1st Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am
Engrossments | ||
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1st Engrossment | Posted on 08/14/1998 |
1.1 A bill for an act 1.2 relating to health; revising the data and research 1.3 initiatives of MinnesotaCare; amending Minnesota 1.4 Statutes 1994, sections 13.99, by adding a 1.5 subdivision; 62J.04, subdivision 3; 62J.06; 62J.212; 1.6 62J.37; 62J.38; 62J.40; 62J.41, subdivisions 1 and 2; 1.7 62J.54; 62J.55; 62J.58; 62Q.03, subdivisions 1, 6, 7, 1.8 8, 9, 10, and by adding subdivisions; 214.16, 1.9 subdivisions 2 and 3; and 295.57; proposing coding for 1.10 new law in Minnesota Statutes, chapter 62J; repealing 1.11 Minnesota Statutes 1994, sections 62J.30; 62J.31; 1.12 62J.32; 62J.33; 62J.34; 62J.35; 62J.41, subdivisions 3 1.13 and 4; 62J.44; and 62J.45. 1.14 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.15 Section 1. Minnesota Statutes 1994, section 13.99, is 1.16 amended by adding a subdivision to read: 1.17 Subd. 115. [HEALTH DATA INSTITUTE DATA.] Data created, 1.18 collected, received, maintained, or disseminated by the 1.19 Minnesota health data institute established under section 1.20 62J.451 are classified under section 62J.452; access to and 1.21 disclosure of such data are governed by section 62J.452. 1.22 Sec. 2. Minnesota Statutes 1994, section 62J.04, 1.23 subdivision 3, is amended to read: 1.24 Subd. 3. [COST CONTAINMENT DUTIES.] After obtaining the 1.25 advice and recommendations of the Minnesota health care 1.26 commission, the commissioner shall: 1.27 (1) establish statewide and regional limits on growth in 1.28 total health care spending under this section, monitorregional1.29andstatewide compliance with the spending limits, and take 2.1 action to achieve compliance to the extent authorized by the 2.2 legislature; 2.3 (2) divide the state into no fewer than four regions, with 2.4 one of those regions being the Minneapolis/St. Paul metropolitan 2.5 statistical area but excluding Chisago, Isanti, Wright, and 2.6 Sherburne counties, for purposes of fostering the development of 2.7 regional health planning and coordination of health care 2.8 delivery among regional health care systems and working to 2.9 achieve spending limits; 2.10 (3) provide technical assistance to regional coordinating 2.11 boards; 2.12 (4) monitor the quality of health care throughout the 2.13 state, conduct consumer satisfaction surveys,and take action as 2.14 necessary to ensure an appropriate level of quality; 2.15 (5) issue recommendations regarding uniform billing forms, 2.16 uniform electronic billing procedures and data interchanges, 2.17 patient identification cards, and other uniform claims and 2.18 administrative procedures for health care providers and private 2.19 and public sector payers. In developing the recommendations, 2.20 the commissioner shall review the work of the work group on 2.21 electronic data interchange (WEDI) and the American National 2.22 Standards Institute (ANSI) at the national level, and the work 2.23 being done at the state and local level. The commissioner may 2.24 adopt rules requiring the use of the Uniform Bill 82/92 form, 2.25 the National Council of Prescription Drug Providers (NCPDP) 3.2 2.26 electronic version, the Health Care Financing Administration 2.27 1500 form, or other standardized forms or procedures; 2.28 (6) undertake health planning responsibilities as provided 2.29 in section 62J.15; 2.30 (7)monitor and promote the development and implementation2.31of practice parameters;2.32(8)authorize, fund, or promote research and 2.33 experimentation on new technologies and health care procedures; 2.34(9) designate referral centers for specialized and2.35high-cost procedures and treatment and establish minimum2.36standards and requirements for particular procedures or3.1treatment;3.2(10)(8) within the limits of appropriations for these 3.3 purposes, administer or contract for statewide consumer 3.4 education and wellness programs that will improve the health of 3.5 Minnesotans and increase individual responsibility relating to 3.6 personal health and the delivery of health care services, 3.7 undertake prevention programs including initiatives to improve 3.8 birth outcomes, expand childhood immunization efforts, and 3.9 provide start-up grants for worksite wellness programs; and 3.10(11) administer the data analysis unit; and3.11(12)(9) undertake other activities to monitor and oversee 3.12 the delivery of health care services in Minnesota with the goal 3.13 of improving affordability, quality, and accessibility of health 3.14 care for all Minnesotans. 3.15 Sec. 3. Minnesota Statutes 1994, section 62J.06, is 3.16 amended to read: 3.17 62J.06 [IMMUNITY FROM LIABILITY.] 3.18 No member of the Minnesota health care commission 3.19 established under section 62J.05, regional coordinating boards 3.20 established under section 62J.09, or the health 3.21planningtechnology advisory committee established under section 3.22 62J.15,data collection advisory committee established under3.23section 62J.30, or practice parameter advisory committee3.24established under section 62J.32shall be held civilly or 3.25 criminally liable for an act or omission by that person if the 3.26 act or omission was in good faith and within the scope of the 3.27 member's responsibilities under this chapter. 3.28 Sec. 4. Minnesota Statutes 1994, section 62J.212, is 3.29 amended to read: 3.30 62J.212 [COLLABORATION ONPUBLIC HEALTH GOALS.] 3.31The commissioner may increase regional spending limits if3.32public health goals for that region are achieved.The 3.33 commissioner shall establish specific public health goals 3.34 including, but not limited to, increased delivery of prenatal 3.35 care, improved birth outcomes, and expanded childhood 3.36 immunizations. The commissioner shall consider the community 4.1 public health goals and the input of the statewide advisory 4.2 committee on community health in establishing the statewide 4.3 goals. 4.4 Sec. 5. [62J.2930] [INFORMATION CLEARINGHOUSE.] 4.5 Subdivision 1. [ESTABLISHMENT.] The commissioner of health 4.6 shall establish an information clearinghouse within the 4.7 department of health to facilitate the ability of consumers, 4.8 employers, providers, health plan companies, and others to 4.9 obtain information on health reform activities in Minnesota. 4.10 The commissioner shall make available through the clearinghouse 4.11 updates on federal and state health reform activities, including 4.12 information developed or collected by the department of health 4.13 on cost containment or other research initiatives, the 4.14 development of integrated service networks, and voluntary 4.15 purchasing pools, action plans submitted by health plan 4.16 companies, reports or recommendations of the health technology 4.17 advisory committee and other entities on technology assessments, 4.18 and reports or recommendations from other formal committees 4.19 applicable to health reform activities. The clearinghouse shall 4.20 also refer requesters to sources of further information or 4.21 assistance. The clearinghouse is subject to chapter 13. 4.22 Subd. 2. [INFORMATION ON HEALTH PLAN COMPANIES.] The 4.23 information clearinghouse shall provide information on all 4.24 health plan companies operating in a specific geographic area to 4.25 consumers and purchasers who request it. 4.26 Subd. 3. [COORDINATION.] To the extent possible, the 4.27 commissioner shall coordinate the activities of the 4.28 clearinghouse with the activities of the Minnesota health data 4.29 institute. 4.30 Sec. 6. [62J.301] [RESEARCH AND DATA INITIATIVES.] 4.31 Subdivision 1. [DEFINITIONS.] For purposes of sections 4.32 62J.2930 to 62J.42, the following definitions apply: 4.33 (a) "Health outcomes data" means data used in research 4.34 designed to identify and analyze the outcomes and costs of 4.35 alternative interventions for a given clinical condition, in 4.36 order to determine the most appropriate and cost-effective means 5.1 to prevent, diagnose, treat, or manage the condition, or in 5.2 order to develop and test methods for reducing inappropriate or 5.3 unnecessary variations in the type and frequency of 5.4 interventions. 5.5 (b) "Encounter level data" means data related to the 5.6 utilization of health care services by, and the provision of 5.7 health care services to individual patients, enrollees, or 5.8 insureds, including claims data, abstracts of medical records, 5.9 and data from patient interviews and patient surveys. 5.10 Subd. 2. [STATEMENT OF PURPOSE.] The commissioner of 5.11 health shall conduct data and research initiatives in order to 5.12 monitor and improve the efficiency and effectiveness of health 5.13 care in Minnesota. 5.14 Subd. 3. [GENERAL DUTIES.] The commissioner shall: 5.15 (1) collect and maintain data which enable population-based 5.16 monitoring and trending of the access, utilization, quality, and 5.17 cost of health care services within Minnesota; 5.18 (2) collect and maintain data for the purpose of estimating 5.19 total Minnesota health care expenditures and trends; 5.20 (3) collect and maintain data for the purposes of setting 5.21 limits under section 62J.04, and measuring growth limit 5.22 compliance; 5.23 (4) conduct applied research using existing and new data 5.24 and promote applications based on existing research; 5.25 (5) develop and implement data collection procedures to 5.26 ensure a high level of cooperation from health care providers 5.27 and health plan companies, as defined in section 62Q.01, 5.28 subdivision 4; 5.29 (6) work closely with health plan companies and health care 5.30 providers to promote improvements in health care efficiency and 5.31 effectiveness; and 5.32 (7) participate as a partner or sponsor of private sector 5.33 initiatives that promote publicly disseminated applied research 5.34 on health care delivery, outcomes, costs, quality, and 5.35 management. 5.36 Subd. 4. [INFORMATION TO BE COLLECTED.] (a) The data 6.1 collected may include health outcomes data, patient functional 6.2 status, and health status. The data collected may include 6.3 information necessary to measure and make adjustments for 6.4 differences in the severity of patient condition across 6.5 different health care providers, and may include data obtained 6.6 directly from the patient or from patient medical records, as 6.7 provided in section 62J.321, subdivision 1. 6.8 (b) The commissioner may: 6.9 (1) collect the encounter level data required for the 6.10 research and data initiatives of sections 62J.301 to 62J.42, 6.11 using, to the greatest extent possible, standardized forms and 6.12 procedures; and 6.13 (2) process the data collected to ensure validity, 6.14 consistency, accuracy, and completeness, and as appropriate, 6.15 merge data collected from different sources. 6.16 (c) For purposes of estimating total health care spending 6.17 and forecasting rates of growth in health care spending, the 6.18 commissioner may collect from health care providers data on 6.19 patient revenues and health care spending during a time period 6.20 specified by the commissioner. The commissioner may also 6.21 collect data on health care revenues and spending from group 6.22 purchasers of health care. Health care providers and group 6.23 purchasers doing business in the state shall provide the data 6.24 requested by the commissioner at the times and in the form 6.25 specified by the commissioner. Professional licensing boards 6.26 and state agencies responsible for licensing, registering, or 6.27 regulating providers and group purchasers shall cooperate fully 6.28 with the commissioner in achieving compliance with the reporting 6.29 requirements. 6.30 Subd. 5. [NONLIMITING.] Nothing in this section shall be 6.31 construed to limit the powers granted to the commissioner of 6.32 health under chapter 62D, 62N, 144, or 144A. 6.33 Sec. 7. [62J.311] [ANALYSIS AND USE OF DATA.] 6.34 Subdivision 1. [DATA ANALYSIS.] The commissioner shall 6.35 analyze the data collected to: 6.36 (1) assist the state in developing and refining its health 7.1 policy in the areas of access, utilization, quality, and cost; 7.2 (2) assist the state in promoting efficiency and 7.3 effectiveness in the financing and delivery of health services; 7.4 (3) monitor and track accessibility, utilization, quality, 7.5 and cost of health care services within the state; 7.6 (4) evaluate the impact of health care reform activities; 7.7 (5) assist the state in its public health activities; and 7.8 (6) evaluate and determine the most appropriate methods for 7.9 ongoing data collection. 