HF 2236

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; establishing a performance
reporting and quality improvement payment system for
public health care programs; amending Minnesota
Statutes 2004, sections 256B.69, subdivision 5a;
256L.12, subdivision 9; proposing coding for new law
in Minnesota Statutes, chapter 256B.

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

Section 1.

new text begin [256B.072] PERFORMANCE REPORTING AND QUALITY
IMPROVEMENT PAYMENT SYSTEM.
new text end

new text begin (a) The commissioner of human services shall establish a
performance reporting and payment system for health care
providers who provide health care services to public program
recipients covered under this chapter and chapters 256D and 256L.
new text end

new text begin (b) The measures used for the performance reporting and
payment system for medical groups or single-physician practices
shall include, but are not limited to, measures of care for
asthma, diabetes, hypertension, and coronary artery disease and
measures of preventive care services. The measures used for the
performance reporting and payment system for inpatient hospitals
shall include, but are not limited to, measures of care for
acute myocardial infarction, heart failure, and pneumonia;
measures of care and prevention of surgical infections; measures
of prevention of ventilator-associated pneumonia, central
line-associated bloodstream infections, and harm caused by
medication errors; and measures of rates of inpatient
mortality. In the case of a medical group, single-physician
practice, and inpatient hospital measures, the measures used
shall be consistent with measures published by nonprofit
Minnesota or national organizations that produce and disseminate
health care quality measures or evidence-based health care
guidelines. To enable a consistent measurement process across
the community, the commissioner may use measures of care
provided for patients in addition to those identified in
paragraph (a). The commissioner shall collaborate with other
health care reporting organizations to ensure that the measures
described in this section are consistent with those reported by
those organizations and used by other purchasers in Minnesota.
new text end

new text begin (c) For recipients seen on or after January 1, 2007, the
commissioner shall provide a performance payment to providers
who have achieved certain levels of performance established by
the commissioner with respect to the measures or who have
achieved certain rates of improvement established by the
commissioner with respect to the measures or whose rates of
achievement have increased over a previous period, as
established by the commissioner. The performance payment may be
a fixed dollar amount per patient, paid quarterly or annually,
or alternatively payment may be made as a percentage increase
over payments allowed elsewhere in statute for the recipients
identified in paragraph (a). In order for providers to be
eligible for a performance payment under this section, the
commissioner may require the providers to submit information in
a required format to a health care reporting organization or to
cooperate with the information collection procedures of that
organization. The commissioner may contract with a reporting
organization to assist with the collection of reporting
information and to prevent duplication of reporting. The
commissioner may limit application of the performance payment
system to providers that provide a sufficiently large volume of
care to permit adequate statistical precision in the measurement
of that care, as established by the commissioner, after
consulting with other health care quality reporting
organizations.
new text end

new text begin (d) For recipients who are not enrolled in a managed care
plan under this chapter and chapters 256D and 256L, the
performance payments shall be funded with:
new text end

new text begin (1) a reduction in payments for fee-for-service hospital
and physician services of up to five percent for services
rendered on or after January 1, 2007, as long as all savings due
to the reductions are paid out by the end of the following
calendar year to providers with the highest rates of achievement
as defined in paragraph (c); and
new text end

new text begin (2) up to 50 percent of the projected savings in the
fee-for-service program costs due to improved results of these
measures with the eligible providers.
new text end

new text begin (e) For recipients enrolled in a managed care plan under
this chapter or chapter 256D or 256L, the commissioner shall
require that the managed care plan provide performance payments
to physicians and hospitals consistent with the performance
payments described under this section.
new text end

new text begin (f) The commissioner shall publish a description of the
proposed performance reporting and payment system for the
calendar year beginning January 1, 2007, and each subsequent
calendar year, at least three months prior to the beginning of
that calendar year.
new text end

new text begin (g) By April 1, 2007, and annually thereafter, the
commissioner shall report through a public Web site the results
by medical group, single-physician practice, and hospital of the
measures and the performance payments under this section, and
shall compare the results by medical group, single-physician
practice, and hospital for patients enrolled in public programs
to patients enrolled in private health plans. To achieve this
reporting, the commissioner may contract with a health care
reporting organization that operates a Web site suitable for
this purpose.
new text end

Sec. 2.

Minnesota Statutes 2004, section 256B.69,
subdivision 5a, is amended to read:

Subd. 5a.

Managed care contracts.

(a) Managed care
contracts under this section and sections 256L.12 and 256D.03,
shall be entered into or renewed on a calendar year basis
beginning January 1, 1996. Managed care contracts which were in
effect on June 30, 1995, and set to renew on July 1, 1995, shall
be renewed for the period July 1, 1995 through December 31, 1995
at the same terms that were in effect on June 30, 1995. The
commissioner may issue separate contracts with requirements
specific to services to medical assistance recipients age 65 and
older.

(b) A prepaid health plan providing covered health services
for eligible persons pursuant to chapters 256B, 256D, and 256L,
is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care
programs under chapters 256B, 256D, and 256L, established after
the effective date of a contract with the commissioner take
effect when the contract is next issued or renewed.

(c) Effective for services rendered on or after January 1,
2003, new text begin to December 31, 2005, new text end the commissioner shall withhold five
percent of managed care plan payments under this section for the
prepaid medical assistance and general assistance medical care
programs 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 withheld
funds must be returned no sooner than July of the following year
if performance targets in the contract are achieved. The
commissioner may exclude special demonstration projects under
subdivision 23. 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) Effective for services rendered on or after January 1,
2006, the commissioner shall withhold six percent of managed
care plan payments under this section for the prepaid medical
assistance and general assistance medical care programs. Five
percent of the withheld funds shall be returned no sooner than
July 1 and no later than July 31 of the following calendar year
if the rate of performance for diabetes care for the managed
care plan's enrollees diagnosed with diabetes is at least ten
percent higher than the median rate of the public assistance
program enrollees diagnosed with diabetes as established in
section 256B.072. The performance reporting and payment system
requirements, including the performance rate expectations
established by the commissioner, must be outlined in writing
prior to the contract effective date. One percent of the
withheld funds shall be returned no sooner than July 1 and no
later than July 31 of the following calendar year, pending
completion of other performance targets. Criteria for
assessment of each performance target must be outlined in
writing prior to the contract effective date. The commissioner
may exclude special demonstration projects under subdivision
23. 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 end

Sec. 3.

Minnesota Statutes 2004, 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) deleted text begin 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.
deleted text end

deleted text begin (c) deleted text end For services rendered on or after January 1, 2004, new text begin to
December 31, 2005, new text end 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 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 (c) Effective for services rendered on or after January 1,
2006, the commissioner shall withhold six percent of managed
care plan payments under this section for the prepaid medical
assistance and general assistance medical care programs. Five
percent of the withheld funds shall be returned no sooner than
July 1 and no later than July 31 of the following calendar year
if the rate of performance for diabetes care for the managed
care plan's enrollees diagnosed with diabetes is at least ten
percent higher than the median rate of the public assistance
program enrollees diagnosed with diabetes as established in
section 256B.072. The performance reporting and payment system
requirements, including the performance rate expectations
established by the commissioner, must be outlined in writing
prior to the contract effective date. One percent of the
withheld funds shall be returned no sooner than July 1 and no
later than July 31 of the following calendar year, pending
completion of other performance targets. Criteria for
assessment of each performance target must be outlined in
writing prior to the contract effective date. The commissioner
may exclude special demonstration projects under section
256B.69, subdivision 23. 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 end