1.1 	A bill for an act
1.2 	relating to health; modifying best practices
1.3 	guidelines; establishing a quality improvement
1.4 	investment program; appropriating money; amending
1.5 	Minnesota Statutes 2004, section 62J.43.
1.6 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.7 	Section 1. Minnesota Statutes 2004, section 62J.43, is
1.8 	amended to read:
1.9 	62J.43  BEST PRACTICES EVIDENCE-BASED HEALTH CARE
1.10 	GUIDELINES AND QUALITY IMPROVEMENT.
1.11 	(a) Subdivision 1.[ADOPTION OF EVIDENCE-BASED
1.12 	GUIDELINES.] To improve quality and reduce health care costs,
1.13 	state agencies shall encourage the adoption use of best practice 
1.14 	evidence-based health care guidelines and participation in best
1.15 	practices quality of care measurement activities by physicians 
1.16 	medical groups, hospitals, other health care providers, and
1.17 	health plan companies.  The commissioner of health shall
1.18 	facilitate access to best practice evidence-based health care 
1.19 	guidelines and quality of care measurement information to for 
1.20 	providers, purchasers, and consumers by:
1.21 	(1) identifying and promoting local community-based,
1.22 	physician-designed best practices care evidence-based health
1.23 	care guidelines across the Minnesota health care system using
1.24 	local community-based, physician-designed guidelines whenever
1.25 	they are available and meet the criteria set forth in
2.1 	subdivision 2;
2.2 	(2) disseminating information available to the commissioner
2.3 	on adherence to best practices care by physicians the
2.4 	performance of Minnesota medical groups, hospitals,and other
2.5 	health care providers in Minnesota in providing care in
2.6 	accordance with evidence-based health care guidelines;
2.7 	(3) educating consumers and purchasers on how to
2.8 	effectively use this information effectively in choosing their
2.9 	providers and in making purchasing decisions; and
2.10 	(4) making best practices evidence-based health care
2.11 	guidelines and quality of care measurement information available
2.12 	to enrollees and program participants through the Department of
2.13 	Health's Web site.  The commissioner may convene an advisory
2.14 	committee to ensure that the Web site is designed to provide
2.15 	user friendly and easy accessibility.
2.16 	(b)  The commissioner of health shall collaborate with a
2.17 	nonprofit Minnesota quality improvement organization
2.18 	specializing in best practices and quality of care measurements
2.19 	to provide best practices criteria and assist in the collection
2.20 	of the data.
2.21 	(c) Subd. 2.[CRITERIA FOR EVIDENCE-BASED
2.22 	GUIDELINES.] Guidelines identified under this section must meet
2.23 	the following criteria:
2.24 	(1) the scope and intended use of the guideline application
2.25 	are clearly stated;
2.26 	(2) the authors are listed and any conflicts of interest
2.27 	are disclosed;
2.28 	(3) the authors represent all pertinent clinical fields or
2.29 	other means of input have been used for pertinent clinical
2.30 	fields not represented among the authors;
2.31 	(4) the development process is explicitly stated;
2.32 	(5) the guideline is grounded in evidence;
2.33 	(6) the evidence is cited and graded with respect to its
2.34 	strength;
2.35 	(7) the document itself is clear and practical;
2.36 	(8) the document is flexible in use, with exceptions noted
3.1 	or provided for with general statements;
3.2 	(9) measures are included for use in systems improvement
3.3 	pursued to improve the likelihood that health care will be
3.4 	provided in accordance with the guideline; and 
3.5 	(10) the document provides for scheduled reviews and
3.6 	updating.
3.7 		Subd. 3.Identification of evidence-based health care
3.8 	guidelines. In order to identify evidence-based guidelines for
3.9 	promotion under this section, the commissioner of health shall
3.10 	collaborate with a nonprofit Minnesota quality improvement
3.11 	organization that specializes in producing guidelines and using
3.12 	them to improve health care.  The guidelines identified may be
3.13 	ones produced by that organization or ones produced by other
3.14 	nonprofit Minnesota or national organizations, provided that the
3.15 	guidelines fulfill the criteria set forth in subdivision 2.