7.10 Subd. 2. [CRITERIA FOR DATA AND RESEARCH INITIATIVES.] (a) 7.11 Data and research initiatives by the commissioner must: 7.12 (1) serve the needs of the general public, public sector 7.13 health care programs, employers and other purchasers of health 7.14 care, health care providers, including providers serving large 7.15 numbers of people with low-income, and health plan companies as 7.16 applicable; 7.17 (2) be based on scientifically sound and statistically 7.18 valid methods; 7.19 (3) be statewide in scope, to the extent feasible, in order 7.20 to benefit health care purchasers and providers in all parts of 7.21 Minnesota and to ensure broad and representative health care 7.22 data for research comparisons and applications; 7.23 (4) emphasize data that is useful, relevant, and 7.24 nonredundant of existing data. The initiatives may duplicate 7.25 existing private data collection activities, if necessary to 7.26 ensure that the data collected will be in the public domain; 7.27 (5) be structured to minimize the administrative burden on 7.28 health plan companies, health care providers, and the health 7.29 care delivery system, and minimize any privacy impact on 7.30 individuals; and 7.31 (6) promote continuous improvement in the efficiency and 7.32 effectiveness of health care delivery. 7.33 (b) Data and research initiatives related to public sector 7.34 health care programs must: 7.35 (1) assist the state's current health care financing and 7.36 delivery programs to deliver and purchase health care in a 8.1 manner that promotes improvements in health care efficiency and 8.2 effectiveness; 8.3 (2) assist the state in its public health activities, 8.4 including the analysis of disease prevalence and trends and the 8.5 development of public health responses; 8.6 (3) assist the state in developing and refining its overall 8.7 health policy, including policy related to health care costs, 8.8 quality, and access; and 8.9 (4) provide data that allows the evaluation of state health 8.10 care financing and delivery programs. 8.11 Sec. 8. [62J.321] [DATA COLLECTION AND PROCESSING 8.12 PROCEDURES.] 8.13 Subdivision 1. [DATA COLLECTION.] (a) The commissioner 8.14 shall collect data from health care providers, health plan 8.15 companies, and individuals in the most cost-effective manner, 8.16 which does not unduly burden them. The commissioner may require 8.17 health care providers and health plan companies to collect and 8.18 provide patient health records and claim files, and cooperate in 8.19 other ways with the data collection process. The commissioner 8.20 may also require health care providers and health plan companies 8.21 to provide mailing lists of patients. Patient consent shall not 8.22 be required for the release of data to the commissioner pursuant 8.23 to sections 62J.301 to 62J.42 by any group purchaser, health 8.24 plan company, health care provider; or agent, contractor, or 8.25 association acting on behalf of a group purchaser or health care 8.26 provider. Any group purchaser, health plan company, health care 8.27 provider; or agent, contractor, or association acting on behalf 8.28 of a group purchaser or health care provider, that releases data 8.29 to the commissioner in good faith pursuant to sections 62J.301 8.30 to 62J.42 shall be immune from civil liability and criminal 8.31 prosecution. 8.32 (b) When a group purchaser, health plan company, or health 8.33 care provider submits patient identifying data, as defined in 8.34 section 62J.451, to the commissioner pursuant to sections 8.35 62J.301 to 62J.42, and the data is submitted to the commissioner 8.36 in electronic form, or through other electronic means including, 9.1 but not limited to, the electronic data interchange system 9.2 defined in section 62J.451, the group purchaser, health plan 9.3 company, or health care provider shall submit the patient 9.4 identifying data in encrypted form, using an encryption method 9.5 specified by the commissioner. Submission of encrypted data as 9.6 provided in this paragraph satisfies the requirements of section 9.7 144.335, subdivision 3b. 9.8 (c) The commissioner shall require all health care 9.9 providers, group purchasers, and state agencies to use a 9.10 standard patient identifier and a standard identifier for 9.11 providers and health plan companies when reporting data under 9.12 this chapter. The commissioner must encrypt patient identifiers 9.13 to prevent identification of individual patients and to enable 9.14 release of otherwise private data to researchers, providers, and 9.15 group purchasers in a manner consistent with chapter 13 and 9.16 sections 62J.55 and 144.335. This encryption must ensure that 9.17 any data released must be in a form that makes it impossible to 9.18 identify individual patients. 9.19 Subd. 2. [FAILURE TO PROVIDE DATA.] The intentional 9.20 failure to provide the data requested under this chapter is 9.21 grounds for disciplinary or regulatory action against a 9.22 regulated provider or group purchaser. The commissioner may 9.23 assess a fine against a provider or group purchaser who refuses 9.24 to provide data required by the commissioner. If a provider or 9.25 group purchaser refuses to provide the data required, the 9.26 commissioner may obtain a court order requiring the provider or 9.27 group purchaser to produce documents and allowing the 9.28 commissioner to inspect the records of the provider or group 9.29 purchaser for purposes of obtaining the data required. 9.30 Subd. 3. [DATA COLLECTION AND REVIEW.] Data collection 9.31 must continue for a sufficient time to permit: adequate 9.32 analysis by researchers and appropriate providers, including 9.33 providers who will be impacted by the data; feedback to 9.34 providers; monitoring for changes in practice patterns; and the 9.35 data and research criteria of section 62J.311, subdivision 2, to 9.36 be fulfilled. 10.1 Subd. 4. [USE OF EXISTING DATA.] (a) The commissioner 10.2 shall negotiate with private sector organizations currently 10.3 collecting health care data of interest to the commissioner to 10.4 obtain required data in a cost-effective manner and minimize 10.5 administrative costs. The commissioner shall attempt to 10.6 establish links between the health care data collected to 10.7 fulfill sections 62J.301 to 62J.42 and existing private sector 10.8 data and shall consider and implement methods to streamline data 10.9 collection in order to reduce public and private sector 10.10 administrative costs. 10.11 (b) The commissioner shall use existing public sector data, 10.12 such as those existing for medical assistance and Medicare, to 10.13 the greatest extent possible. The commissioner shall establish 10.14 links between existing public sector data and consider and 10.15 implement methods to streamline public sector data collection in 10.16 order to reduce public and private sector administrative costs. 10.17 Subd. 5. [DATA CLASSIFICATION.] (a) Data collected to 10.18 fulfill the data and research initiatives authorized by sections 10.19 62J.301 to 62J.42 that identify individual patients or providers 10.20 are private data on individuals, and data not on individuals are 10.21 nonpublic data. The commissioner shall establish procedures and 10.22 safeguards to ensure that data released by the commissioner is 10.23 in a form that does not identify specific patients, providers, 10.24 employers, individual or group purchasers, or other specific 10.25 individuals and organizations, except with the permission of the 10.26 affected individual or organization, or as permitted elsewhere 10.27 in this chapter. 10.28 (b) Raw unaggregated data collected from household and 10.29 employer surveys used by the commissioner to monitor the number 10.30 of uninsured individuals, reasons for lack of insurance 10.31 coverage, and to evaluate the effectiveness of health care 10.32 reform, are subject to the same data classifications as data 10.33 collected pursuant to sections 62J.301 to 62J.42. 10.34 (c) Notwithstanding sections 13.03, subdivisions 6 to 8; 10.35 13.10, subdivisions 1 to 4; and 138.17, data received by the 10.36 commissioner pursuant to sections 62J.301 to 62J.42, shall 11.1 retain the classification designated under this section and 11.2 shall not be disclosed other than pursuant to this section. 11.3 (d) Summary data collected to fulfill the data and research 11.4 initiatives authorized by sections 62J.301 to 62J.42 may be 11.5 disseminated under section 13.05, subdivision 7. For the 11.6 purposes of this section, summary data includes nonpublic data 11.7 not on individuals. 11.8 (e) Notwithstanding paragraph (a), the commissioner may 11.9 publish nonpublic or private data collected pursuant to sections 11.10 62J.301 to 62J.42 on health care costs and spending, quality and 11.11 outcomes, and utilization for health care institutions, 11.12 individual health care professionals and groups of health care 11.13 professionals, group purchasers, and integrated service 11.14 networks, with a description of the methodology used for 11.15 analysis. The commissioner may not make public any patient 11.16 identifying information except as specified in statute. The 11.17 commissioner shall not reveal the name of an institution, group 11.18 of professionals, individual health care professional, group 11.19 purchaser, or integrated service network until after the 11.20 institution, group of professionals, individual health care 11.21 professional, group purchaser, or integrated service network has 11.22 had 21 days to review the data and comment. The commissioner 11.23 shall include comments received in the release of the data. 11.24 (f) A provider or group purchaser may contest whether the 11.25 data meets the criteria of section 62J.311, subdivision 2, 11.26 paragraph (a), clause (2), in accordance with a contested case 11.27 proceeding as set forth in sections 14.57 to 14.62, subject to 11.28 appeal in accordance with sections 14.63 to 14.68. To obtain a 11.29 contested case hearing, the provider or group purchaser must 11.30 make a written request to the commissioner before the end of the 11.31 time period for review and comment. Within ten days of the 11.32 assignment of an administrative law judge, the provider or group 11.33 purchaser shall make a clear showing to the administrative law 11.34 judge of probable success in a hearing on the issue of whether 11.35 the data are accurate and valid and were collected based on the 11.36 criteria of section 62J.311, subdivision 2, paragraph (a), 12.1 clause (2). If the administrative law judge determines that the 12.2 provider or group purchaser has made such a showing, the data 12.3 shall remain private or nonpublic during the contested case 12.4 proceeding and appeal. If the administrative law judge 12.5 determines that the provider or group purchaser has not made 12.6 such a showing, the commissioner may publish the data 12.7 immediately, with comments received in the release of the data. 12.8 The contested case proceeding and subsequent appeal is not an 12.9 exclusive remedy and any person may seek a remedy pursuant to 12.10 section 13.08, subdivisions 1 to 4, or as otherwise authorized 12.11 by law. 12.12 Subd. 6. [RULEMAKING.] The commissioner may adopt rules to 12.13 implement sections 62J.301 to 62J.42. 12.14 Subd. 7. [FEDERAL AND OTHER GRANTS.] The commissioner may 12.15 seek federal funding, and funding from private and other 12.16 nonstate sources, for data and research initiatives. 12.17 Subd. 8. [CONTRACTS AND GRANTS.] To carry out the duties 12.18 assigned in sections 62J.301 to 62J.42, the commissioner may 12.19 contract with or provide grants to private sector entities. Any 12.20 contract or grant must require the private sector entity to 12.21 maintain the data which it receives according to the statutory 12.22 provisions applicable to the data. 12.23 Sec. 9. [62J.322] [PROVIDER INFORMATION PILOT STUDY.] 12.24 The commissioner shall develop a pilot study to collect 12.25 comparative data from health care providers on opportunities and 12.26 barriers to the provision of quality, cost-effective health 12.27 care. The provider information pilot study shall include 12.28 providers in community integrated service networks, integrated 12.29 service networks, health maintenance organizations, preferred 12.30 provider organizations, indemnity insurance plans, public 12.31 programs, and other health plan companies. Health plan 12.32 companies and group purchasers shall provide to the commissioner 12.33 providers' names, health plan assignment, and other appropriate 12.34 data necessary for the commissioner to conduct the study. The 12.35 provider information pilot study shall examine factors that 12.36 increase and hinder access to the provision of quality, 13.1 cost-effective health care. The study may examine: 13.2 (1) administrative barriers and facilitators; 13.3 (2) time spent obtaining permission for appropriate and 13.4 necessary treatments; 13.5 (3) latitude to order appropriate and necessary tests, 13.6 pharmaceuticals, and referrals to specialty providers; 13.7 (4) assistance available for decreasing administrative and 13.8 other routine paperwork activities; 13.9 (5) continuing education opportunities provided; 13.10 (6) access to readily available information on diagnoses, 13.11 diseases, outcomes, and new technologies; 13.12 (7) continuous quality improvement activities; 13.13 (8) inclusion in administrative decision making; 13.14 (9) access to social services and other services that 13.15 facilitate continuity of care; 13.16 (10) economic incentives and disincentives; 13.17 (11) peer review procedures; and 13.18 (12) the prerogative to address public health needs. 