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Minnesota Legislature

Office of the Revisor of Statutes

HF 3056

4th Engrossment - 86th Legislature (2009 - 2010) Posted on 05/12/2010 09:16am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 4th Engrossment

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A bill for an act
relating to health; modifying the provider peer grouping timelines and system;
adding provision to agricultural cooperative health plan for farmers; requiring
reports; amending Minnesota Statutes 2008, sections 62U.04, subdivisions 3,
9; 256B.0754, subdivision 2; Laws 2007, chapter 147, article 12, section 14;
repealing Minnesota Statutes 2009 Supplement, section 256B.032.

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

Section 1.

Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:


Subd. 3.

Provider peer grouping.

(a) The commissioner shall develop a peer
grouping system for providers based on a combined measure that incorporates both
provider risk-adjusted cost of care and quality of care, and for specific conditions as
determined by the commissioner. In developing this system, the commissioner shall
consult and coordinate with health care providers, health plan companies, state agencies,
and organizations that work to improve health care quality in Minnesota. For purposes of
the final establishment of the peer grouping system, the commissioner shall not contract
with any private entity, organization, or consortium of entities that has or will have a direct
financial interest in the outcome of the system.

(b) deleted text beginBeginning June 1deleted text endnew text begin By no later than October 15new text end, 2010, the commissioner shall
disseminate information to providers on their new text begintotal new text endcost of care, new text begintotal new text endresource use, new text begintotal
new text endquality of care, and the new text begintotal care new text endresults of the grouping developed under this subdivision
in comparison to an appropriate peer group. Any analyses or reports that identify
providers may only be published after the provider has been provided the opportunity by
the commissioner to review the underlying data and submit comments. new text beginProviders may be
given any data for which they are the subject of the data.
new text endThe provider shall have deleted text begin21deleted text endnew text begin 30
new text end days to review the data for accuracynew text begin and initiate an appeal as specified in paragraph (d)new text end.

(c) new text beginBy no later than January 1, 2011, the commissioner shall disseminate information
to providers on their condition-specific cost of care, condition-specific resource use,
condition-specific quality of care, and the condition-specific results of the grouping
developed under this subdivision in comparison to an appropriate peer group. Any
analyses or reports that identify providers may only be published after the provider has
been provided the opportunity by the commissioner to review the underlying data and
submit comments. Providers may be given any data for which they are the subject of the
data. The provider shall have 30 days to review the data for accuracy and initiate an
appeal as specified in paragraph (d).
new text end

new text begin (d) new text endThe commissioner shall establish an appeals process to resolve disputes from
providers regarding the accuracy of the data used to develop analyses or reports.new text begin When
a provider appeals the accuracy of the data used to calculate the peer grouping system
results, the provider shall:
new text end

new text begin (1) clearly indicate the reason they believe the data used to calculate the peer group
system results are not accurate;
new text end

new text begin (2) provide evidence and documentation to support the reason that data was not
accurate; and
new text end

new text begin (3) cooperate with the commissioner, including allowing the commissioner access to
data necessary and relevant to resolving the dispute.
new text end

new text begin If a provider does not meet the requirements of this paragraph, a provider's appeal shall be
considered withdrawn. The commissioner shall not publish results for a specific provider
under paragraph (e) or (f) while that provider has an unresolved appeal.
new text end

deleted text begin (d)deleted text endnew text begin (e)new text end Beginning deleted text beginSeptember 1, 2010deleted text endnew text begin January 1, 2011new text end, the commissioner shall, no
less than annually, publish information on providers' new text begintotal new text endcost, new text begintotal resource use, new text endnew text begintotal
new text endquality, and the results of the new text begintotal care portion of the new text endpeer grouping process. The results
that are published must be on a risk-adjusted basis.

new text begin (f) Beginning March 30, 2011, the commissioner shall no less than annually
publish information on providers' condition-specific cost, condition-specific resource use,
condition-specific quality, and the results of the condition-specific portion of the peer
grouping process. The results that are published must be on a risk-adjusted basis.
new text end

new text begin (g) Prior to disseminating data to providers under paragraph (b) or (c) or publishing
information under paragraph (e) or (f), the commissioner shall ensure the scientific
validity and reliability of the results according to the standards described in paragraph (h).
If additional time is needed to establish the scientific validity and reliability of the results,
the commissioner may delay the dissemination of data to providers under paragraph (b) or
(c), or the publication of information under paragraph (e) or (f). If the delay is more than
60 days, the commissioner shall report in writing to the Legislative Commission on Health
Care Access the following information:
new text end

new text begin (1) the reason for the delay;
new text end

new text begin (2) the actions being taken to resolve the delay and establish the scientific validity
and reliability of the results; and
new text end

new text begin (3) the new dates by which the results shall be disseminated.
new text end

new text begin If there is a delay under this paragraph, the commissioner must disseminate the
information to providers under paragraph (b) or (c) at least 90 days before publishing
results under paragraph (e) or (f).
new text end

new text begin (h) The commissioner's assurance of valid and reliable clinic and hospital peer
grouping performance results shall include, at a minimum, the following:
new text end

new text begin (1) use of the best available evidence, research, and methodologies; and
new text end

new text begin (2) establishment of an explicit minimum reliability threshold developed in
collaboration with the subjects of the data and the users of the data, at a level not below
nationally accepted standards where such standards exist.
new text end

new text begin In achieving these thresholds, the commissioner shall not aggregate clinics that are not
part of the same system or practice group. The commissioner shall consult with and solicit
feedback from representatives of physician clinics and hospitals during the peer grouping
data analysis process to obtain input on the methodological options prior to final analysis
and on the design, development, and testing of provider reports.
new text end

Sec. 2.

