1.1 	A bill for an act
1.2 	relating to health; modifying data collected under the all-payer claims database 
1.3 	and uses of this data; requiring the commissioner of health to study and report on 
1.4 	systems used by health plan companies and third-party administrators to pay health 
1.5 	care providers;amending Minnesota Statutes 2020, sections 62U.04, subdivision 
1.6 	11, by adding a subdivision; 62U.10, subdivision 7; Minnesota Statutes 2021 
1.7 	Supplement, section 62U.04, subdivisions 4, 5.
1.8 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.9 	Section 1. Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 4, is amended 
1.10 	to read:
1.11 		Subd. 4.Encounter data. (a) All health plan companies and third-party administrators 
1.12 	shall submit encounter data on a monthly basis to a private entity designated by the 
1.13 	commissioner of health. The data shall be submitted in a form and manner specified by the 
1.14 	commissioner subject to the following requirements:
1.15 	(1) the data must be de-identified data as described under the Code of Federal Regulations, 
1.16 	title 45, section 164.514;
1.17 	(2) the data for each encounter must include an identifier for the patient's health care 
1.18 	home if the patient has selected a health care home, data on contractual value-based payments,
1.19 	and, for claims incurred on or after January 1, 2019, data deemed necessary by the 
1.20 	commissioner to uniquely identify claims in the individual health insurance market; and
1.21 	(3) except for the identifier described in clause (2), the data must not include information 
1.22 	that is not included in a health care claim or equivalent encounter information transaction 
1.23 	that is required under section 62J.536.
2.1 	(b) The commissioner or the commissioner's designee shall only use the data submitted 
2.2 	under paragraph (a) to carry out the commissioner's responsibilities in this section, including 
2.3 	supplying the data to providers so they can verify their results of the peer grouping process 
2.4 	consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), 
2.5 	and adopted by the commissioner and, if necessary, submit comments to the commissioner 
2.6 	or initiate an appeal.
2.7 	(c) Data on providers collected under this subdivision are private data on individuals or 
2.8 	nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary data 
2.9 	in section 13.02, subdivision 19, summary data prepared under this subdivision may be 
2.10 	derived from nonpublic data. The commissioner or the commissioner's designee shall 
2.11 	establish procedures and safeguards to protect the integrity and confidentiality of any data 
2.12 	that it maintains.
2.13 	(d) The commissioner or the commissioner's designee shall not publish analyses or 
2.14 	reports that identify, or could potentially identify, individual patients.
2.15 	(e) The commissioner shall compile summary information on the data submitted under 
2.16 	this subdivision. The commissioner shall work with its vendors to assess the data submitted 
2.17 	in terms of compliance with the data submission requirements and the completeness of the 
2.18 	data submitted by comparing the data with summary information compiled by the 
2.19 	commissioner and with established and emerging data quality standards to ensure data 
2.20 	quality.

2.21 	Sec. 2. Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 5, is amended 
2.22 	to read:
2.23 		Subd. 5.Pricing data. (a) All health plan companies and third-party administrators shall 
2.24 	submit, on a monthly basis, data on their contracted prices with health care providers to a 
2.25 	private entity designated by the commissioner of health for the purposes of performing the 
2.26 	analyses required under this subdivision. Data on contracted prices submitted under this 
2.27 	paragraph must include data on supplemental contractual value-based payments paid to 
2.28 	health care providers. The data shall be submitted in the form and manner specified by the 
2.29 	commissioner of health.
2.30 	(b) The commissioner or the commissioner's designee shall only use the data submitted 
2.31 	under this subdivision to carry out the commissioner's responsibilities under this section, 
2.32 	including supplying the data to providers so they can verify their results of the peer grouping 
2.33 	process consistent with the recommendations developed pursuant to subdivision 3c, paragraph 
3.1 	(d), and adopted by the commissioner and, if necessary, submit comments to the 
3.2 	commissioner or initiate an appeal.
3.3 	(c) Data collected under this subdivision are nonpublic data as defined in section 13.02. 
3.4 	Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary 
3.5 	data prepared under this section may be derived from nonpublic data. The commissioner 
3.6 	shall establish procedures and safeguards to protect the integrity and confidentiality of any 
3.7 	data that it maintains.