13.19 In selecting additional data for collection, the 13.20 commissioner shall consider the: (i) statistical validity of 13.21 the data; (ii) public need for the data; (iii) estimated expense 13.22 of collecting and reporting the data; and (iv) usefulness of the 13.23 data to identify barriers and opportunities to improve quality 13.24 care provision within health plan companies. 13.25 Sec. 10. Minnesota Statutes 1994, section 62J.37, is 13.26 amended to read: 13.27 62J.37 [COST CONTAINMENT DATA FROM INTEGRATED SERVICE 13.28 NETWORKS.] 13.29 The commissioner shall require integrated service networks 13.30 operating under section 62N.06, subdivision 1, to submit data on 13.31 health care spending and revenue for calendar year19941996 by 13.32February 15, 1995April 1, 1997. EachFebruary 15April 1 13.33 thereafter, integrated service networks shall submit to the 13.34 commissioner data on health care spending and revenue for the 13.35 preceding calendar year. The data must be provided in the form 13.36 specified by the commissioner. To the extent that an integrated 14.1 service network is operated by a group purchaser under section 14.2 62N.06, subdivision 2, the integrated service network is exempt 14.3 from this section and the group purchaser must provide data on 14.4 the integrated service network under section 62J.38. 14.5 Sec. 11. Minnesota Statutes 1994, section 62J.38, is 14.6 amended to read: 14.7 62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 14.8 (a) The commissioner shall require group purchasers to 14.9 submit detailed data on total health care spending forcalendar14.10years 1990, 1991, and 1992, and foreach calendar year1993 and14.11successive calendar years. Group purchasers shall submit data 14.12 for the 1993 calendar year by April 1, 1994, and each April 1 14.13 thereafter shall submit data for the preceding calendar year. 14.14 (b) The commissioner shall require each group purchaser to 14.15 submit data on revenue, expenses, and member months, as 14.16 applicable. Revenue data must distinguish between premium 14.17 revenue and revenue from other sources and must also include 14.18 information on the amount of revenue in reserves and changes in 14.19 reserves. Expenditure data, including raw data from claims, 14.20mustmay be provided separately for the following categories or 14.21 for other categories required by the commissioner: physician 14.22 services, dental services, other professional services, 14.23 inpatient hospital services, outpatient hospital services, 14.24 emergencyand out-of-area care, pharmacy services and 14.25prescription drugsother nondurable medical goods, mental health 14.26services, and chemical dependency services, other expenditures, 14.27 subscriber liability, and administrative costs. The 14.28 commissioner may require each group purchaser to submit any 14.29 other data, including data in unaggregated form, for the 14.30 purposes of developing spending estimates, setting spending 14.31 limits, and monitoring actual spending and costs. 14.32 (c) The commissioner may collect information on: 14.33 (1) premiums, benefit levels, managed care procedures, and 14.34 other features of health plan companies; 14.35 (2) prices, provider experience, and other information for 14.36 services less commonly covered by insurance or for which 15.1 patients commonly face significant out-of-pocket expenses; and 15.2 (3) information on health care services not provided 15.3 through health plan companies, including information on prices, 15.4 costs, expenditures, and utilization. 15.5(c) State agencies and(d) Allothergroup purchasers shall 15.6 provide the required data using a uniform format and uniform 15.7 definitions, as prescribed by the commissioner. 15.8 Sec. 12. Minnesota Statutes 1994, section 62J.40, is 15.9 amended to read: 15.10 62J.40 [COST CONTAINMENT DATA FROM STATE AGENCIES AND OTHER 15.11 GOVERNMENTAL UNITS.] 15.12In addition to providing the data required under section15.1362J.38, the commissioners of human services, commerce, labor and15.14industry, and employee relations and(a) Allotherstate 15.15 departments or agencies that administer one or more health care 15.16 programs shall provide to the commissioner of health any 15.17 additional data on the health care programs they administer that 15.18 is requested by the commissioner of health, including data in 15.19 unaggregated form, for purposes of developing estimates of 15.20 spending, setting spending limits, and monitoring actual 15.21 spending. The data must be provided at the times and in the 15.22 form specified by the commissioner of health. 15.23 (b) For purposes of estimating total health care spending 15.24 as provided in section 62J.301, subdivision 4, paragraph (c), 15.25 all local governmental units shall provide expenditure data to 15.26 the commissioner. The commissioner shall consult with 15.27 representatives of the affected local government units in 15.28 establishing definitions, reporting formats, and reporting time 15.29 frames. As much as possible, the data shall be collected in a 15.30 manner that ensures that the data collected is consistent with 15.31 data collected from the private sector and minimizes the 15.32 reporting burden to local government. 15.33 Sec. 13. Minnesota Statutes 1994, section 62J.41, 15.34 subdivision 1, is amended to read: 15.35 Subdivision 1. [COST CONTAINMENT DATA TO BE COLLECTED FROM 15.36 PROVIDERS.] The commissioner shall require health care providers 16.1 to collect and provide both patient specific information and 16.2 descriptive and financial aggregate data on: 16.3 (1) the total number of patients served; 16.4 (2) the total number of patients served by state of 16.5 residence and Minnesota county; 16.6 (3) the site or sites where the health care provider 16.7 provides services; 16.8 (4) the number of individuals employed, by type of 16.9 employee, by the health care provider; 16.10 (5) the services and their costs for which no payment was 16.11 received; 16.12 (6) total revenue by type of payer or by groups of payers, 16.13 including but not limited to, revenue from Medicare, medical 16.14 assistance, MinnesotaCare, nonprofit health service plan 16.15 corporations, commercial insurers, integrated service networks, 16.16 health maintenance organizations, and individual patients; 16.17 (7) revenue from research activities; 16.18 (8) revenue from educational activities; 16.19 (9) revenue from out-of-pocket payments by patients; 16.20 (10) revenue from donations; and 16.21 (11) any other data required by the commissioner, including 16.22 data in unaggregated form, for the purposes of developing 16.23 spending estimates, setting spending limits, monitoring actual 16.24 spending, and monitoring costsand quality. 16.25 The commissioner may, by rule, modify the data submission 16.26 categories listed above if the commissioner determines that this 16.27 will reduce the reporting burden on providers without having a 16.28 significant negative effect on necessary data collection efforts. 16.29 Sec. 14. Minnesota Statutes 1994, section 62J.41, 16.30 subdivision 2, is amended to read: 16.31 Subd. 2. [ANNUAL MONITORING AND ESTIMATES.] The 16.32 commissioner shall require health care providers to submit the 16.33 required data for the period July 1, 1993 to December 31, 1993, 16.34 by April 1, 1994. Health care providers shall submit data for 16.35 the 1994 calendar year by April 1, 1995, and each April 1 16.36 thereafter shall submit data for the preceding calendar year. 17.1 The commissioner of revenue may collect health care service 17.2 revenue data from health care providers, if the commissioner of 17.3 revenue and the commissioner agree that this is the most 17.4 efficient method of collecting the data. Thecommissioner of17.5revenue shall provide any data collected to the commissioner of17.6healthcommissioners of health and revenue shall have the 17.7 authority to share data collected pursuant to this section. 17.8 Sec. 15. [62J.451] [MINNESOTA HEALTH DATA INSTITUTE.] 17.9 Subdivision 1. [STATEMENT OF PURPOSE.] It is the intention 17.10 of the legislature to create a partnership between the public 17.11 and the private sectors for the coordination of efforts related 17.12 to the collection, analysis, and dissemination of cost, access, 17.13 quality, utilization, and other performance data, to the extent 17.14 administratively efficient and effective. 17.15 The Minnesota health data institute shall be a partnership 17.16 between the commissioner of health and a board of directors 17.17 representing group purchasers, health care providers, and 17.18 consumers. 17.19 Subd. 2. [DEFINITIONS.] For purposes of this section and 17.20 section 62J.452, the following definitions apply. 17.21 (a) "Analysis" means the identification of selected data 17.22 elements, a description of the methodology used to select or 17.23 analyze those data elements, and any other commentary, 17.24 conclusions, or other descriptive material that the health data 17.25 institute determines is appropriately included, all of which is 17.26 undertaken by the health data institute for one or more of the 17.27 purposes or objectives set forth in subdivisions 1 and 3, or by 17.28 other authorized researchers pursuant to section 62J.452, 17.29 subdivision 6. 17.30 (b) "Board" means the board of directors of the health data 17.31 institute. 17.32 (c) "Database" means a compilation of selected data 17.33 elements by the health data institute for the purpose of 17.34 conducting an analysis or facilitating an analysis by another 17.35 party. 17.36 (d) "Electronic data interchange system" or "EDI system" 18.1 means the electronic data system developed, implemented, 18.2 maintained, or operated by the health data institute, as 18.3 permitted by subdivisions 3, clause (2), and 5, according to 18.4 standards adopted by the health data institute. 18.5 (e) "Encounter level data" means data related to the 18.6 utilization of health care services by, and the provision of 18.7 health care services to, individual patients, enrollees, or 18.8 insureds, including claims data, abstracts of medical records, 18.9 and data from patient interviews and patient surveys. 18.10 (f) "Group purchaser" has the definition provided in 18.11 section 62J.03, subdivision 6. 18.12 (g) "Health data institute" means the public-private 18.13 partnership between the commissioner of health and the board of 18.14 directors established under this section. 18.15 (h) "Health plan company" has the definition provided in 18.16 section 62Q.01, subdivision 4. 18.17 (i) "Industry participant" means any group purchaser, 18.18 employers with employee health benefit plans, regardless of the 18.19 manner in which benefits are provided or paid for under the 18.20 plan, provider, or state agency or political subdivision, with 18.21 the exception of professional licensing boards or law 18.22 enforcement agencies. 18.23 (j) "Industry participant identifying data" means any data 18.24 that identifies a specific industry participant directly, or 18.25 which identifies characteristics which reasonably could uniquely 18.26 identify such specific industry participant circumstantially. 18.27 For purposes of this definition, an industry participant is not 18.28 "directly identified" by the use of a unique identification 18.29 number, provided that the number is coded or encrypted through a 18.30 reliable system that can reasonably assure that such numbers 18.31 cannot be traced back by an unauthorized person to determine the 18.32 identity of an industry participant with a particular number. 18.33 (k) "Patient" is an individual as defined in section 13.02, 18.34 subdivision 8, except that "patient" does not include any 18.35 industry participant acting as an industry participant rather 18.36 than as a consumer of health care services or coverage. 19.1 (l) "Patient identifying data" means data that identifies a 19.2 patient directly, or which identifies characteristics which 19.3 reasonably could uniquely identify such specific patients 19.4 circumstantially. For purposes of this definition, a patient is 19.5 not "directly identified" by the use of a unique identification 19.6 number, provided that the number is coded or encrypted through a 19.7 reliable system that can reasonably assure that such numbers 19.8 cannot be traced back by an unauthorized person to determine the 19.9 identity of a patient with a particular number. 19.10 (m) "Performance" means the degree to which a health plan 19.11 company, provider organization, or other entity delivers 19.12 quality, cost-effective services compared to other similar 19.13 entities, or to a given level of care set as a goal to be 19.14 attained. 