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HF 4094

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/07/2022 03:02pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health; modifying data collected under the all-payer claims database
and uses of this data; requiring the commissioner of health to study and report on
systems used by health plan companies and third-party administrators to pay health
care providers; amending Minnesota Statutes 2020, sections 62U.04, subdivision
11, by adding a subdivision; 62U.10, subdivision 7; Minnesota Statutes 2021
Supplement, section 62U.04, subdivisions 4, 5.

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

Section 1.

Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 4, is amended
to read:


Subd. 4.

Encounter data.

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

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

(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care homenew text begin, data on contractual value-based payments,new text end
anddeleted text begin, for claims incurred on or after January 1, 2019,deleted text end data deemed necessary by the
commissioner to uniquely identify claims in the individual health insurance market; and

(3) except for the identifier described in clause (2), the data must not include information
that is not included in a health care claim or equivalent encounter information transaction
that is required under section 62J.536.

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

(c) Data on providers collected under this subdivision are private data on individuals or
nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary data
in section 13.02, subdivision 19, summary data prepared under this subdivision may be
derived from nonpublic data. The commissioner or the commissioner's designee shall
establish procedures and safeguards to protect the integrity and confidentiality of any data
that it maintains.

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

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

Sec. 2.

Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 5, is amended
to read:


Subd. 5.

Pricing data.

(a) All health plan companies and third-party administrators shall
submit, on a monthly basis, data on their contracted prices with health care providers to a
private entity designated by the commissioner of health for the purposes of performing the
analyses required under this subdivision. new text beginData on contracted prices submitted under this
paragraph must include data on supplemental contractual value-based payments paid to
health care providers.
new text endThe data shall be submitted in the form and manner specified by the
commissioner of health.

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

(c) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this section may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data that it maintains.

Sec. 3.

Minnesota Statutes 2020, section 62U.04, is amended by adding a subdivision to
read:


new text begin Subd. 5b. new text end

new text begin Non-claims-based payments. new text end

new text begin (a) Beginning in 2024, all health plan companies
and third-party administrators shall submit to a private entity designated by the commissioner
of health all non-claims-based payments made to health care providers. The data shall be
submitted in a form, manner, and frequency specified by the commissioner. Non-claims-based
payments are payments to health care providers designed to pay for value over volume and
include alternative payment models or incentives, payments for infrastructure expenditures
or investments, or payments for workforce expenditures or investments. Non-claims-based
payments submitted under this subdivision must, to the extent possible, be attributed to a
health care provider in the same manner in which claims-based data are attributed to a health
care provider and, where appropriate, must be combined with data collected under
subdivisions 4 and 5 in analyses of health care spending.
new text end

new text begin (b) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this section may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data that it maintains.
new text end

new text begin (c) The commissioner shall consult with health plan companies, hospitals, and health
care providers in developing the data reported under this subdivision and standardized
reporting forms.
new text end

Sec. 4.

Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:


Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 deleted text beginanddeleted text endnew text begin,new text end 5new text begin, and 5bnew text end for the
following purposes:

(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data
available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.

(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.

deleted text begin (d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
deleted text end

deleted text begin (e)deleted text endnew text begin (d)new text end The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).

Sec. 5.

Minnesota Statutes 2020, section 62U.10, subdivision 7, is amended to read:


Subd. 7.

Outcomes reporting; savings determination.

(a) Beginning November 1,
2016, and each November 1 thereafter, the commissioner of health shall determine the actual
total private and public health care and long-term care spending for Minnesota residents
related to each health indicator projected in subdivision 6 for the most recent calendar year
available. The commissioner shall determine the difference between the projected and actual
spending for each health indicator and for each year, and determine the savings attributable
to changes in these health indicators. The assumptions and research methods used to calculate
actual spending must be determined to be appropriate by an independent actuarial consultant.
If the actual spending is less than the projected spending, the commissioner, in consultation
with the commissioners of human services and management and budget, shall use the
proportion of spending for state-administered health care programs to total private and
public health care spending for each health indicator for the calendar year two years before
the current calendar year to determine the percentage of the calculated aggregate savings
amount accruing to state-administered health care programs.

(b) The commissioner may use the data submitted under section 62U.04, subdivisions
4 deleted text beginanddeleted text endnew text begin,new text end 5, new text beginand 5b, new text endto complete the activities required under this section, but may only report
publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.

Sec. 6. new text beginREPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The terms defined in this subdivision apply to this section.
new text end

new text begin (b) "Commissioner" means commissioner of health.
new text end

new text begin (c) "Primary care services" means integrated, accessible health care services provided
by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of
family and community. Primary care services include but are not limited to preventive
services, office visits, administration of vaccines, annual physicals, pre-operative physicals,
assessments, care coordination, development of treatment plans, management of chronic
conditions, and diagnostic tests.
new text end

new text begin (d) "Non-claims-based payments" means payments to health care providers designed to
support and reward value over volume and include alternative payment models or incentives,
payments for infrastructure expenditures or investments, or payments for workforce
expenditures or investments.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin (a) To provide the legislature with information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
by February 15, 2023, on the volume and distribution of health care spending across payment
models in use by health plan companies and third-party administrators, with a particular
focus on value-based care models and primary care spending.
new text end

new text begin (b) The report must include health plan company and third-party-specific estimates on
health care spending for claims-based payments and non-claims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in Minnesota health
care programs, Medicare Advantage, and commercial health insurance. The report must
also include recommendations on changes needed to gather better data from health plan
companies and third-party administrators on the use of value-based payments that pays for
value over volume of services provided, that promotes the health of all Minnesotans, that
reduces health disparities, and that supports the provision of primary care services and
preventive services.
new text end

new text begin (c) In preparing the report, the commissioner shall perform the following duties:
new text end

new text begin (1) describe the form, manner, and timeline for submission of data by health plan
companies and third-party administrators to produce estimates as specified in paragraph
(b);
new text end

new text begin (2) collect summary data that permits the computation of:
new text end

new text begin (i) the percentage of total payments that are non-claims-based payments; and
new text end

new text begin (ii) the percentage of payments in item (i) that are for primary care services;
new text end

new text begin (3) where data was not directly derived, collect methods used to estimate data elements;
new text end

new text begin (4) notwithstanding the provisions in Minnesota Statutes, section 62U.04, subdivision
11, conduct analyses of the magnitude of primary care payments using data collected by
the commissioner in Minnesota Statutes, section 62U.04; and
new text end

new text begin (5) conduct interviews with health plan companies and third-party administrators to
better understand the types of non-claims-based payments and models in use, the purposes
or goals of each, the criteria for providers to qualify for these payments, and the timing and
structure of making these payments between health plan companies, third-party administrators
and health care provider organizations.
new text end

new text begin (d) Health plan companies and third-party administrators must comply with data requests
from the commissioner in paragraph (b) within 60 days.
new text end

new text begin (e) Data collected under this subdivision are nonpublic data as defined in Minnesota
Statutes, section 13.02. Notwithstanding the definition of summary data in Minnesota
Statutes, section 13.02, subdivision 19, summary data prepared under this section may be
derived from nonpublic data. The commissioner shall establish procedures and safeguards
to protect the integrity and confidentiality of any data that the commissioner maintains.
new text end