3.8 	Sec. 3. Minnesota Statutes 2020, section 62U.04, is amended by adding a subdivision to 
3.9 	read:
3.10 		Subd. 5b.Non-claims-based payments. (a) Beginning in 2024, all health plan companies 
3.11 	and third-party administrators shall submit to a private entity designated by the commissioner 
3.12 	of health all non-claims-based payments made to health care providers. The data shall be 
3.13 	submitted in a form, manner, and frequency specified by the commissioner. Non-claims-based 
3.14 	payments are payments to health care providers designed to pay for value over volume and 
3.15 	include alternative payment models or incentives, payments for infrastructure expenditures 
3.16 	or investments, or payments for workforce expenditures or investments. Non-claims-based 
3.17 	payments submitted under this subdivision must, to the extent possible, be attributed to a 
3.18 	health care provider in the same manner in which claims-based data are attributed to a health 
3.19 	care provider and, where appropriate, must be combined with data collected under 
3.20 	subdivisions 4 and 5 in analyses of health care spending.
3.21 	(b) Data collected under this subdivision are nonpublic data as defined in section 13.02. 
3.22 	Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary 
3.23 	data prepared under this section may be derived from nonpublic data. The commissioner 
3.24 	shall establish procedures and safeguards to protect the integrity and confidentiality of any 
3.25 	data that it maintains.
3.26 	(c) The commissioner shall consult with health plan companies, hospitals, and health 
3.27 	care providers in developing the data reported under this subdivision and standardized 
3.28 	reporting forms.

3.29 	Sec. 4. Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:
3.30 		Subd. 11.Restricted uses of the all-payer claims data. (a) Notwithstanding subdivision 
3.31 	4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's 
3.32 	designee shall only use the data submitted under subdivisions 4 and, 5, and 5b for the 
3.33 	following purposes:
4.1 	(1) to evaluate the performance of the health care home program as authorized under 
4.2 	section 62U.03, subdivision 7;
4.3 	(2) to study, in collaboration with the reducing avoidable readmissions effectively 
4.4 	(RARE) campaign, hospital readmission trends and rates;
4.5 	(3) to analyze variations in health care costs, quality, utilization, and illness burden based 
4.6 	on geographical areas or populations;
4.7 	(4) to evaluate the state innovation model (SIM) testing grant received by the Departments 
4.8 	of Health and Human Services, including the analysis of health care cost, quality, and 
4.9 	utilization baseline and trend information for targeted populations and communities; and
4.10 	(5) to compile one or more public use files of summary data or tables that must:
4.11 	(i) be available to the public for no or minimal cost by March 1, 2016, and available by 
4.12 	web-based electronic data download by June 30, 2019;
4.13 	(ii) not identify individual patients, payers, or providers;
4.14 	(iii) be updated by the commissioner, at least annually, with the most current data 
4.15 	available;
4.16 	(iv) contain clear and conspicuous explanations of the characteristics of the data, such 
4.17 	as the dates of the data contained in the files, the absence of costs of care for uninsured 
4.18 	patients or nonresidents, and other disclaimers that provide appropriate context; and
4.19 	(v) not lead to the collection of additional data elements beyond what is authorized under 
4.20 	this section as of June 30, 2015.
4.21 	(b) The commissioner may publish the results of the authorized uses identified in 
4.22 	paragraph (a) so long as the data released publicly do not contain information or descriptions 
4.23 	in which the identity of individual hospitals, clinics, or other providers may be discerned.
4.24 	(c) Nothing in this subdivision shall be construed to prohibit the commissioner from 
4.25 	using the data collected under subdivision 4 to complete the state-based risk adjustment 
4.26 	system assessment due to the legislature on October 1, 2015.
4.27 	(d) The commissioner or the commissioner's designee may use the data submitted under 
4.28 	subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1, 
4.29 	2023.
4.30 	(e) (d) The commissioner shall consult with the all-payer claims database work group 
4.31 	established under subdivision 12 regarding the technical considerations necessary to create 
4.32 	the public use files of summary data described in paragraph (a), clause (5).