19.15 (n) "Provider" or "health care provider" has the meaning 19.16 given in section 62J.03, subdivision 8. 19.17 (o) "Roster data" with regard to the enrollee of a health 19.18 plan company or group purchaser means an enrollee's name, 19.19 address, telephone number, date of birth, gender, and enrollment 19.20 status under a group purchaser's health plan. "Roster data" 19.21 with regard to a patient of a provider means the patient's name, 19.22 address, telephone number, date of birth, gender, and date or 19.23 dates treated, including, if applicable, the date of admission 19.24 and the date of discharge. 19.25 Subd. 3. [OBJECTIVES OF THE HEALTH DATA INSTITUTE.] (a) 19.26 The health data institute shall: 19.27 (1) develop a data collection plan that provides 19.28 coordination for public and private sector data collection 19.29 efforts related to the performance measurement and improvement 19.30 of the health care delivery system; 19.31 (2) establish an electronic data interchange system that 19.32 may be used by the public and private sectors to exchange health 19.33 care data in a cost-efficient manner; 19.34 (3) develop a mechanism to collect, analyze, and 19.35 disseminate information for comparing the cost and quality of 19.36 health care delivery system components, including health plan 20.1 companies and provider organizations; 20.2 (4) develop policies and procedures to protect the privacy 20.3 of individual-identifiable data, and to assure appropriate 20.4 access to and disclosure of information specific to individual 20.5 health plan companies and provider organizations collected 20.6 pursuant to this section; and 20.7 (5) use and build upon existing data sources and 20.8 performance measurement efforts, and improve upon these existing 20.9 data sources and measurement efforts through the integration of 20.10 data systems and the standardization of concepts, to the 20.11 greatest extent possible. 20.12 (b) In carrying out its responsibilities, the health data 20.13 institute may contract with private sector organizations 20.14 currently collecting data on specific health-related areas of 20.15 interest to the health data institute, in order to achieve 20.16 maximum efficiency and cost-effectiveness. The health data 20.17 institute may establish links between the data collected and 20.18 maintained by the health data institute and private sector data 20.19 through the health data institute's electronic data interchange 20.20 system, and may implement methods to streamline data collection 20.21 in order to reduce public and private sector administrative 20.22 costs. The health data institute may use or establish links 20.23 with public sector data, such as that existing for medical 20.24 assistance and Medicare, to the extent permitted by state and 20.25 federal law. The health data institute may also recommend 20.26 methods to streamline public sector data collection in order to 20.27 reduce public and private sector administrative costs. 20.28 (c) Any contract with a private sector entity must require 20.29 the private sector entity to maintain the data collected 20.30 according to the applicable data privacy provisions, as provided 20.31 in section 62J.452. 20.32 Subd. 4. [DATA COLLECTION PLAN.] (a) The health data 20.33 institute shall develop a plan that: 20.34 (1) identifies the health care data needs of consumers, 20.35 group purchasers, providers, and the state regarding the 20.36 performance of health care delivery system components including 21.1 health plan companies and provider organizations; 21.2 (2) specifies data collection objectives, strategies, 21.3 priorities, cost estimates, administrative and operational 21.4 guidelines, and implementation timelines for the health data 21.5 institute; and 21.6 (3) identifies the data needed for the health data 21.7 institute to carry out the duties assigned in this section. The 21.8 plan must take into consideration existing data sources and data 21.9 sources that can easily be made uniform for links to other data 21.10 sets. 21.11 (b) This plan shall be updated on an annual basis. 21.12 Subd. 5. [HEALTH CARE ELECTRONIC DATA INTERCHANGE 21.13 SYSTEM.] (a) The health data institute shall establish an 21.14 electronic data interchange system that electronically 21.15 transmits, collects, archives, and provides users of data with 21.16 the data necessary for their specific interests, in order to 21.17 promote a high quality, cost-effective, consumer-responsive 21.18 health care system. This public-private information system 21.19 shall be developed to make health care claims processing and 21.20 financial settlement transactions more efficient and to provide 21.21 an efficient, unobtrusive method for meeting the shared 21.22 electronic data interchange needs of consumers, group 21.23 purchasers, providers, and the state. 21.24 (b) The health data institute shall operate the Minnesota 21.25 center for health care electronic data interchange established 21.26 in section 62J.57, and shall integrate the goals, objectives, 21.27 and activities of the center with those of the health data 21.28 institute's electronic data interchange system. 21.29 Subd. 6. [PERFORMANCE MEASUREMENT INFORMATION.] (a) The 21.30 health data institute shall develop and implement a performance 21.31 measurement plan to analyze and disseminate health care data to 21.32 address the needs of consumers, group purchasers, providers, and 21.33 the state for performance measurement at various levels of the 21.34 health care system in the state. The plan shall include a 21.35 mechanism to: 21.36 (1) provide comparative information to consumers, 22.1 purchasers, and policymakers for use in performance assessment 22.2 of health care system components, including health plan 22.3 companies and provider organizations; 22.4 (2) complement and enhance, but not replace, existing 22.5 internal performance improvement efforts of health care 22.6 providers and plans; and 22.7 (3) reduce unnecessary administrative costs in the health 22.8 care system by eliminating duplication in the collection of data 22.9 for both evaluation and improvement efforts. 22.10 (b) Performance measurement at the provider organization 22.11 level may be conducted on a condition-specific basis. Criteria 22.12 for selecting conditions for measurement may include: 22.13 (1) relevance to consumers and purchasers; 22.14 (2) prevalence of conditions; 22.15 (3) costs related to diagnosis and treatment; 22.16 (4) demonstrated efficacy of treatments; 22.17 (5) evidence of variability in management; 22.18 (6) existence of risk adjustment methodologies to control 22.19 for patient and other risk factors contributing to variation in 22.20 cost and quality; 22.21 (7) existence of practice guidelines related to the 22.22 condition; and 22.23 (8) relevance of the condition to public health goals. 22.24 (c) Performance measurement on a condition-specific basis 22.25 may consider multiple dimensions of performance, including, but 22.26 not limited to: 22.27 (1) accessibility; 22.28 (2) appropriateness; 22.29 (3) effectiveness, including clinical outcomes, patient 22.30 satisfaction, and functional status; and 22.31 (4) efficiency. 22.32 (d) Collection of data for condition-specific performance 22.33 measurement may be conducted at the patient level. 22.34 Encounter-level data collected for this purpose may include 22.35 unique identifiers for patients, providers, payers, and 22.36 employers in order to link episodes of care across care settings 23.1 and over time. The health data institute must encrypt patient 23.2 identifiers to prevent identification of individual patients and 23.3 to enable release of otherwise private data to researchers, 23.4 providers, and group purchasers in a manner consistent with 23.5 chapter 13 and sections 62J.452 and 144.335. 23.6 Subd. 6a. [HEALTH PLAN COMPANY PERFORMANCE 23.7 MEASUREMENT.] As part of the performance measurement plan 23.8 specified in subdivision 6, the health data institute shall 23.9 develop a mechanism to assess the performance of health plan 23.10 companies, and to disseminate this information through reports 23.11 and other means to consumers, purchasers, policymakers, and 23.12 other interested parties, consistent with the data policies 23.13 specified in section 62J.452. 23.14 Subd. 6b. [CONSUMER SURVEYS.] (a) The health data 23.15 institute shall develop and implement a mechanism for collecting 23.16 comparative data on consumer perceptions of the health care 23.17 system, including consumer satisfaction, through adoption of a 23.18 standard consumer survey. This survey shall include enrollees 23.19 in community integrated service networks, integrated service 23.20 networks, health maintenance organizations, preferred provider 23.21 organizations, indemnity insurance plans, public programs, and 23.22 other health plan companies. The health data institute, in 23.23 consultation with the health care commission, shall determine a 23.24 mechanism for the inclusion of the uninsured. This consumer 23.25 survey may be conducted every two years. A focused survey may 23.26 be conducted on the off years. Health plan companies and group 23.27 purchasers shall provide to the health data institute roster 23.28 data as defined in subdivision 2, including the names, 23.29 addresses, and telephone numbers of enrollees and former 23.30 enrollees and other data necessary for the completion of this 23.31 survey. This roster data provided by the health plan companies 23.32 and group purchasers is classified as provided under section 23.33 62J.452. The health data institute may analyze and prepare 23.34 findings from the raw, unaggregated data, and the findings from 23.35 this survey may be included in the health plan company 23.36 performance reports specified in subdivision 6a, and in other 24.1 reports developed and disseminated by the health data institute 24.2 and the commissioner. The raw, unaggregated data is classified 24.3 as provided under section 62J.452, and may be made available by 24.4 the health data institute to the extent permitted under section 24.5 62J.452. The health data institute shall provide raw, 24.6 unaggregated data to the commissioner. The survey may include 24.7 information on the following subjects: 24.8 (1) enrollees' overall satisfaction with their health care 24.9 plan; 24.10 (2) consumers' perception of access to emergency, urgent, 24.11 routine, and preventive care, including locations, hours, 24.12 waiting times, and access to care when needed; 24.13 (3) premiums and costs; 24.14 (4) technical competence of providers; 24.15 (5) communication, courtesy, respect, reassurance, and 24.16 support; 24.17 (6) choice and continuity of providers; 24.18 (7) continuity of care; 24.19 (8) outcomes of care; 24.20 (9) services offered by the plan, including range of 24.21 services, coverage for preventive and routine services, and 24.22 coverage for illness and hospitalization; 24.23 (10) availability of information; and 24.24 (11) paperwork. 24.25 (b) The health data institute shall appoint a consumer 24.26 advisory group which shall consist of 13 individuals, 24.27 representing enrollees from public and private health plan 24.28 companies and programs and two uninsured consumers, to advise 24.29 the health data institute on issues of concern to consumers. 24.30 The advisory group must have at least one member from each 24.31 regional coordinating board region of the state. The advisory 24.32 group expires June 30, 1996. 24.33 Subd. 6c. [PROVIDER ORGANIZATION PERFORMANCE MEASUREMENT.] 24.34 As part of the performance measurement plan specified in 24.35 subdivision 6, the health data institute shall develop a 24.36 mechanism to assess the performance of hospitals and other 25.1 provider organizations, and to disseminate this information to 25.2 consumers, purchasers, policymakers, and other interested 25.3 parties, consistent with the data policies specified in section 25.4 62J.452. Data to be collected may include structural 25.5 characteristics including staff-mix and nurse-patient ratios. 25.6 In selecting additional data for collection, the health data 25.7 institute may consider: 25.8 (1) feasibility and statistical validity of the indicator; 25.9 (2) purchaser and public demand for the indicator; 25.10 (3) estimated expense of collecting and reporting the 25.11 indicator; and 25.12 (4) usefulness of the indicator for internal improvement 25.13 purposes. 25.14 Subd. 7. [DISSEMINATION OF REPORTS; OTHER 25.15 INFORMATION.] (a) The health data institute shall establish a 25.16 mechanism for the dissemination of reports and other information 25.17 to consumers, group purchasers, health plan companies, 25.18 providers, and the state. When applicable, the health data 25.19 institute shall coordinate its dissemination of information 25.20 responsibilities with those of the commissioner, to the extent 25.21 administratively efficient and effective. 