<a id="pl.1.3"></a><var>1.3</var>amending Minnesota Statutes 2008, sections 62U.04, subdivisions 3, 9; <br/>
<a id="pl.1.4"></a><var>1.4</var>256B.0754, subdivision 2; repealing Minnesota Statutes 2009 Supplement, <br/>
<a id="pl.1.5"></a><var>1.5</var>section 256B.032.<br/>
<a id="pl.1.6"></a><var>1.6</var>BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:<br/>
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<a id="bill.0.1.0"></a><a id="pl.1.7"></a><var>1.7</var>    Section 1. Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:<br/>
<a id="pl.1.8"></a><var>1.8</var>    Subd. 3. <b>Provider peer grouping.</b> (a) The commissioner shall develop a peer <br/>
<a id="pl.1.9"></a><var>1.9</var>grouping system for providers based on a combined measure that incorporates both <br/>
<a id="pl.1.10"></a><var>1.10</var>provider risk-adjusted cost of care and quality of care, and for specific conditions as <br/>
<a id="pl.1.11"></a><var>1.11</var>determined by the commissioner. In developing this system, the commissioner shall <br/>
<a id="pl.1.12"></a><var>1.12</var>consult and coordinate with health care providers, health plan companies, state agencies, <br/>
<a id="pl.1.13"></a><var>1.13</var>and organizations that work to improve health care quality in Minnesota. For purposes of <br/>
<a id="pl.1.14"></a><var>1.14</var>the final establishment of the peer grouping system, the commissioner shall not contract <br/>
<a id="pl.1.15"></a><var>1.15</var>with any private entity, organization, or consortium of entities that has or will have a direct <br/>
<a id="pl.1.16"></a><var>1.16</var>financial interest in the outcome of the system.<br/>
<a id="pl.1.17"></a><var>1.17</var>    (b) Beginning June 1 By no later than October 15, 2010, the commissioner shall <br/>
<a id="pl.1.18"></a><var>1.18</var>disseminate information to providers on their total cost of care, total resource use, total <br/>
<a id="pl.1.19"></a><var>1.19</var>quality of care, and the total care results of the grouping developed under this subdivision <br/>
<a id="pl.1.20"></a><var>1.20</var>in comparison to an appropriate peer group. Any analyses or reports that identify <br/>
<a id="pl.1.21"></a><var>1.21</var>providers may only be published after the provider has been provided the opportunity by <br/>
<a id="pl.1.22"></a><var>1.22</var>the commissioner to review the underlying data and submit comments. Providers may be <br/>
<a id="pl.1.23"></a><var>1.23</var>given any data for which they are the subject of the data. The provider shall have 21 30 <br/>
<a id="pl.1.24"></a><var>1.24</var> days to review the data for accuracy and initiate an appeal as specified in paragraph (d). <br/>
<a id="pl.2.1"></a><var>2.1</var>    (c) By no later than January 1, 2011, the commissioner shall disseminate information <br/>
<a id="pl.2.2"></a><var>2.2</var>to providers on their condition-specific cost of care, condition-specific resource use, <br/>
<a id="pl.2.3"></a><var>2.3</var>condition-specific quality of care, and the condition-specific results of the grouping <br/>
<a id="pl.2.4"></a><var>2.4</var>developed under this subdivision in comparison to an appropriate peer group. Any <br/>
<a id="pl.2.5"></a><var>2.5</var>analyses or reports that identify providers may only be published after the provider has <br/>
<a id="pl.2.6"></a><var>2.6</var>been provided the opportunity by the commissioner to review the underlying data and <br/>
<a id="pl.2.7"></a><var>2.7</var>submit comments. Providers may be given any data for which they are the subject of the <br/>
<a id="pl.2.8"></a><var>2.8</var>data. The provider shall have 30 days to review the data for accuracy and initiate an <br/>
<a id="pl.2.9"></a><var>2.9</var>appeal as specified in paragraph (d).<br/>
<a id="pl.2.10"></a><var>2.10</var>(d) The commissioner shall establish an appeals process to resolve disputes from <br/>
<a id="pl.2.11"></a><var>2.11</var>providers regarding the accuracy of the data used to develop analyses or reports. When <br/>
<a id="pl.2.12"></a><var>2.12</var>a provider appeals the accuracy of the data used to calculate the peer grouping system <br/>
<a id="pl.2.13"></a><var>2.13</var>results, the provider shall:<br/>
<a id="pl.2.14"></a><var>2.14</var>(1) clearly indicate the reason they believe the data used to calculate the peer group <br/>
<a id="pl.2.15"></a><var>2.15</var>system results are not accurate;<br/>
<a id="pl.2.16"></a><var>2.16</var>(2) provide evidence and documentation to support the reason that data was not <br/>
<a id="pl.2.17"></a><var>2.17</var>accurate; and<br/>
<a id="pl.2.18"></a><var>2.18</var>(3) cooperate with the commissioner, including allowing the commissioner access to <br/>