5.1 	Sec. 5. Minnesota Statutes 2020, section 62U.10, subdivision 7, is amended to read:
5.2 		Subd. 7.Outcomes reporting; savings determination. (a) Beginning November 1, 
5.3 	2016, and each November 1 thereafter, the commissioner of health shall determine the actual 
5.4 	total private and public health care and long-term care spending for Minnesota residents 
5.5 	related to each health indicator projected in subdivision 6 for the most recent calendar year 
5.6 	available. The commissioner shall determine the difference between the projected and actual 
5.7 	spending for each health indicator and for each year, and determine the savings attributable 
5.8 	to changes in these health indicators. The assumptions and research methods used to calculate 
5.9 	actual spending must be determined to be appropriate by an independent actuarial consultant. 
5.10 	If the actual spending is less than the projected spending, the commissioner, in consultation 
5.11 	with the commissioners of human services and management and budget, shall use the 
5.12 	proportion of spending for state-administered health care programs to total private and 
5.13 	public health care spending for each health indicator for the calendar year two years before 
5.14 	the current calendar year to determine the percentage of the calculated aggregate savings 
5.15 	amount accruing to state-administered health care programs.
5.16 	(b) The commissioner may use the data submitted under section 62U.04, subdivisions 
5.17 	4 and, 5, and 5b, to complete the activities required under this section, but may only report 
5.18 	publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.

5.19 	Sec. 6. REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
 5.20 		Subdivision 1.Definitions. (a) The terms defined in this subdivision apply to this section.
5.21 	(b) "Commissioner" means commissioner of health.
5.22 	(c) "Primary care services" means integrated, accessible health care services provided 
5.23 	by clinicians who are accountable for addressing a large majority of personal health care 
5.24 	needs, developing a sustained partnership with patients, and practicing in the context of 
5.25 	family and community. Primary care services include but are not limited to preventive 
5.26 	services, office visits, administration of vaccines, annual physicals, pre-operative physicals, 
5.27 	assessments, care coordination, development of treatment plans, management of chronic 
5.28 	conditions, and diagnostic tests.
5.29 	(d) "Non-claims-based payments" means payments to health care providers designed to 
5.30 	support and reward value over volume and include alternative payment models or incentives, 
5.31 	payments for infrastructure expenditures or investments, or payments for workforce 
5.32 	expenditures or investments.
6.1 		Subd. 2.Report. (a) To provide the legislature with information needed to meet the 
6.2 	evolving health care needs of Minnesotans, the commissioner shall report to the legislature 
6.3 	by February 15, 2023, on the volume and distribution of health care spending across payment 
6.4 	models in use by health plan companies and third-party administrators, with a particular 
6.5 	focus on value-based care models and primary care spending.
6.6 	(b) The report must include health plan company and third-party-specific estimates on 
6.7 	health care spending for claims-based payments and non-claims-based payments for the 
6.8 	most recent available year, reported separately for Minnesotans enrolled in Minnesota health 
6.9 	care programs, Medicare Advantage, and commercial health insurance. The report must 
6.10 	also include recommendations on changes needed to gather better data from health plan 
6.11 	companies and third-party administrators on the use of value-based payments that pays for 
6.12 	value over volume of services provided, that promotes the health of all Minnesotans, that 
6.13 	reduces health disparities, and that supports the provision of primary care services and 
6.14 	preventive services.
6.15 	(c) In preparing the report, the commissioner shall perform the following duties:
6.16 	(1) describe the form, manner, and timeline for submission of data by health plan 
6.17 	companies and third-party administrators to produce estimates as specified in paragraph 
6.18 	(b);
6.19 	(2) collect summary data that permits the computation of:
6.20 	(i) the percentage of total payments that are non-claims-based payments; and
6.21 	(ii) the percentage of payments in item (i) that are for primary care services;
6.22 	(3) where data was not directly derived, collect methods used to estimate data elements;
6.23 	(4) notwithstanding the provisions in Minnesota Statutes, section 62U.04, subdivision 
6.24 	11, conduct analyses of the magnitude of primary care payments using data collected by 
6.25 	the commissioner in Minnesota Statutes, section 62U.04; and
6.26 	(5) conduct interviews with health plan companies and third-party administrators to 
6.27 	better understand the types of non-claims-based payments and models in use, the purposes 
6.28 	or goals of each, the criteria for providers to qualify for these payments, and the timing and 
6.29 	structure of making these payments between health plan companies, third-party administrators 
6.30 	and health care provider organizations.
6.31 	(d) Health plan companies and third-party administrators must comply with data requests 
6.32 	from the commissioner in paragraph (b) within 60 days.
7.1 	(e) Data collected under this subdivision are nonpublic data as defined in Minnesota 
7.2 	Statutes, section 13.02. Notwithstanding the definition of summary data in Minnesota 
7.3 	Statutes, section 13.02, subdivision 19, summary data prepared under this section may be 
7.4 	derived from nonpublic data. The commissioner shall establish procedures and safeguards 
7.5 	to protect the integrity and confidentiality of any data that the commissioner maintains.