25.22 (b) The health data institute may require those requesting 25.23 data from its databases to contribute toward the cost of data 25.24 collection through the payments of fees. 25.25 (c) The health data institute shall not allow a group 25.26 purchaser or health care provider to use or have access to the 25.27 electronic data interchange system or to access data under 25.28 section 62J.452, subdivision 6 or 7, unless the group purchaser 25.29 or health care provider cooperates with the data collection 25.30 efforts of the health data institute by submitting or making 25.31 available through the EDI system or other means all data 25.32 requested by the health data institute. The health data 25.33 institute shall prohibit group purchasers and health care 25.34 providers from transferring, providing, or sharing data obtained 25.35 from the health data institute under section 62J.452, 25.36 subdivision 6 or 7, with a group purchaser or health care 26.1 provider that does not cooperate with the data collection 26.2 efforts of the health data institute. 26.3 Subd. 8. [ANNUAL REPORT.] (a) The health data institute 26.4 shall submit to the chairs of the senate joint crime prevention 26.5 and judiciary subcommittee on privacy, the house judiciary 26.6 committee, the legislative commission on health care access, the 26.7 commissioner, and the governor a report on the activities of the 26.8 health data institute by February 1 of each year beginning 26.9 February 1, 1996. The report shall include: 26.10 (1) a description of the data initiatives undertaken by the 26.11 health data institute, including a statement of the purpose and 26.12 a summary of the results of the initiative; 26.13 (2) a description of the steps taken by the health data 26.14 institute to comply with the confidentiality requirements of 26.15 this section and other applicable laws, and of the health data 26.16 institute's internal policies and operating procedures relating 26.17 to data privacy and confidentiality; and 26.18 (3) a description of the actions taken by the health data 26.19 institute to ensure that the EDI system being established 26.20 pursuant to subdivisions 3, clause (2), and 5, protects the 26.21 confidentiality requirements of this section and other 26.22 applicable laws. 26.23 (b) If the health data institute amends or adopts an 26.24 internal policy or operating procedure relating to data privacy 26.25 and confidentiality, it shall submit copies of such policy or 26.26 procedure within 30 days of its adoption to the public officials 26.27 identified in this subdivision. 26.28 Subd. 9. [BOARD OF DIRECTORS.] The health data institute 26.29 is governed by a 20-member board of directors consisting of the 26.30 following members: 26.31 (1) two representatives of hospitals, one appointed by the 26.32 Minnesota Hospital Association and one appointed by the 26.33 Metropolitan HealthCare Council, to reflect a mix of urban and 26.34 rural institutions; 26.35 (2) four representatives of health carriers, two appointed 26.36 by the Minnesota council of health maintenance organizations, 27.1 one appointed by Blue Cross and Blue Shield of Minnesota, and 27.2 one appointed by the Insurance Federation of Minnesota; 27.3 (3) two consumer members, one appointed by the 27.4 commissioner, and one appointed by the AFL-CIO as a labor union 27.5 representative; 27.6 (4) five group purchaser representatives appointed by the 27.7 Minnesota consortium of health care purchasers to reflect a mix 27.8 of urban and rural, large and small, and self-insured 27.9 purchasers; 27.10 (5) two physicians appointed by the Minnesota Medical 27.11 Association, to reflect a mix of urban and rural practitioners; 27.12 (6) one representative of teaching and research 27.13 institutions, appointed jointly by the Mayo Foundation and the 27.14 Minnesota Association of Public Teaching Hospitals; 27.15 (7) one nursing representative appointed by the Minnesota 27.16 Nurses Association; and 27.17 (8) three representatives of state agencies, one member 27.18 representing the department of employee relations, one member 27.19 representing the department of human services, and one member 27.20 representing the department of health. 27.21 Subd. 10. [TERMS; COMPENSATION; REMOVAL; AND 27.22 VACANCIES.] The board is governed by section 15.0575. 27.23 Subd. 11. [STATUTORY GOVERNANCE.] The health data 27.24 institute is subject to chapter 13 and section 471.705. 27.25 Subd. 12. [STAFF.] The board may hire an executive 27.26 director. The executive director and other health data 27.27 institute staff are not state employees but are covered by 27.28 section 3.736. The executive director and other health data 27.29 institute staff may participate in the following plans for 27.30 employees in the unclassified service until January 1, 1996: 27.31 the state retirement plan, the state deferred compensation plan, 27.32 and the health, dental, and life insurance plans. The attorney 27.33 general shall provide legal services to the board. 27.34 Subd. 13. [FEDERAL AND OTHER GRANTS.] The health data 27.35 institute may seek federal funding, and funding from private and 27.36 other nonstate sources for the initiative required by the board. 28.1 Subd. 14. [CONTRACTS.] To carry out the duties assigned in 28.2 this section, the health data institute may contract with 28.3 private sector entities. Any contract must require the private 28.4 sector entity to maintain the data which it receives according 28.5 to the statutory provisions applicable to the data and any other 28.6 applicable provision specified in section 62J.452. 28.7 Subd. 15. [NONLIMITING.] Nothing in this section shall be 28.8 construed to limit the powers granted to the commissioner of 28.9 health in chapter 62D, 62N, 144, or 144A. 28.10 Sec. 16. [62J.452] [PROTECTION OF PRIVACY AND 28.11 CONFIDENTIALITY OF HEALTH CARE DATA.] 28.12 Subdivision 1. [STATEMENT OF PURPOSE.] The health data 28.13 institute shall adopt data collection, analysis, and 28.14 dissemination policies that reflect the importance of protecting 28.15 the right of privacy of patients in their health care data in 28.16 connection with each data initiative that the health data 28.17 institute intends to undertake. 28.18 Subd. 2. [DATA CLASSIFICATIONS.] (a) Data collected, 28.19 obtained, received, or created by the health data institute 28.20 shall be private or nonpublic, as applicable, unless given a 28.21 different classification in this subdivision. Data classified 28.22 as private or nonpublic under this subdivision may be released 28.23 or disclosed only as permitted under this subdivision and under 28.24 the other subdivisions referenced in this subdivision. For 28.25 purposes of this section, data that identify individual patients 28.26 or industry participants are private data on individuals or 28.27 nonpublic data, as appropriate, and data not on individuals are 28.28 nonpublic data. Notwithstanding sections 13.03, subdivisions 6 28.29 to 8; 13.10, subdivisions 1 to 4; and 138.17, data received by 28.30 the health data institute shall retain the classification 28.31 designated under this chapter and shall not be disclosed other 28.32 than pursuant to this chapter. Nothing in this subdivision 28.33 prevents patients from gaining access to their health record 28.34 information pursuant to section 144.335. 28.35 (b) When industry participants, as defined in section 28.36 62J.451, are required by statute to provide patient identifying 29.1 data to the commissioner pursuant to this chapter or to the 29.2 health data institute pursuant to section 62J.451, they shall be 29.3 able to provide the data with or without patient consent, and 29.4 may not be held liable for doing so. 29.5 (c) When an industry participant submits patient 29.6 identifying data to the health data institute, and the data is 29.7 submitted to the health data institute in electronic form, or 29.8 through other electronic means including, but not limited to, 29.9 the electronic data interchange system defined in section 29.10 62J.451, the industry participant shall submit the patient 29.11 identifying data in encrypted form, using an encryption method 29.12 supplied or specified by the health data institute. Submission 29.13 of encrypted data as provided in this paragraph satisfies the 29.14 requirements of section 144.335, subdivision 3b. 29.15 (d) Patient identifying data may be disclosed only as 29.16 permitted under subdivision 3. 29.17 (e) Industry participant identifying data which is not 29.18 patient identifying data may be disclosed only by being made 29.19 public in an analysis as permitted under subdivisions 4 and 5 or 29.20 through access to an approved researcher, industry participant, 29.21 or contractor as permitted under subdivision 6 or 7. 29.22 (f) Data that is not patient identifying data and not 29.23 industry participant identifying data is public data. 29.24 (g) Data that describes the finances, governance, internal 29.25 operations, policies or operating procedures of the health data 29.26 institute, and that does not identify patients or industry 29.27 participants or identifies them only in connection with their 29.28 involvement with the health data institute, is public data. 29.29 Subd. 3. [PATIENT IDENTIFYING DATA.] (a) The health data 29.30 institute must not make public any analysis that contains 29.31 patient identifying data. 29.32 (b) The health data institute may disclose patient 29.33 identifying data only as follows: 29.34 (1) to research organizations that meet the requirements 29.35 set forth in subdivision 6, paragraph (a), but only to the 29.36 extent that such disclosure is also permitted by section 30.1 144.335, subdivision 3a, paragraph (a); or 30.2 (2) to a contractor of, or vendor of services to the health 30.3 data institute for the purposes of conducting a survey or 30.4 analysis, provided that such contractor or vendor agrees to 30.5 comply with all data privacy requirements applicable to the 30.6 health data institute, and to destroy or return to the health 30.7 data institute all copies of patient identifying data in the 30.8 possession of such contractor or vendor upon completion of the 30.9 contract. 30.10 Subd. 4. [ANALYSIS TO BE MADE PUBLIC BY THE HEALTH DATA 30.11 INSTITUTE.] (a) Notwithstanding the classification under 30.12 subdivision 2 or other provision of state law of data included 30.13 or used in an analysis, the health data institute may make 30.14 public data in an analysis pursuant to this subdivision and 30.15 subdivision 5. Such analysis may include industry participant 30.16 identifying data but must not include patient identifying data. 30.17 In making its determination as to whether to make an analysis or 30.18 the data used in the analysis public, the health data institute 30.19 shall consider and determine, in accordance with policies and 30.20 criteria developed by the health data institute, that the data 30.21 and analysis are sufficiently accurate, complete, reliable, 30.22 valid, and as appropriate, case-mixed and severity adjusted, and 30.23 statistically and clinically significant. 30.24 (b) Prior to making an analysis public, the health data 30.25 institute must provide to any industry participant identified in 30.26 the analysis an opportunity to use the fair hearing procedure 30.27 established under subdivision 5. 30.28 (c) Accompanying an analysis made public by the health data 30.29 institute, the health data institute shall also make public 30.30 descriptions of the database used in the analysis, the methods 30.31 of adjusting for case mix and severity, and assuring accuracy, 30.32 completeness, reliability, and statistical and clinical 30.33 significance, as appropriate, and appropriate uses of the 30.34 analysis and related analytical data, including precautionary 30.35 statements regarding the limitations of the analysis and related 30.36 analytical data. 31.1 Subd. 5. [FAIR HEARING PROCEDURE PRIOR TO MAKING AN 31.2 ANALYSIS PUBLIC.] (a) The health data institute may not make 31.3 public an analysis that identifies an industry participant 31.4 unless the health data institute first complies with this 31.5 subdivision. A draft of the portion of the analysis that 31.6 identifies an industry participant must be furnished upon an 31.7 industry participant's request to that industry participant 31.8 prior to making that portion of the analysis public. Such draft 31.9 analysis is private or nonpublic, as applicable. The industry 31.10 participants so identified have the right to a hearing, at which 31.11 the industry participants may object to or seek modification of 31.12 the analysis. The cost of the hearing shall be borne by the 31.13 industry participant requesting the hearing. 