SF 302

2nd Engrossment - 93rd Legislature (2023 - 2024) Posted on 10/25/2023 09:46am

A bill for an act
relating to health; requiring disclosure of certain payments made to health care
providers; changing provisions for all-payer claims data; requiring a report on
transparency of health care payments; amending Minnesota Statutes 2022, sections
62U.04, subdivisions 4, 5, 5a, 11, by adding subdivisions; 62U.10, subdivision 7.

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

Section 1.

Minnesota Statutes 2022, section 62U.04, subdivision 4, is amended to read:

Subd. 4.

Encounter data.

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

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

(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care home new text begin , data on contractual value-based payments, new text end
and deleted 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; deleted text begin and
deleted text end

(3) new text begin the data must include enrollee race and ethnicity, to the extent available; and
new text end

new text begin (4) new text end except for the deleted text begin identifier deleted text end new text begin data new text end described in deleted text begin clause deleted text end new text begin clauses new text end (2) new text begin and (3) new text end , the data must
not include information that is not included in a health care claim new text begin , dental care claim, new text end 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.

new text begin EFFECTIVE DATE. new text end

new text begin Paragraph (a), clause (3), is effective retroactively from January
1, 2023, and applies to claims incurred on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2022, section 62U.04, subdivision 5, is amended to read:

Subd. 5.

Pricing data.

(a) All health plan companies new text begin , dental plan companies, new text end 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 begin Data on contracted
prices submitted under this paragraph must include data on supplemental contractual
value-based payments paid to health care providers. new text end The 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 new text begin private data on individuals or new text end 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 2022, section 62U.04, subdivision 5a, is amended to read:

Subd. 5a.

Self-insurers.

new text begin (a) new text end The commissioner shall not require a self-insurer governed
by the federal Employee Retirement Income Security Act of 1974 (ERISA) to comply with
this section.

new text begin (b) A third-party administrator must annually notify the self-insurers whose health plans
are administered by the third-party administrator that the self-insurer may elect to have the
third-party administrator submit encounter data, data on contracted prices, and data on
nonclaims-based payments under subdivisions 4, 5, and 5b, from the self-insurer's health
plan for the upcoming plan year. This notice must be provided in a form and manner specified
by the commissioner. After receiving responses from self-insurers, a third-party administrator
must, in a form and manner specified by the commissioner, report to the commissioner:
new text end

new text begin (1) the self-insurers that elected to have the third-party administrator submit encounter
data and data on contracted prices from the self-insurer's health plan for the upcoming plan
year;
new text end

new text begin (2) the self-insurers that declined to have the third-party administrator submit encounter
data and data on contracted prices from the self-insurer's health plan for the upcoming plan
year; and
new text end

new text begin (3) data deemed necessary by the commissioner to identify and track the status of
reporting of data from self-insured health plans.
new text end

new text begin (c) Data 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 shall establish procedures and safeguards to protect the
integrity and confidentiality of any data maintained by the commissioner.
new text end

Sec. 4.

Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to
read:

new text begin Subd. 5b. new text end

new text begin Nonclaims-based payments. new text end

new text begin (a) Beginning January 1, 2025, all health plan
companies and third-party administrators shall submit to a private entity designated by the
commissioner of health all nonclaims-based payments made to health care providers. The
data shall be submitted in a form, manner, and frequency specified by the commissioner.
Nonclaims-based payments are payments to health care providers designed to pay for value
of health care services over volume of health care services and include alternative payment
models or incentives, payments for infrastructure expenditures or investments, and payments
for workforce expenditures or investments. Nonclaims-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, 5, and 5a, in
analyses of health care spending.
new text end

new text begin (b) Data 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 shall establish procedures and safeguards to protect the
integrity and confidentiality of any data maintained by the commissioner.
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. 5.

Minnesota Statutes 2022, 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 begin and deleted text end new text begin , new text end 5 new text begin , 5a, and 5b new 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; new text begin and
new text end

(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 deleted text begin ; and
deleted text end

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

(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.

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

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

Sec. 6.

Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to
read:

new text begin Subd. 13. new text end

new text begin Expanded access to and use of the all-payer claims data. new text end

new text begin (a) The
commissioner may make any data submitted under this section, including data classified as
private or nonpublic, available to individuals and organizations engaged in efforts to research
or affect transformation in health care outcomes, access, quality, disparities, or spending,
provided use of the data serves a public benefit and is not employed to:
new text end

new text begin (1) create an unfair market advantage for any participant in the health care market in the
state of Minnesota, health plan companies, payers, and providers;
new text end

new text begin (2) reidentify or attempt to reidentify an individual in the data; and
new text end

new text begin (3) publicly report details derived from the data regarding any contract between a health
plan company and a provider.
new text end

new text begin (b) To implement provisions in paragraph (a), the commissioner must:
new text end

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

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

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

Sec. 7.

Minnesota Statutes 2022, section 62U.10, subdivision 7, is amended to read:

Subd. 7.

Outcomes reporting; savings determination.

(a) deleted text begin Beginning November 1,
2016, and deleted text end Each November 1 deleted text begin thereafter deleted text end , the commissioner of health shall determine the
actual total private and public health Next 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 Previous 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 begin and deleted text end new text begin , new text end 5, new text begin 5a, and 5b, new text end to 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. 8. new text begin REPORT 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 the commissioner of health.
new text end

new text begin (c) "Nonclaims-based payments" means payments to health care providers designed to
support and reward value of health care services over volume of health care services and
includes alternative payment models or incentives, payments for infrastructure expenditures
or investments, and payments for workforce expenditures or investments.
new text end

new text begin (d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02,
subdivision 9.
new text end

new text begin (e) "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 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, 2024, on the volume and distribution of health care spending across payment
models used 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 specific health plan and third-party administrator estimates
of health care spending for claims-based payments and nonclaims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in state 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 pay for value of
health care services provided over volume of services provided, promote the health of all
Minnesotans, reduce health disparities, and support the provision of primary care services
and preventive services.
new text end

new text begin (c) In preparing the report, the commissioner shall:
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 nonclaims-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, specify the methods used to estimate data
elements;
new text end

new text begin (4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses
of the magnitude of primary care payments using data collected by the commissioner under
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 nonclaims-based payments and models in use, the purposes
or goals of each, the criteria for health care providers to qualify for these payments, and the
timing and structure of health plan companies or third-party administrators making these
payments to 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 under this section within 60 days after receiving the request.
new text end

new text begin (e) Data collected under this section is nonpublic data. 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 maintained
by the commissioner.
new text end