3.16 		Subd. 4.Initial evidence-based health care guidelines.
 3.17 	The initial best practices and quality of care measurement
3.18 	criteria developed topics of the evidence-based health care
3.19 	guidelines initially identified and promoted shall include
3.20 	asthma, diabetes, and at least two other preventive health
3.21 	measures.  Hypertension and coronary artery diseases shall be
3.22 	included within one year following availability hypertension,
3.23 	coronary artery disease, depression, preventive services, acute
3.24 	myocardial infarction, heart failure, pneumonia, and surgical
3.25 	infections.  The guidelines on these topics shall be identified
3.26 	and promotion begun by December 15, 2005.
3.27 		Subd. 5.Measurement and reporting of performance. In
3.28 	order to disseminate information on the performance of medical
3.29 	groups, hospitals, and other health care providers in providing
3.30 	care in accordance with evidence-based guidelines, the
3.31 	commissioner shall collaborate with one or more nonprofit
3.32 	Minnesota organizations that specialize in the development of
3.33 	health care quality measures derived from evidence-based
3.34 	guidelines, in the measurement of performance by health care
3.35 	providers, and in the reporting of performance using publicly
3.36 	accessible means, including Web sites.  The Department of Health
4.1 	shall not measure performance directly but shall determine
4.2 	whether performance is being measured competently and accurately
4.3 	by one or more nonprofit organizations and shall provide on its
4.4 	Web site links to the Web site or sites of the measuring
4.5 	organization or organizations chosen by the commissioner.  The
4.6 	commissioner shall encourage the development over time of a
4.7 	single nonprofit Minnesota measurement and reporting
4.8 	organization that reports on the performance of medical groups,
4.9 	hospitals, and other health care providers.
4.10 	(d) Subd. 6.[USE IN STATE CONTRACTS WITH HEALTH PLANS.]
4.11 	The commissioners of human services and employee relations may
4.12 	use the data publicly reported performance measurements
4.13 	described in subdivision 5 to make decisions about contracts
4.14 	they enter into with health plan companies and to establish
4.15 	programs of performance payment designed to reward either
4.16 	high-quality care or improvements in quality achieved by medical
4.17 	groups, hospitals, and other health care providers.
4.18 	(e) Subd. 7.[LIMITATIONS.] This section does not apply if
4.19 	the best practices evidence-based health care guidelines
4.20 	authorize or recommend denial of treatment, food, or fluids
4.21 	necessary to sustain life on the basis of the patient's age or
4.22 	expected length of life or the patient's present or predicted
4.23 	disability, degree of medical dependency, or quality of life.
4.24 	(f) The commissioner of health, human services, and
4.25 	employee relations shall report to the legislature by January
4.26 	15, 2005, on the status of best practices and quality of care
4.27 	initiatives, and shall present recommendations to the
4.28 	legislature on any statutory changes needed to increase the
4.29 	effectiveness of these initiatives.
4.30 	(g) This section expires June 30, 2006.

4.31 	Sec. 2. QUALITY IMPROVEMENT INVESTMENT PROGRAM.
 4.32 	The commissioner of health, in consultation with the
4.33 	commissioners of finance and administration, shall submit
4.34 	recommendations to the legislature by December 15, 2005, to
4.35 	establish a quality improvement investment program to provide
4.36 	technical assistance, grants, and low-interest loans to health
5.1 	care organizations and health professional associations to
5.2 	support establishing or updating electronic information systems
5.3 	in all health care settings to support the efficient and
5.4 	effective delivery of safe, evidence-based health care services
5.5 	and to reduce administrative costs.

5.6 	Sec. 3. APPROPRIATION.
 5.7 	$....... is appropriated from the general fund to the
5.8 	commissioner of health for the fiscal year ending June 30, 2006,
5.9 	for the report required under section 2.

5.10 	Sec. 4. EFFECTIVE DATE.
 5.11 	Sections 1 to 3 are effective July 1, 2005.