HF 3056
1st Committee Engrossment - 86th Legislature (2009 - 2010)
Posted on 03/19/2013 07:29 p.m.
KEY: stricken = removed, old language.
underscored = added, new language.
Line numbers
1.1A bill for an act
1.2relating to health; modifying provider peer grouping timelines and system;
1.3amending Minnesota Statutes 2008, sections 62U.04, subdivisions 3, 9;
1.4256B.0754, subdivision 2; repealing Minnesota Statutes 2009 Supplement,
1.5section 256B.032.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:
1.8 Subd. 3. Provider peer grouping. (a) The commissioner shall develop a peer
1.9grouping system for providers based on a combined measure that incorporates both
1.10provider risk-adjusted cost of care and quality of care, and for specific conditions as
1.11determined by the commissioner. In developing this system, the commissioner shall
1.12consult and coordinate with health care providers, health plan companies, state agencies,
1.13and organizations that work to improve health care quality in Minnesota. For purposes of
1.14the final establishment of the peer grouping system, the commissioner shall not contract
1.15with any private entity, organization, or consortium of entities that has or will have a direct
1.16financial interest in the outcome of the system.
1.17 (b) Beginning June 1new text begin By no later than October 15new text end , 2010, the commissioner shall
1.18disseminate information to providers on theirnew text begin totalnew text end cost of care,new text begin totalnew text end resource use,new text begin totalnew text end
1.19quality of care, and thenew text begin total carenew text end results of the grouping developed under this subdivision
1.20in comparison to an appropriate peer group. Any analyses or reports that identify
1.21providers may only be published after the provider has been provided the opportunity by
1.22the commissioner to review the underlying data and submit comments.new text begin Providers may be new text end
1.23new text begin given any data for which they are the subject of the data.new text end The provider shall have 21new text begin 30new text end
1.24days to review the data for accuracynew text begin and initiate an appeal as specified in paragraph (d)new text end .
2.1 (c) new text begin By no later than January 1, 2011, the commissioner shall disseminate information new text end
2.2new text begin to providers on their condition-specific cost of care, condition-specific resource use, new text end
2.3new text begin condition-specific quality of care, and the condition-specific results of the grouping new text end
2.4new text begin developed under this subdivision in comparison to an appropriate peer group. Any new text end
2.5new text begin analyses or reports that identify providers may only be published after the provider has new text end
2.6new text begin been provided the opportunity by the commissioner to review the underlying data and new text end
2.7new text begin submit comments. Providers may be given any data for which they are the subject of the new text end
2.8new text begin data. The provider has 30 days to review the data for accuracy and initiate an appeal as new text end
2.9new text begin specified in paragraph (d).new text end
2.10new text begin (d) new text end The commissioner shall establish an appeals process to resolve disputes from
2.11providers regarding the accuracy of the data used to develop analyses or reports.new text begin When new text end
2.12new text begin a provider appeals the accuracy of the data used to calculate the peer grouping system new text end
2.13new text begin results, the provider shall:new text end
2.14new text begin (1) clearly indicate the reason they believe the data used to calculate the peer group new text end
2.15new text begin system results are not accurate;new text end
2.16new text begin (2) provide evidence and documentation to support the reason that data was not new text end
2.17new text begin accurate; andnew text end
2.18new text begin (3) cooperate with the commissioner, including allowing the commissioner access to new text end
2.19new text begin data necessary and relevant to resolving the dispute.new text end
2.20new text begin If a provider does not meet the requirements of this paragraph, a provider's appeal shall be new text end
2.21new text begin considered withdrawn. The commissioner shall not publish results for a specific provider new text end
2.22new text begin under paragraph (e) or (f) while that provider has an unresolved appeal.new text end
2.23 (d)new text begin (e)new text end Beginning September 1, 2010new text begin January 1, 2011new text end , the commissioner shall, no
2.24less than annually, publish information on providers'new text begin totalnew text end cost,new text begin total resource use, totalnew text end
2.25quality, and the results of thenew text begin total care portion of thenew text end peer grouping process. The results
2.26that are published must be on a risk-adjusted basis.