<a id="pl.2.19"></a><var>2.19</var>data necessary and relevant to resolving the dispute.<br/>
<a id="pl.2.20"></a><var>2.20</var>If a provider does not meet the requirements of this paragraph, a provider's appeal shall be <br/>
<a id="pl.2.21"></a><var>2.21</var>considered withdrawn. The commissioner shall not publish results for a specific provider <br/>
<a id="pl.2.22"></a><var>2.22</var>under paragraph (e) or (f) while that provider has an unresolved appeal.<br/>
<a id="pl.2.23"></a><var>2.23</var>    (d) (e) Beginning September 1, 2010 January 1, 2011, the commissioner shall, no <br/>
<a id="pl.2.24"></a><var>2.24</var>less than annually, publish information on providers' total cost, total resource use, total <br/>
<a id="pl.2.25"></a><var>2.25</var>quality, and the results of the total care portion of the peer grouping process. The results <br/>
<a id="pl.2.26"></a><var>2.26</var>that are published must be on a risk-adjusted basis. <br/>
<a id="pl.2.27"></a><var>2.27</var>(f) Beginning March 30, 2011, the commissioner shall no less than annually <br/>
<a id="pl.2.28"></a><var>2.28</var>publish information on providers' condition-specific cost, condition-specific resource use, <br/>
<a id="pl.2.29"></a><var>2.29</var>condition-specific quality, and the results of the condition-specific portion of the peer <br/>
<a id="pl.2.30"></a><var>2.30</var>grouping process. The results that are published must be on a risk-adjusted basis.<br/>
<a id="pl.2.31"></a><var>2.31</var>(g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing <br/>
<a id="pl.2.32"></a><var>2.32</var>information under paragraph (e) or (f), the commissioner shall ensure the scientific <br/>
<a id="pl.2.33"></a><var>2.33</var>validity and reliability of the results according to the standards described in paragraph (h). <br/>
<a id="pl.2.34"></a><var>2.34</var>If additional time is needed to establish the scientific validity and reliability of the results, <br/>
<a id="pl.2.35"></a><var>2.35</var>the commissioner may delay the dissemination of data to providers under paragraph (b) or <br/>
<a id="pl.2.36"></a><var>2.36</var>(c), or the publication of information under paragraph (e) or (f). If the delay is more than <br/>
<a id="pl.3.1"></a><var>3.1</var>60 days, the commissioner shall report in writing to the Legislative Commission on Health <br/>
<a id="pl.3.2"></a><var>3.2</var>Care Access the following information:<br/>
<a id="pl.3.3"></a><var>3.3</var>(1) the reason for the delay;<br/>
<a id="pl.3.4"></a><var>3.4</var>(2) the actions being taken to resolve the delay and establish the scientific validity <br/>
<a id="pl.3.5"></a><var>3.5</var>and reliability of the results; and<br/>
<a id="pl.3.6"></a><var>3.6</var>(3) the new dates by which the results shall be disseminated.<br/>
<a id="pl.3.7"></a><var>3.7</var>If there is a delay under this paragraph, the commissioner must disseminate the <br/>
<a id="pl.3.8"></a><var>3.8</var>information to providers under paragraph (b) or (c) at least 90 days before publishing <br/>
<a id="pl.3.9"></a><var>3.9</var>results under paragraph (e) or (f).<br/>
<a id="pl.3.10"></a><var>3.10</var>(h) The commissioner's assurance of valid and reliable clinic and hospital peer <br/>
<a id="pl.3.11"></a><var>3.11</var>grouping performance results shall include, at a minimum, the following:<br/>
<a id="pl.3.12"></a><var>3.12</var>(1) use of the best available evidence, research, and methodologies; and<br/>
<a id="pl.3.13"></a><var>3.13</var>(2) establishment of an explicit minimum reliability threshold developed in <br/>
<a id="pl.3.14"></a><var>3.14</var>collaboration with the subjects of the data and the users of the data, at a level not below <br/>
<a id="pl.3.15"></a><var>3.15</var>nationally accepted standards where such standards exist.<br/>
<a id="pl.3.16"></a><var>3.16</var>In achieving these thresholds, the commissioner shall not aggregate clinics that are not <br/>
<a id="pl.3.17"></a><var>3.17</var>part of the same system or practice group. The commissioner shall consult with and solicit <br/>
<a id="pl.3.18"></a><var>3.18</var>feedback from representatives of physician clinics and hospitals during the peer grouping <br/>
<a id="pl.3.19"></a><var>3.19</var>data analysis process to obtain input on the methodological options prior to final analysis <br/>
<a id="pl.3.20"></a><var>3.20</var>and on the design, development, and testing of provider reports.<br/>
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<a id="bill.0.2.0"></a><a id="pl.3.21"></a><var>3.21</var>    Sec. 2. Minnesota Statutes 2008, section 62U.04, subdivision 9, is amended to read:<br/>
<a id="pl.3.22"></a><var>3.22</var>    Subd. 9. <b>Uses of information.</b> (a) By January 1, 2011 no later than 12 months after <br/>
