
cardiovascular conditions, control of high blood pressure, persistence of beta-blocker
treatment after a heart attack, and inpatient utilization of acute care.
new text end