2.27new text begin (f) Beginning March 30, 2011, the commissioner shall no less than annually new text end
2.28new text begin publish information on providers' condition-specific cost, condition-specific resource use, new text end
2.29new text begin condition-specific quality, and the results of the condition-specific portion of the peer new text end
2.30new text begin grouping process. The results that are published must be on a risk-adjusted basis.new text end
2.31new text begin (g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing new text end
2.32new text begin information under paragraph (e) or (f), the commissioner shall ensure the scientific new text end
2.33new text begin validity and reliability of the results according to the standards described in paragraph (h). new text end
2.34new text begin If additional time is needed to establish the scientific validity and reliability of the results, new text end
2.35new text begin the commissioner may delay the dissemination of data to providers under paragraph (b) new text end
2.36new text begin or (c), or the publication of information under paragraph (e) or (f). If the delay is more new text end
3.1new text begin than 60 days, the commissioner shall report the following information in writing to the new text end
3.2new text begin Legislative Commission on Health Care Access:new text end
3.3new text begin (1) the reason for the delay;new text end
3.4new text begin (2) the actions being taken to resolve the delay and establish the scientific validity new text end
3.5new text begin and reliability of the results; andnew text end
3.6new text begin (3) the new dates by which the results shall be disseminated.new text end
3.7new text begin If there is a delay under this paragraph, the commissioner must disseminate the new text end
3.8new text begin information to providers under paragraph (b) or (c) at least 90 days before publishing new text end
3.9new text begin results under paragraph (e) or (f).new text end
3.10new text begin (h) The commissioner's assurance of valid and reliable clinic and hospital peer new text end
3.11new text begin grouping performance results shall include, at a minimum, the following:new text end
3.12new text begin (1) use of the best available evidence, research, and methodologies;new text end
3.13new text begin (2) a reliability threshold of no less than 0.70 for purposes of disseminating data to new text end
3.14new text begin providers and of no less than 0.80 for purposes of public reporting.new text end
3.15new text begin In achieving these thresholds, the commissioner shall not aggregate clinics that are new text end
3.16new text begin not part of the same system or practice group. The commissioner shall consult with and new text end
3.17new text begin solicit feedback from representatives of physician clinics and hospitals during the peer new text end
3.18new text begin grouping data analysis process to obtain input on the methodological options prior to final new text end
3.19new text begin analysis and on the design, development, and testing of provider reports.new text end
3.20 Sec. 2. Minnesota Statutes 2008, section 62U.04, subdivision 9, is amended to read:
3.21 Subd. 9. Uses of information. (a) By January 1, 2011new text begin no later than 12 months after new text end
3.22new text begin the commissioner publishes the information in section 62U.04, subdivision 3, paragraph new text end
3.23new text begin (e)new text end :
3.24 (1) the commissioner of management and budget shall use the information and
3.25methods developed under subdivision 3 to strengthen incentives for members of the state
3.26employee group insurance program to use high-quality, low-cost providers;
3.27 (2) all political subdivisions, as defined in section
13.02, subdivision 11, that offer
3.28health benefits to their employees must offer plans that differentiate providers on their
3.29cost and quality performance and create incentives for members to use better-performing
3.30providers;
3.31 (3) all health plan companies shall use the information and methods developed
3.32under subdivision 3 to develop products that encourage consumers to use high-quality,
3.33low-cost providers; and
3.34 (4) health plan companies that issue health plans in the individual market or the
3.35small employer market must offer at least one health plan that uses the information
4.1developed under subdivision 3 to establish financial incentives for consumers to choose
4.2higher-quality, lower-cost providers through enrollee cost-sharing or selective provider
4.3networks.
4.4 (b) By January 1, 2011, the commissioner of health shall report to the governor
4.5and the legislature on recommendations to encourage health plan companies to promote
4.6widespread adoption of products that encourage the use of high-quality, low-cost providers.
4.7The commissioner's recommendations may include tax incentives, public reporting of
4.8health plan performance, regulatory incentives or changes, and other strategies.
4.9 Sec. 3. Minnesota Statutes 2008, section 256B.0754, subdivision 2, is amended to read:
4.10 Subd. 2. Payment reform. By January 1, 2011new text begin no later than 12 months after the new text end
4.11new text begin commissioner of health publishes the information in section 62U.04, subdivision 3, new text end
4.12new text begin paragraph (e)new text end , the commissioner of human services shall use the information and methods
4.13developed under section
62U.04 to establish a payment system that:
4.14 (1) rewards high-quality, low-cost providers;
4.15 (2) creates enrollee incentives to receive care from high-quality, low-cost providers;
4.16and
4.17 (3) fosters collaboration among providers to reduce cost shifting from one part of
4.18the health continuum to another.
4.19 Sec. 4. new text begin REPEALER.new text end
4.20new text begin Minnesota Statutes 2009 Supplement, section 256B.032,new text end new text begin is repealed.new text end