Minnesota Statutes 2008, section 62U.04, subdivision 9, is amended to read:


Subd. 9.

Uses of information.

(a) By deleted text beginJanuary 1, 2011deleted text endnew text begin no later than 12 months after
the commissioner publishes the information in subdivision 3, paragraph (e)
new text end:

(1) the commissioner of management and budget shall use the information and
methods developed under subdivision 3 to strengthen incentives for members of the state
employee group insurance program to use high-quality, low-cost providers;

(2) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
health benefits to their employees must offer plans that differentiate providers on their
cost and quality performance and create incentives for members to use better-performing
providers;

(3) all health plan companies shall use the information and methods developed
under subdivision 3 to develop products that encourage consumers to use high-quality,
low-cost providers; and

(4) health plan companies that issue health plans in the individual market or the
small employer market must offer at least one health plan that uses the information
developed under subdivision 3 to establish financial incentives for consumers to choose
higher-quality, lower-cost providers through enrollee cost-sharing or selective provider
networks.

(b) By January 1, 2011, the commissioner of health shall report to the governor
and the legislature on recommendations to encourage health plan companies to promote
widespread adoption of products that encourage the use of high-quality, low-cost providers.
The commissioner's recommendations may include tax incentives, public reporting of
health plan performance, regulatory incentives or changes, and other strategies.

Sec. 3.

Minnesota Statutes 2008, section 256B.0754, subdivision 2, is amended to read:


Subd. 2.

Payment reform.

By deleted text beginJanuary 1, 2011deleted text endnew text begin no later than 12 months after the
commissioner of health publishes the information in section 62U.04, subdivision 3,
paragraph (e)
new text end, the commissioner of human services shall use the information and methods
developed under section 62U.04 to establish a payment system that:

(1) rewards high-quality, low-cost providers;

(2) creates enrollee incentives to receive care from high-quality, low-cost providers;
and

(3) fosters collaboration among providers to reduce cost shifting from one part of
the health continuum to another.

Sec. 4.

Laws 2007, chapter 147, article 12, section 14, is amended to read:


Sec. 14. AGRICULTURAL COOPERATIVE HEALTH PLAN FOR
FARMERS.

Subdivision 1.

Pilot project requirements.

Notwithstanding contrary provisions of
Minnesota Statutes, chapter 62H, the following apply to a joint self-insurance pilot project
administered by a trust sponsored by one or more agricultural cooperatives organized
under Minnesota Statutes, chapter 308Anew text begin or 308Bnew text end, or under a federal charter for the
purpose of offering health coverage to members of the cooperatives and their families,
provided the project satisfies the other requirements of Minnesota Statutes, chapter 62H:

(1) Minnesota Statutes, section 62H.02, paragraph (b), does not apply;

(2) the notice period required under Minnesota Statutes, section 62H.02, paragraph
(e), is 90 days;

(3) a joint self-insurance plan may elect to treat the sale of a health plan to or for
an employer that has only one eligible employee who has not waived coverage as the
sale of an individual health plan as allowed under Minnesota Statutes, section 62L.02,
subdivision 26
;

(4) Minnesota Statutes, section 297I.05, subdivision 12, paragraph (c), applies; and

(5) the trust must pay the assessment for the Minnesota Comprehensive Health
Association as provided under Minnesota Statutes, section 62E.11.

Subd. 2.

Evaluation and renewal.

The pilot project authorized under this section
is for a period of four years from the date of initial enrollment. The commissioner of
commerce shall grant an extension of four additional years if the trust provides evidence
that it remains in compliance with the requirements of this section and other applicable
laws and rules. If the commissioner determines that the operation of the trust has not
improved access, expanded health plan choices, or improved the affordability of health
coverage for farm families, or that it has significantly damaged access, choice, or
affordability for other consumers not enrolled in the trust, the commissioner shall provide
at least 180 days' advance written notice to the trust and to the chairs of the senate and
house finance and policy committees with jurisdiction over health and insurance of the
commissioner's intention not to renew the pilot project at the expiration of a four-year
period.

new text begin Subd. 3. new text end

new text begin Use of surplus lines. new text end

new text begin Plans created under this section may use surplus lines
carriers to fulfill its obligations under chapter 62H.
new text end

Sec. 5. new text beginPAYMENT REFORM IMPLEMENTATION REPORT.
new text end

new text begin By April 1, 2011, the commissioner of human services shall report to the chairs of
the senate Health and Human Services Budget Division and the house of representatives
Health Care and Human Services Finance Division recommendations for implementing
the payment reform in Minnesota Statutes, section 256B.0754, subdivision 2. The
recommendations shall include:
new text end

new text begin (1) legislative changes needed to fully implement this payment reform; and
new text end

new text begin (2) an analysis of the fiscal impact of implementing this payment reform.
new text end

Sec. 6. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2009 Supplement, section 256B.032, new text end new text begin is repealed.
new text end