<a id="pl.3.23"></a><var>3.23</var>the commissioner publishes the information in subdivision 3, paragraph (e):<br/>
<a id="pl.3.24"></a><var>3.24</var>    (1) the commissioner of management and budget shall use the information and <br/>
<a id="pl.3.25"></a><var>3.25</var>methods developed under subdivision 3 to strengthen incentives for members of the state <br/>
<a id="pl.3.26"></a><var>3.26</var>employee group insurance program to use high-quality, low-cost providers;<br/>
<a id="pl.3.27"></a><var>3.27</var>    (2) all political subdivisions, as defined in section 
         <statute_ref>13.02, subdivision 11</statute_ref>, that offer <br/>
<a id="pl.3.28"></a><var>3.28</var>health benefits to their employees must offer plans that differentiate providers on their <br/>
<a id="pl.3.29"></a><var>3.29</var>cost and quality performance and create incentives for members to use better-performing <br/>
<a id="pl.3.30"></a><var>3.30</var>providers;<br/>
<a id="pl.3.31"></a><var>3.31</var>    (3) all health plan companies shall use the information and methods developed <br/>
<a id="pl.3.32"></a><var>3.32</var>under subdivision 3 to develop products that encourage consumers to use high-quality, <br/>
<a id="pl.3.33"></a><var>3.33</var>low-cost providers; and<br/>
<a id="pl.3.34"></a><var>3.34</var>    (4) health plan companies that issue health plans in the individual market or the <br/>
<a id="pl.3.35"></a><var>3.35</var>small employer market must offer at least one health plan that uses the information <br/>
<a id="pl.4.1"></a><var>4.1</var>developed under subdivision 3 to establish financial incentives for consumers to choose <br/>
<a id="pl.4.2"></a><var>4.2</var>higher-quality, lower-cost providers through enrollee cost-sharing or selective provider <br/>
<a id="pl.4.3"></a><var>4.3</var>networks.<br/>
<a id="pl.4.4"></a><var>4.4</var>    (b) By January 1, 2011, the commissioner of health shall report to the governor <br/>
<a id="pl.4.5"></a><var>4.5</var>and the legislature on recommendations to encourage health plan companies to promote <br/>
<a id="pl.4.6"></a><var>4.6</var>widespread adoption of products that encourage the use of high-quality, low-cost providers. <br/>
<a id="pl.4.7"></a><var>4.7</var>The commissioner's recommendations may include tax incentives, public reporting of <br/>
<a id="pl.4.8"></a><var>4.8</var>health plan performance, regulatory incentives or changes, and other strategies.<br/>
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<a id="bill.0.3.0"></a><a id="pl.4.9"></a><var>4.9</var>    Sec. 3. Minnesota Statutes 2008, section 256B.0754, subdivision 2, is amended to read:<br/>
<a id="pl.4.10"></a><var>4.10</var>    Subd. 2. <b>Payment reform.</b> By January 1, 2011 no later than 12 months after the <br/>
<a id="pl.4.11"></a><var>4.11</var>commissioner of health publishes the information in section 62U.04, subdivision 3, <br/>
<a id="pl.4.12"></a><var>4.12</var>paragraph (e), the commissioner of human services shall use the information and methods <br/>
<a id="pl.4.13"></a><var>4.13</var>developed under section 
         <statute_ref>62U.04</statute_ref> to establish a payment system that:<br/>
<a id="pl.4.14"></a><var>4.14</var>    (1) rewards high-quality, low-cost providers;<br/>
<a id="pl.4.15"></a><var>4.15</var>    (2) creates enrollee incentives to receive care from high-quality, low-cost providers; <br/>
<a id="pl.4.16"></a><var>4.16</var>and<br/>
<a id="pl.4.17"></a><var>4.17</var>    (3) fosters collaboration among providers to reduce cost shifting from one part of <br/>
<a id="pl.4.18"></a><var>4.18</var>the health continuum to another.<br/>
<br/>
<a id="bill.0.4.0"></a><a id="pl.4.19"></a><var>4.19</var>    Sec. 4. <b>PAYMENT REFORM IMPLEMENTATION REPORT.</b><br/>
<a id="pl.4.20"></a><var>4.20</var>By April 1, 2011, the commissioner of human services shall report to the chairs of <br/>
<a id="pl.4.21"></a><var>4.21</var>the senate Health and Human Services Budget Division and the house of representatives <br/>
<a id="pl.4.22"></a><var>4.22</var>Health Care and Human Services Finance Division recommendations for implementing <br/>
<a id="pl.4.23"></a><var>4.23</var>the payment reform in Minnesota Statutes, section 256B.0754, subdivision 2. The <br/>
<a id="pl.4.24"></a><var>4.24</var>recommendations shall include:<br/>
<a id="pl.4.25"></a><var>4.25</var>(1) legislative changes needed to fully implement this payment reform; and<br/>
<a id="pl.4.26"></a><var>4.26</var>(2) an analysis of the fiscal impact of implementing this payment reform.<br/>
<br/>
<a id="bill.0.5.0"></a><a id="pl.4.27"></a><var>4.27</var>    Sec. 5. <b> REPEALER.</b><br/>
<a id="pl.4.28"></a><var>4.28</var>Minnesota Statutes 2009 Supplement, section 256B.032, is repealed.<br/>