HF 1487

Introduction - 94th Legislature (2025 - 2026)

Posted on 02/24/2025 03:28 p.m.

A bill for an act
relating to health; requiring data on fully denied claims to be submitted to the
all-payer claims database; establishing a fee schedule for expanded access to data
in the all-payer claims database; appropriating money; amending Minnesota Statutes
2024, section 62U.04, subdivisions 4, 13, by adding a subdivision.

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

Section 1.

Minnesota Statutes 2024, section 62U.04, subdivision 4, is amended to read:

Subd. 4.

Encounter data.

(a) All health plan companies, dental organizations, and
third-party administrators shall submit encounter data on a monthly basis to a private entity
designated by the commissioner of health. The data shall be submitted in a form and manner
specified by the commissioner subject to the following requirements:

(1) the data must be de-identified data as described under the Code of Federal Regulations,
title 45, section 164.514;

(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care home, data on contractual value-based payments,
and data deemed necessary by the commissioner to uniquely identify claims in the individual
health insurance market;

(3) the data must include enrollee race and ethnicity, to the extent available, for claims
incurred on or after January 1, 2023; deleted text begin and
deleted text end

(4) except for the data described in clauses (2) and (3), the data must not include
information that is not included in a health care claim, dental care claim, or equivalent
encounter information transaction that is required under section 62J.536 deleted text begin . deleted text end new text begin ; and
new text end

new text begin (5) the data must include at least the following data fields for any fully denied claims:
new text end

new text begin (i) an indicator of which claim lines were denied;
new text end

new text begin (ii) the reason for denial of each denied claim line;
new text end

new text begin (iii) the claim line status in terms of adjudication; and
new text end

new text begin (iv) a claim identifier to link the original claim to subsequent actions on the claim.
new text end

(b) The commissioner or the commissioner's designee shall only use the data submitted
under paragraph (a) to carry out the commissioner's responsibilities in this section, including
supplying the data to providers so they can verify their results of the peer grouping process
consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
and adopted by the commissioner and, if necessary, submit comments to the commissioner
or initiate an appeal.

(c) Data on providers collected under this subdivision are private data on individuals or
nonpublic data, as defined in section 13.02. Notwithstanding the data classifications in this
paragraph, data on providers collected under this subdivision may be released or published
as authorized in subdivision 11. The commissioner or the commissioner's designee shall
establish procedures and safeguards to protect the integrity and confidentiality of any data
that it maintains.

(d) The commissioner or the commissioner's designee shall not publish analyses or
reports that identify, or could potentially identify, individual patients.

(e) The commissioner shall compile summary information on the data submitted under
this subdivision. The commissioner shall work with its vendors to assess the data submitted
in terms of compliance with the data submission requirements and the completeness of the
data submitted by comparing the data with summary information compiled by the
commissioner and with established and emerging data quality standards to ensure data
quality.

Sec. 2.

Minnesota Statutes 2024, section 62U.04, subdivision 13, is amended to read:

Subd. 13.

Expanded access to and use of the all-payer claims data.

(a) The
commissioner or the commissioner's designee shall make the data submitted under
subdivisions 4, 5, 5a, and 5b, including data classified as private or nonpublic, available to
individuals and organizations engaged in research on, or efforts to effect transformation in,
health care outcomes, access, quality, disparities, or spending, provided the use of the data
serves a public benefit. Data made available under this subdivision may not be used to:

(1) create an unfair market advantage for any participant in the health care market in
Minnesota, including health plan companies, payers, and providers;

(2) reidentify or attempt to reidentify an individual in the data; or

(3) publicly report contract details between a health plan company and provider and
derived from the data.