31.14 (b) The health data institute shall establish the hearing 31.15 procedure in writing. The hearing procedure shall include the 31.16 following: 31.17 (1) the provision of reasonable notice of the health data 31.18 institute's intention to make such analysis public; 31.19 (2) an opportunity for the identified industry participants 31.20 to submit written statements to the health data institute board 31.21 of directors or its designate, to be represented, and to append 31.22 a statement to such analysis to be included with it when and if 31.23 the analysis is made public; and 31.24 (3) access by the identified industry participants to 31.25 industry participant identifying data, but only as permitted by 31.26 subdivision 6 or 7. 31.27 (c) The health data institute shall make the hearing 31.28 procedure available in advance to industry participants which 31.29 are identified in an analysis. The written hearing procedure is 31.30 public data. The following data related to a hearing is public: 31.31 (1) the parties involved; 31.32 (2) the dates of the hearing; and 31.33 (3) a general description of the issue and the results of 31.34 the hearing; all other data relating to the hearing is private 31.35 or nonpublic. 31.36 Subd. 6. [ACCESS BY APPROVED RESEARCHERS TO DATA THAT 32.1 IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 32.2 PATIENTS.] (a) The health data institute shall provide access to 32.3 industry participant identifying data, but not patient 32.4 identifying data, once those data are in analyzable form, upon 32.5 request to research organizations or individuals that: 32.6 (1) have as explicit goals research purposes that promote 32.7 individual or public health and the release of research results 32.8 to the public as determined by the health data institute 32.9 according to standards it adopts for evaluating such goals; 32.10 (2) enforce strict and explicit policies which protect the 32.11 confidentiality and integrity of data as determined by the 32.12 health data institute according to standards it adopts for 32.13 evaluating such policies; 32.14 (3) agree not to make public, redisclose, or transfer the 32.15 data to any other individual or organization, except as 32.16 permitted under paragraph (b); 32.17 (4) demonstrate a research purpose for the data that can be 32.18 accomplished only if the data are provided in a form that 32.19 identifies specific industry participants as determined by the 32.20 health data institute according to standards it adopts for 32.21 evaluating such research purposes; and 32.22 (5) agree to disclose analysis in a public forum or 32.23 publication only pursuant to subdivisions 4 and 5 and other 32.24 applicable statutes and the health data institute's operating 32.25 rules governing the making of an analysis public by the health 32.26 data institute. 32.27 (b) Contractors of entities that have access under 32.28 paragraph (a) may also have access to industry participant 32.29 identifying data, provided that the contract requires the 32.30 contractor to comply with the confidentiality requirements set 32.31 forth in this section and under any other statute applicable to 32.32 the entity. 32.33 Subd. 7. [ACCESS BY INDUSTRY PARTICIPANTS TO DATA THAT 32.34 IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 32.35 PATIENTS.] (a) The health data institute may provide, to an 32.36 industry participant, data that identifies that industry 33.1 participant or other industry participants, to the extent 33.2 permitted under this subdivision. An employer or an employer 33.3 purchasing group may receive data relating to care provided to 33.4 patients for which that employer acts as the payer. A health 33.5 plan company may receive data relating to care provided to 33.6 enrollees of that health plan company. A provider may receive 33.7 data relating to care provided to patients of that provider. 33.8 (b) An industry participant may receive data that 33.9 identifies that industry participant or other industry 33.10 participants and that relates to care purchased or provided by 33.11 industry participants other than the industry participant 33.12 seeking the data. These data must be provided by the health 33.13 data institute only with appropriate authorization from all 33.14 industry participants identified. 33.15 (c) The health data institute must not provide access to 33.16 any data under this subdivision that is patient identifying data 33.17 as defined in section 62J.451, subdivision 2, paragraph (l), 33.18 even if providing that data would otherwise be allowed under 33.19 this subdivision. 33.20 (d) To receive data under this subdivision, an industry 33.21 participant must cooperate with the health data institute as 33.22 provided under section 62J.451, subdivision 7, paragraph (c). 33.23 (e) Contractors of entities that have access under 33.24 paragraph (b) may have access to industry participant 33.25 identifying data, provided that the contract requires the 33.26 contractor to comply with the confidentiality requirements set 33.27 forth in this section and under any other statute applicable to 33.28 the entity. 33.29 Subd. 8. [STATUS OF DATA ON THE ELECTRONIC DATA 33.30 INTERCHANGE SYSTEM.] (a) Data created or generated by or in the 33.31 custody of an industry participant, and transferred 33.32 electronically by that industry participant to another industry 33.33 participant using the EDI system developed, implemented, 33.34 maintained, or operated by the health data institute, as 33.35 permitted by section 62J.451, subdivision 3, clause (2), and 33.36 subdivision 5, is not subject to this section or to chapter 13 34.1 except as provided below. 34.2 (b) Data created or generated by or in the custody of an 34.3 industry participant is subject to the privacy protections 34.4 applicable to the data, including, but not limited to, chapter 34.5 13 with respect to state agencies and political subdivisions, 34.6 the Minnesota insurance fair information reporting act with 34.7 respect to industry participants subject to it, and section 34.8 144.335, with respect to providers and other industry 34.9 participants subject to such section. 34.10 Subd. 9. [AUTHORIZATION OF STATE AGENCIES AND POLITICAL 34.11 SUBDIVISIONS TO PROVIDE DATA.] (a) Notwithstanding any 34.12 limitation in chapter 13 or section 62J.321, subdivision 5, 34.13 regarding the disclosure of not public data, all state agencies 34.14 and political subdivisions, including, but not limited to, 34.15 municipalities, counties, and hospital districts may provide not 34.16 public data relating to health care costs, quality, or outcomes 34.17 to the health data institute for the purposes set forth in 34.18 section 62J.451. 34.19 (b) Data provided by the commissioner pursuant to paragraph 34.20 (a) may not include patient identifying data as defined in 34.21 section 62J.451, subdivision 2, paragraph (1). For data 34.22 provided by the commissioner of health pursuant to paragraph 34.23 (a), the health data institute and anyone receiving the data 34.24 from the health data institute, is prohibited from unencrypting 34.25 or attempting to link the data with other patient identifying 34.26 data sources. 34.27 (c) Any data provided to the health data institute pursuant 34.28 to paragraph (a) shall retain the same classification that it 34.29 had with the state agency or political subdivision that provided 34.30 it. The authorization in this subdivision is subject to any 34.31 federal law restricting or prohibiting such disclosure of the 34.32 data described above. 34.33 (d) Notwithstanding any limitation in chapter 13 or this 34.34 section and section 62J.451 regarding the disclosure of 34.35 nonpublic and private data, the health data institute may 34.36 provide nonpublic and private data to any state agency that is a 35.1 member of the board of the health data institute. Any such data 35.2 provided to a state agency shall retain nonpublic or private 35.3 classification, as applicable. 35.4 Subd. 10. [CIVIL REMEDIES.] Violation of any of the 35.5 confidentiality requirements set forth in subdivision 3; 4, 35.6 paragraph (a); 6; or 7, by the health data institute, its board 35.7 members, employees and contractors, any industry participant, or 35.8 by any other person is subject to the provisions of section 35.9 13.08. The health data institute is immune from liability for 35.10 exercising its discretion in a manner that is not an abuse of 35.11 its discretion under this section or section 62J.451. The 35.12 health data institute is immune from liability for the actions 35.13 of persons not under the direction and control of the health 35.14 data institute, where it has complied with the requirements of 35.15 this section and other applicable laws with regard to the 35.16 disclosure of data. The remedies set forth in this section do 35.17 not preclude any person from pursuing any other remedies 35.18 authorized by law. 35.19 Subd. 11. [PENALTIES.] (a) Any person who willfully 35.20 violates the confidentiality requirements set forth in 35.21 subdivision 3; 4, paragraph (a); 6; or 7, shall be guilty of a 35.22 misdemeanor. 35.23 (b) Any person who willfully violates the confidentiality 35.24 requirements of subdivision 3, 4, 6, 7, 8, or 9, by willfully 35.25 disclosing patient or industry participant identifying data for 35.26 compensation or remuneration of any kind or for the purpose of 35.27 damaging the reputation of any patient or industry participant 35.28 or any other malicious purpose, shall be guilty of a gross 35.29 misdemeanor. 35.30 Subd. 12. [DISCOVERABILITY OF HEALTH DATA INSTITUTE 35.31 DATA.] (a) Data created, collected, received, maintained or 35.32 disseminated by the health data institute shall not be subject 35.33 to discovery or introduction into evidence in any civil or 35.34 criminal action. Data created, collected, received, maintained, 35.35 or disseminated by the health data institute that is otherwise 35.36 available from original sources is subject to discovery from 36.1 those sources and may be introduced into evidence in civil or 36.2 criminal actions in accordance with and subject to applicable 36.3 laws and rules of evidence and civil or criminal procedure, as 36.4 applicable. 36.5 (b) Information related to submission of data to the health 36.6 data institute by industry participants is not discoverable in 36.7 any civil or criminal action. Discovery requests prohibited 36.8 under this paragraph include, but are not limited to, document 36.9 requests or interrogatories that ask for "all data provided to 36.10 the Minnesota health data institute." 36.11 Sec. 17. Minnesota Statutes 1994, section 62J.54, is 36.12 amended to read: 36.13 62J.54 [IDENTIFICATION AND IMPLEMENTATION OF UNIQUE 36.14 IDENTIFIERS.] 36.15 Subdivision 1. [UNIQUE IDENTIFICATION NUMBER FOR HEALTH 36.16 CARE PROVIDER ORGANIZATIONS.] (a) On and after January 1, 36.1719961998, all group purchasers and health care providers in 36.18 Minnesota shall use a unique identification number to identify 36.19 health care provider organizations, except as provided in 36.20 paragraph (d). 36.21 (b) Following the recommendation of the workgroup for 36.22 electronic data interchange, the federal tax identification 36.23 number assigned to each health care provider organization by the 36.24 Internal Revenue Service of the Department of the Treasury shall 36.25 be used as the unique identification number for health care 36.26 provider organizations. 36.27 (c) The unique health care provider organization identifier 36.28 shall be used for purposes of submitting and receiving claims, 36.29 and in conjunction with other data collection and reporting 36.30 functions. 36.31 (d) The state and federal health care programs administered 36.32 by the department of human services shall use the unique 36.33 identification number assigned to health care providers for 36.34 implementation of the Medicaid Management Information System or 36.35 the uniform provider identification number (UPIN) assigned by 36.36 the Health Care Financing Administration. 37.1 Subd. 2. [UNIQUE IDENTIFICATION NUMBER FOR INDIVIDUAL 37.2 HEALTH CARE PROVIDERS.] (a) On and after January 1,19961998, 37.3 all group purchasers and health care providers in Minnesota 37.4 shall use a unique identification number to identify an 37.5 individual health care provider, except as provided in paragraph 37.6 (d). 37.7 (b) The uniform provider identification number (UPIN) 37.8 assigned by the Health Care Financing Administration shall be 37.9 used as the unique identification number for individual health 37.10 care providers. Providers who do not currently have a UPIN 37.11 number shall request one from the health care financing 37.12 administration. 37.13 (c) The unique individual health care provider identifier 37.14 shall be used for purposes of submitting and receiving claims, 37.15 and in conjunction with other data collection and reporting 37.16 functions. 37.17 (d) The state and federal health care programs administered 37.18 by the department of human services shall use the unique 37.19 identification number assigned to health care providers for 37.20 implementation of the Medicaid Management Information System or 37.21 the uniform provider identification number (UPIN) assigned by 37.22 the health care financing administration. 