HF 3056

as introduced - 86th Legislature (2009 - 2010) Posted on 02/17/2010 04:29pm

A bill for an act
relating to health; establishing a quality improvement program for physician
clinics and hospitals; amending Minnesota Statutes 2008, section 62U.04,
subdivisions 3, 6, 9, by adding a subdivision; 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) Beginning June 1, 2010, the commissioner shall disseminate information to
providers on their cost of care, resource use, quality of care, and the 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. deleted text begin The provider shall have 21 days to review the data for accuracy.
deleted text end

(c) The commissioner shall establish an appeals process to resolve disputes from
providers regarding the accuracy of the data used to develop analyses or reports.

(d) Beginning September 1, deleted text begin 2010 deleted text end new text begin 2011 new text end , the commissioner shall, no less than
annually, publish information on providers' cost, quality, and the results of the peer
grouping process. The results that are published must be on a risk-adjusted basis.

Sec. 2.

Minnesota Statutes 2008, section 62U.04, is amended by adding a subdivision
to read:

new text begin Subd. 3a. new text end

new text begin Quality improvement. new text end

new text begin Beginning June 1, 2010, the commissioner shall
establish a quality improvement program for physician clinics and hospitals that utilizes
the underlying data and results generated from the provider peer grouping system. The
program shall annually provide physician clinics and hospitals with appropriate tools to
understand their performance and to improve their results. The commissioner may choose
to focus the program on those physician clinics and hospitals that deviate from identified
thresholds of performance.
new text end

Sec. 3.

Minnesota Statutes 2008, section 62U.04, subdivision 6, is amended to read:

Subd. 6.

Contracting.

new text begin (a) new text end The commissioner may contract with a private entity
or consortium of entities to develop the standards. The private entity or consortium
must be nonprofit and have governance that includes representatives from the following
stakeholder groups: health care providers, health plan companies, hospitals, consumers,
employers or other health care purchasers, and state government. The entity or consortium
must ensure that the representatives of stakeholder groups in the aggregate reflect all
geographic areas of the state. No one stakeholder group shall have a majority of the votes
on any issue or hold extraordinary powers not granted to any other governance stakeholder.

new text begin (b) The commissioner shall contract with a private entity or consortium of entities
to manage and implement the quality improvement program for physician clinics and
hospitals. The entity or consortium shall represent physicians and hospitals from all
geographic areas of the state.
new text end

Sec. 4.

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

Subd. 9.

Uses of information.

(a) By January 1, deleted text begin 2011 deleted text end new text begin 2012 new text end :

(1) the commissioner of management and budget deleted text begin shall deleted text end new text begin may new text end 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 deleted text begin must deleted text end new text begin may new text end 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 deleted text begin shall deleted text end new text begin may new text end 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 deleted text begin must deleted text end new text begin may new text end 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, deleted text begin 2011 deleted text end new text begin 2012 new text end , 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. 5. 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