(b) To implement paragraph (a), the commissioner shall:

(1) establish detailed requirements for data access; a process for data users to apply to
access and use the data; legally enforceable data use agreements to which data users must
consent; a clear and robust oversight process for data access and use, including a data
management plan, that ensures compliance with state and federal data privacy laws;
agreements for state agencies and the University of Minnesota to ensure proper and efficient
use and security of data; and technical assistance for users of the data and for stakeholders;

(2) deleted text begin develop a fee deleted text end new text begin assess fees according to the fee new text end schedule new text begin in subdivision 14 new text end to support
the cost of expanded access to and use of the data, provided the fees charged under the
schedule do not create a barrier to access or use for those most affected by disparities; deleted text begin and
deleted text end

(3) create a research advisory group to advise the commissioner on applications for data
use under this subdivision, including an examination of the rigor of the research approach,
the technical capabilities of the proposed user, and the ability of the proposed user to
successfully safeguard the data deleted text begin . deleted text end new text begin ; and
new text end

new text begin (4) annually publish on the Department of Health website a list of projects authorized
under this subdivision.
new text end

Sec. 3.

Minnesota Statutes 2024, section 62U.04, is amended by adding a subdivision to
read:

new text begin Subd. 14. new text end

new text begin Fees for expanded access to and use of the all-payer claims database. new text end

new text begin (a)
For purposes of this section:
new text end

new text begin (1) "custom data set or report" means a de-identified data set or report for which a
standard data set or limited-use data set is not appropriate, that only provides the minimum
necessary data, and that is de-identified using the expert determination method as defined
in Code of Federal Regulations, title 45, section 164.514(b)(1);
new text end

new text begin (2) "data file" means a data file derived from medical claims, pharmacy claims, dental
claims, eligibility information, membership information, or provider information for a single
year;
new text end

new text begin (3) "limited-use data set" means a data set that meets the requirements in Code of Federal
Regulations, title 45, section 164.514(e), the data of which, disclosed under the principle
of minimum necessity, may include protected health information from which certain direct
identifiers of individuals have been removed; and
new text end

new text begin (4) "standard data set" means a static data release designed by the commissioner to serve
a wide range of projects in which nearly all de-identified releasable data elements are
disclosed in one release after applying the safe harbor de-identification method as defined
in Code of Federal Regulations, title 45, section 164.514(b)(2), and from which protected
health information and any combination of data elements that directly identify any person
are excluded.
new text end

new text begin (b) The commissioner must assess fees on an individual or organization that requests to
access or receive data for an activity specified in subdivision 13 for the cost of accessing
or receiving the data. "Cost" under this paragraph may include but is not limited to the cost
of producing and releasing data to the individual or organization under subdivision 13 and
managing infrastructure and operations. The commissioner must assess fees according to
the following schedule, based on the type of data requested and number of years for which
access is requested:
new text end

new text begin (1) the fee for a standard data set is $3,500 per data file per year;
new text end

new text begin (2) the fee for a limited-use data set is $7,000 per data file per year; and
new text end

new text begin (3) the fee for a custom data set or report is $100 per hour of staff time expended, not
to exceed 40 hours of staff time.
new text end

new text begin (c) The commissioner may grant a partial or full waiver of the fees in paragraph (b) if
the individual or organization requesting access to the data meets at least one of the following
criteria:
new text end

new text begin (1) the fee represents a financial hardship to the individual or organization;
new text end

new text begin (2) the organization is a self-insured data submitter under this section;
new text end

new text begin (3) the individual or organization is affiliated with an academic institution; or
new text end

new text begin (4) the individual or organization requests a high volume of data files.
new text end

new text begin In determining whether to grant a waiver under this paragraph, the commissioner may
consult with the research advisory group established under subdivision 13.
new text end

new text begin (d) An individual or organization that receives approval to access or receive data under
subdivision 13 must pay all required fees in full before accessing or receiving the requested
data.
new text end

new text begin (e) Fees paid by an individual or organization approved to access or receive data under
subdivision 13 are nonrefundable. Fees collected under this subdivision must be deposited
in an account in the special revenue fund. Money in that account does not cancel and is
appropriated to the commissioner for purposes of offsetting the cost of providing expanded
access to data under subdivision 13 and maintaining data submitted under subdivisions 4
to 5b.
new text end

new text begin (f) The commissioner must publish the fee schedule in paragraph (b) on the Department
of Health website.
new text end

Sec. 4. new text begin APPROPRIATION; COLLECTION OF DATA ON FULLY DENIED
CLAIMS.
new text end

new text begin $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
fund to the commissioner of health for purposes of collecting data on fully denied claims
according to Minnesota Statutes, section 62U.04, subdivision 4.
new text end