37.23 Subd. 3. [UNIQUE IDENTIFICATION NUMBER FOR GROUP 37.24 PURCHASERS.] (a) On and after January 1,19961998, all group 37.25 purchasers and health care providers in Minnesota shall use a 37.26 unique identification number to identify group purchasers. 37.27 (b) The federal tax identification number assigned to each 37.28 group purchaser by the Internal Revenue Service of the 37.29 Department of the Treasury shall be used as the unique 37.30 identification number for group purchasers. This paragraph 37.31 applies until the codes described in paragraph (c) are available 37.32 and feasible to use, as determined by the commissioner. 37.33 (c) A two-part code, consisting of 11 characters and 37.34 modeled after the National Association of Insurance 37.35 Commissioners company code shall be assigned to each group 37.36 purchaser and used as the unique identification number for group 38.1 purchasers. The first six characters, or prefix, shall contain 38.2 the numeric code, or company code, assigned by the National 38.3 Association of Insurance Commissioners. The last five 38.4 characters, or suffix, which is optional, shall contain further 38.5 codes that will enable group purchasers to further route 38.6 electronic transaction in their internal systems. 38.7 (d) The unique group purchaser identifier shall be used for 38.8 purposes of submitting and receiving claims, and in conjunction 38.9 with other data collection and reporting functions. 38.10 Subd. 4. [UNIQUE PATIENT IDENTIFICATION NUMBER.] (a) On 38.11 and after January 1,19961998, all group purchasers and health 38.12 care providers in Minnesota shall use a unique identification 38.13 number to identify each patient who receives health care 38.14 services in Minnesota, except as provided in paragraph (e). 38.15 (b) Except as provided in paragraph (d), following the 38.16 recommendation of the workgroup for electronic data interchange, 38.17 the social security number of the patient shall be used as the 38.18 unique patient identification number. 38.19 (c) The unique patient identification number shall be used 38.20 by group purchasers and health care providers for purposes of 38.21 submitting and receiving claims, and in conjunction with other 38.22 data collection and reporting functions. 38.23 (d) The commissioner shall develop an alternate numbering 38.24 system for patients who do not have or refuse to provide a 38.25 social security number. This provision does not require that 38.26 patients provide their social security numbers and does not 38.27 require group purchasers or providers to demand that patients 38.28 provide their social security numbers. Group purchasers and 38.29 health care providers shall establish procedures to notify 38.30 patients that they can elect not to have their social security 38.31 number used as the unique patient identification number. 38.32 (e) The state and federal health care programs administered 38.33 by the department of human services shall use the unique person 38.34 master index (PMI) identification number assigned to clients 38.35 participating in programs administered by the department of 38.36 human services. 39.1 Sec. 18. Minnesota Statutes 1994, section 62J.55, is 39.2 amended to read: 39.3 62J.55 [PRIVACY OF UNIQUE IDENTIFIERS.] 39.4 (a) When the unique identifiers specified in section 62J.54 39.5 are used for data collection purposes, the identifiers must be 39.6 encrypted, as required in section62J.3062J.321, subdivision639.7 1. Encryption must follow encryption standards set by the 39.8 National Bureau of Standards and approved by the American 39.9 National Standards Institute as ANSIX3. 92-1982/R 1987 to 39.10 protect the confidentiality of the data. Social security 39.11 numbers must not be maintained in unencrypted form in the 39.12 database, and the data must never be released in a form that 39.13 would allow for the identification of individuals. The 39.14 encryption algorithm and hardware used must not use clipper chip 39.15 technology. 39.16 (b) Providers and group purchasers shall treat medical 39.17 records, including the social security number if it is used as a 39.18 unique patient identifier, in accordance with section 144.335. 39.19 The social security number may be disclosed by providers and 39.20 group purchasers to the commissioner as necessary to allow 39.21 performance of those duties set forth in section 144.05. 39.22 Sec. 19. Minnesota Statutes 1994, section 62J.58, is 39.23 amended to read: 39.24 62J.58 [IMPLEMENTATION OF STANDARD TRANSACTION SETS.] 39.25 Subdivision 1. [CLAIMS PAYMENT.](a) By July 1, 1995Six 39.26 months from the date the commissioner formally recommends the 39.27 use of guides to implement core transaction sets pursuant to 39.28 section 62J.56, subdivision 3, all category I industry 39.29 participants, except pharmacists, shall be able to submit or39.30accept, as appropriate, the ANSI ASC X12 835 health care claim39.31payment/advice transaction set (draft standard for trial use39.32version 3030) for electronic transfer of payment information.39.33(b) By July 1, 1996,and all category II industry 39.34 participants, except pharmacists, shall be able to submit or 39.35 accept, as appropriate, the ANSI ASC X12 835 health care claim 39.36 payment/advice transaction set (draft standard for trial use 40.1 version 3030) for electronic submission of payment information 40.2 to health care providers. 40.3 Subd. 2. [CLAIMS SUBMISSION.]Beginning July 1, 1995Six 40.4 months from the date the commissioner formally recommends the 40.5 use of guides to implement core transaction sets pursuant to 40.6 section 62J.56, subdivision 3, all category I and category II 40.7 industry participants, except pharmacists, shall be able to 40.8 accept or submit, as appropriate, the ANSI ASC X12 837 health 40.9 care claim transaction set (draft standard for trial use version 40.10 3030) for the electronic transfer of health care claim 40.11 information.Category II industry participants, except40.12pharmacists, shall be able to accept or submit, as appropriate,40.13this transaction set, beginning July 1, 1996.40.14 Subd. 3. [ENROLLMENT INFORMATION.]Beginning January 1,40.151996Six months from the date the commissioner formally 40.16 recommends the use of guides to implement core transaction sets 40.17 pursuant to section 62J.56, subdivision 3, all category I and 40.18 category II industry participants, excluding pharmacists, shall 40.19 be able to accept or submit, as appropriate, the ANSI ASC X12 40.20 834 health care enrollment transaction set (draft standard for 40.21 trial use version 3030) for the electronic transfer of 40.22 enrollment and health benefit information.Category II industry40.23participants, except pharmacists, shall be able to accept or40.24submit, as appropriate, this transaction set, beginning January40.251, 1997.40.26 Subd. 4. [ELIGIBILITY INFORMATION.]By January 1, 1996Six 40.27 months from the date the commissioner formally recommends the 40.28 use of guides to implement core transaction sets pursuant to 40.29 section 62J.56, subdivision 3, all category I and category II 40.30 industry participants, except pharmacists, shall be able to 40.31 accept or submit, as appropriate, the ANSI ASC X12 270/271 40.32 health care eligibility transaction set (draft standard for 40.33 trial use version 3030) for the electronic transfer of health 40.34 benefit eligibility information.Category II industry40.35participants, except pharmacists, shall be able to accept or40.36submit, as appropriate, this transaction set, beginning January41.11, 1997.41.2 Subd. 5. [APPLICABILITY.] This section does not require a 41.3 group purchaser, health care provider, or employer to use 41.4 electronic data interchange or to have the capability to do so. 41.5 This section applies only to the extent that a group purchaser, 41.6 health care provider, or employer chooses to use electronic data 41.7 interchange. 41.8 Sec. 20. Minnesota Statutes 1994, section 62Q.03, 41.9 subdivision 1, is amended to read: 41.10 Subdivision 1. [PURPOSE.]Risk adjustment is a vital41.11element of the state's strategy for achieving a more equitable,41.12efficient system of health care delivery and financing for all41.13state residents.The purpose of risk adjustment is to reduce 41.14 the effects of risk selection on health insurance premiums by 41.15 making monetary transfers from health plan companies that insure 41.16 lower risk populations to health plan companies that insure 41.17 higher risk populations. Risk adjustment is needed to: achieve 41.18 a more equitable, efficient system of health care financing; 41.19 remove current disincentives in the health care system to insure 41.20 andserveprovide adequate access for high risk and special 41.21 needs populations; promote fair competition among health plan 41.22 companies on the basis of their ability to efficiently and 41.23 effectively provide services rather than on thehealthrisk 41.24 status of those in a given insurance pool; and help 41.25assuremaintain the viability ofallhealth plan companies, 41.26including community integrated service networksby protecting 41.27 them from the financial effects of enrolling a disproportionate 41.28 number of high risk individuals. It is the commitment of the 41.29 state to develop and implement a risk adjustment systemby July41.301, 1997, and to continue to improve and refine risk adjustment41.31over time. The process for designing and implementing risk41.32adjustment shall be open, explicit, utilize resources and41.33expertise from both the private and public sectors, and include41.34at least the representation described in subdivision 4. The41.35process shall take into account the formative nature of risk41.36adjustment as an emerging science, and shall develop and42.1implement risk adjustment to allow continual modifications,42.2expansions, and refinements over time. The process shall have42.3at least two stages, as described in subdivisions 2 and 3. The 42.4 risk adjustment system shall: 42.5 (1) possess a reasonable level of accuracy and 42.6 administrative feasibility, be adaptable to changes as methods 42.7 improve, incorporate safeguards against fraud and manipulation, 42.8 and shall neither reward inefficiency nor penalize for 42.9 verifiable improvements in health status; 42.10 (2) require participation by all health plan companies 42.11 providing coverage in the individual, small group, and Medicare 42.12 supplement markets; 42.13 (3) address unequal distribution of risk between health 42.14 plan companies, but shall not address the financing of public 42.15 programs or subsidies for low-income people; and 42.16 (4) be developed and implemented by the risk adjustment 42.17 association with joint oversight by the commissioners of health 42.18 and commerce. 42.19 Sec. 21. Minnesota Statutes 1994, section 62Q.03, is 42.20 amended by adding a subdivision to read: 42.21 Subd. 5a. [PUBLIC PROGRAMS.] A separate risk adjustment 42.22 system must be developed for state-run public programs, 42.23 including medical assistance, general assistance medical care, 42.24 and MinnesotaCare. The commissioners of health and human 42.25 services shall convene a work group to discuss and recommend any 42.26 special features of the public program risk adjustment system. 42.27 The system must be developed in accordance with the general risk 42.28 adjustment methodologies described in this section, and may 42.29 include additional demographic factors in addition to age and 42.30 sex, different targeted conditions, or different payment amounts 42.31 for conditions. The risk adjustment system for public programs 42.32 must attempt to reflect the special needs related to poverty, 42.33 cultural or language barriers, and other needs of some segments 42.34 of the public program population. The commissioner of health 42.35 shall work with the risk adjustment association to ensure 42.36 coordination between the risk adjustment systems for the public 43.1 and private sectors. The date for final implementation and the 43.2 final methods for risk adjustment in public programs shall be 43.3 determined by the commissioner of human services, and shall be 43.4 in compliance with state and federal requirements for the 43.5 Medicaid program. 43.6 Sec. 22. Minnesota Statutes 1994, section 62Q.03, is 43.7 amended by adding a subdivision to read: 43.8 Subd. 5b. [MEDICARE SUPPLEMENT MARKET.] A risk adjustment 43.9 system may be developed for the Medicare supplement market. The 43.10 Medicare supplement risk adjustment system may include a 43.11 demographic component and may, but is not required to, include a 43.12 condition-specific risk adjustment component. 43.13 Sec. 23. Minnesota Statutes 1994, section 62Q.03, 43.14 subdivision 6, is amended to read: 43.15 Subd. 6. [CREATION OF RISK ADJUSTMENT ASSOCIATION.] The 43.16 Minnesota risk adjustment association is created on July 1, 43.17 1994, and may operate as a nonprofit unincorporated association, 43.18 but is authorized to incorporate under chapter 317A. 43.19 The provisions of this chapter govern if the provisions of 43.20 chapter 317A conflict with this chapter. The association may 43.21 operate under the approved plan of operation and shall be 43.22 governed in accordance with this chapter and may operate in 43.23 accordance with chapter 317A. If the association incorporates 43.24 as a nonprofit corporation under chapter 317A, the filing of the 43.25 plan of operation meets the requirements of filing articles of 43.26 incorporation. 43.27 The association, its transactions, and all property owned 43.28 by it are exempt from taxation under the laws of this state or 43.29 any of its subdivisions, including, but not limited to, income 43.30 tax, sales tax, use tax, and property tax. The association may 43.31 seek exemption from payment of all fees and taxes levied by the 43.32 federal government. Except as otherwise provided in this 43.33 chapter, the association is not subject to the provisions of 43.34 chapters 14, 60A, 62A, and 62P. The association is not a public 43.35 employer and is not subject to the provisions of chapters 179A 43.36 and 353. The board of directors and health carriers who are 44.1 members of the association are exempt from sections 325D.49 to 44.2 325D.66 in the performance of their duties as directors and 44.3 members of the association. The risk adjustment association is 44.4 subject to the open meeting law. 44.5 Sec. 24. Minnesota Statutes 1994, section 62Q.03, 44.6 subdivision 7, is amended to read: 44.7 Subd. 7. [PURPOSE OF ASSOCIATION.] The association is 44.8established to carry out the purposes of subdivision 1, as44.9further elaborated on by the implementation report described in44.10subdivision 5 and by legislation enacted in 1995 or subsequently44.11 established to develop and implement a private sector risk 44.12 adjustment system. 44.13 Subject to state oversight set forth in subdivision 10, the 44.14 association shall: 44.15 (1) develop and implement comprehensive risk adjustment 44.16 systems for individual, small group, and Medicare supplement 44.17 markets consistent with the provisions of this chapter; 44.18 (2) submit a plan for the development of the risk 44.19 adjustment system which identifies appropriate implementation 44.20 dates consistent with the rating and underwriting restrictions 44.21 of each market, recommends whether transfers attributable to 44.22 risk adjustment should be required between the individual and 44.23 small group markets, and makes other appropriate recommendations 44.24 to the commissioners of health and commerce by November 5, 1995; 44.25 (3) develop a combination of a demographic risk adjustment 44.26 system and payments for targeted conditions; 44.27 (4) test an ambulatory care groups (ACGs), diagnostic cost 44.28 groups (DCGs) system, and recommend whether such a methodology 44.29 should be adopted; 44.30 (5) fund the development and testing of the risk adjustment 44.31 system; 44.32 (6) recommend market conduct guidelines; and 44.33 (7) develop a plan for assessing members for the costs of 44.34 administering the risk adjustment system. 44.35 Sec. 25. Minnesota Statutes 1994, section 62Q.03, 44.36 subdivision 8, is amended to read: 45.1 Subd. 8. [GOVERNANCE.] (a) The association shall be 45.2 governed by an interim 19-member board as follows: one provider 45.3 member appointed by the Minnesota Hospital Association; one 45.4 provider member appointed by the Minnesota Medical Association; 45.5 one provider member appointed by the governor; three members 45.6 appointed by the Minnesota Council of HMOs to include an HMO 45.7 with at least 50 percent of total membership enrolled through a 45.8 public program; three members appointed by Blue Cross and Blue 45.9 Shield of Minnesota, to include a member from a Blue Cross and 45.10 Blue Shield of Minnesota affiliated health plan with fewer than 45.11 50,000 enrollees and located outside the Minneapolis-St. Paul 45.12 metropolitan area; two members appointed by the Insurance 45.13 Federation of Minnesota; one member appointed by the Minnesota 45.14 Association of Counties; and three public members appointed by 45.15 the governor, to include at least one representative of a public 45.16 program. The commissioners of health, commerce, human services, 45.17 and employee relations shall be nonvoting ex officio members. 45.18 (b) The board may elect officers and establish committees 45.19 as necessary. 45.20 (c) A majority of the members of the board constitutes a 45.21 quorum for the transaction of business. 45.22 (d) Approval by a majority of the board members present is 45.23 required for any action of the board. 45.24 (e) Interim board members shall be appointed by July 1, 45.25 1994, and shall serve until a new board is elected according to 45.26 the plan of operation developed by the association. 45.27 (f) A member may designate a representative to act as a 45.28 member of the interim board in the member's absence. 45.29 Sec. 26. Minnesota Statutes 1994, section 62Q.03, is 45.30 amended by adding a subdivision to read: 45.31 Subd. 8a. [PLAN OF OPERATION.] The board shall submit a 45.32 proposed plan of operation by August 15, 1995, to the 45.33 commissioners of health and commerce for review. The 45.34 commissioners of health and commerce shall have the authority to 45.35 approve or reject the plan of operation. 45.36 Amendments to the plan of operation may be made by the 46.1 commissioners or by the directors of the association, subject to 46.2 the approval of the commissioners. 46.3 Sec. 27. Minnesota Statutes 1994, section 62Q.03, 46.4 subdivision 9, is amended to read: 46.5 Subd. 9. [DATA COLLECTION AND DATA PRIVACY.]The board of46.6the association shall consider antitrust implications and46.7establish procedures to assure that pricing and other46.8competitive information is appropriately shared among46.9competitors in the health care market or members of the board.46.10Any information shared shall be distributed only for the46.11purposes of administering or developing any of the tasks46.12identified in subdivisions 2 and 4. In developing these46.13procedures, the board of the association may consider the46.14identification of a state agency or other appropriate third46.15party to receive information of a confidential or competitive46.16nature.The association members shall not have access to 46.17 unaggregated data on individuals or health plan companies. The 46.18 association shall develop, as a part of the plan of operation, 46.19 procedures for ensuring that data is collected by an appropriate 46.20 entity. The commissioners of health and commerce shall have the 46.21 authority to audit and examine data collected by the association 46.22 for the purposes of the development and implementation of the 46.23 risk adjustment system. Data on individuals collected for the 46.24 purposes of risk adjustment development, testing, and operation 46.25 are designated as private data. Data not on individuals which 46.26 is collected for the purposes of development, testing, and 46.27 operation of risk adjustment, are designated as nonpublic data, 46.28 except that the proposed and approved plan of operation, the 46.29 risk adjustment methodologies examined, the plan for testing, 46.30 the plan of the risk adjustment system, minutes of meetings, and 46.31 other general operating information are classified as public 46.32 data. Nothing in this section is intended to prohibit the 46.33 preparation of summary data under section 13.05, subdivision 7. 46.34 The association, state agencies, and any contractors having 46.35 access to this data shall maintain it in accordance with this 46.36 classification. The commissioners of health and human services 47.1 have the authority to collect data from health plan companies as 47.2 needed for the purpose of developing a risk adjustment mechanism 47.3 for public programs. 47.4 Sec. 28. Minnesota Statutes 1994, section 62Q.03, 47.5 subdivision 10, is amended to read: 47.6 Subd. 10. [SUPERVISIONSTATE OVERSIGHT OF RISK ADJUSTMENT 47.7 ACTIVITIES.] The association's activities shall be supervised by 47.8 the commissioners of health and commerce. The commissioners 47.9 shall provide specific oversight functions during the 47.10 development and implementation phases as follows: 47.11 (1) the commissioners shall approve or reject the 47.12 association's plan for testing risk adjustment methods, the 47.13 methods to be used, and any changes to those methods; 47.14 (2) the commissioners must have the right to attend and 47.15 participate in all meetings of the association and its work 47.16 groups or committees, except for meetings involving privileged 47.17 communication between the association and its counsel as 47.18 permitted under section 471.705, subdivision 1d, paragraph (e); 47.19 (3) the commissioners shall approve or reject any 47.20 consultants or administrators used by the association; 47.21 (4) the commissioners shall approve or reject the 47.22 association's plan of operation; and 47.23 (5) the commissioners shall approve or reject the plan for 47.24 the risk adjustment system described in subdivision 7, clause 47.25 (2). 47.26 If the commissioners reject any of the plans identified in 47.27 clauses (1), (4) and (5), the directors shall submit for review 47.28 an appropriate revised plan within 30 days. 47.29 Sec. 29. Minnesota Statutes 1994, section 214.16, 47.30 subdivision 2, is amended to read: 47.31 Subd. 2. [BOARD COOPERATION REQUIRED.] The board shall 47.32 assist the commissioner of healthand the data analysis unitin 47.33 data collection activities required under Laws 1992, chapter 47.34 549, article 7, and shall assist the commissioner of revenue in 47.35 activities related to collection of the health care provider tax 47.36 required under Laws 1992, chapter 549, article 9. Upon the 48.1 request of the commissioner, the data analysis unit,or the 48.2 commissioner of revenue, the board shall make available names 48.3 and addresses of current licensees and provide other information 48.4 or assistance as needed. 48.5 Sec. 30. Minnesota Statutes 1994, section 214.16, 48.6 subdivision 3, is amended to read: 48.7 Subd. 3. [GROUNDS FOR DISCIPLINARY ACTION.] The board 48.8 shall take disciplinary action, which may include license 48.9 revocation, against a regulated person for: 48.10 (1) intentional failure to provide the commissioner of 48.11 healthor the data analysis unit established under section48.1262J.30with the data required under chapter 62J; 48.13 (2) intentional failure to provide the commissioner of 48.14 revenue with data on gross revenue and other information 48.15 required for the commissioner to implement sections 295.50 to 48.16 295.58; and 48.17 (3) intentional failure to pay the health care provider tax 48.18 required under section 295.52. 48.19 Sec. 31. Minnesota Statutes 1994, section 295.57, is 48.20 amended to read: 48.21 295.57 [COLLECTION AND ENFORCEMENT; REFUNDS; RULEMAKING; 48.22 APPLICATION OF OTHER CHAPTERS; ACCESS TO RECORDS.] 48.23 Subdivision 1. [APPLICATION OF OTHER CHAPTERS.] Unless 48.24 specifically provided otherwise by sections 295.50 to 295.58, 48.25 the enforcement, interest, and penalty provisions under chapter 48.26 294, appeal provisions in sections 289A.43 and 289A.65, criminal 48.27 penalties in section 289A.63, and refunds provisions in section 48.28 289A.50, and collection and rulemaking provisions under chapter 48.29 270, apply to a liability for the taxes imposed under sections 48.30 295.50 to 295.58. 48.31 Subd. 2. [ACCESS TO RECORDS.] For purposes of 48.32 administering the taxes imposed by sections 295.50 to 295.59, 48.33 the commissioner may access patients' records that contain 48.34 billing or other financial information without prior consent 48.35 from the patients. The data collected is classified as private 48.36 or nonpublic data. 49.1 Sec. 32. [RULES.] 49.2 Notwithstanding Minnesota Statutes, section 14.05, 49.3 subdivision 1, Minnesota Rules, chapters 4650, 4651, and 4652, 49.4 shall continue in effect under the authority granted in 49.5 Minnesota Statutes, section 62J.321, subdivision 6. 49.6 Sec. 33. [INSTRUCTION TO REVISOR.] 49.7 (a) The revisor of statutes is instructed to change the 49.8 term "data institute" or "institute," where applicable, to 49.9 "health data institute" in the 1996 edition of Minnesota 49.10 Statutes and Minnesota Rules. 49.11 (b) The revisor of statutes is instructed to change any 49.12 statutory reference to the information clearinghouse from 49.13 Minnesota Statutes, section 62J.33 or 62J.33, subdivision 2, to 49.14 62J.2930, in the 1996 edition of Minnesota Statutes and 49.15 Minnesota Rules. 49.16 Sec. 34. [REPEALER.] 49.17 Minnesota Statutes 1994, sections 62J.30; 62J.31; 62J.32; 49.18 62J.33; 62J.34; 62J.35; 62J.41, subdivisions 3 and 4; 62J.44; 49.19 and 62J.45, are repealed.