SF 501

1st Engrossment - 89th Legislature (2015 - 2016) Posted on 08/20/2015 01:50pm

A bill for an act
relating to health; requiring health care quality measures and payment methods
to identify and adjust for health disparities related to race, ethnicity, language,
and sociodemographic risk factors; appropriating money; amending Minnesota
Statutes 2014, sections 62U.02, subdivisions 1, 2, 3, 4; 256B.072.

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

Section 1.

Minnesota Statutes 2014, section 62U.02, subdivision 1, is amended to read:

Subdivision 1.

Development.

(a) The commissioner of health shall develop a
standardized set of measures by which to assess the quality of health care services offered
by health care providers, including health care providers certified as health care homes
under section 256B.0751. Quality measures must be based on medical evidence and be
developed through a process in which providers participate. The measures shall be used
for the quality incentive payment system developed in subdivision 2 and must:

(1) include uniform definitions, measures, and forms for submission of data, to the
greatest extent possible;

(2) seek to avoid increasing the administrative burden on health care providers;

(3) be initially based on existing quality indicators for physician and hospital
services, which are measured and reported publicly by quality measurement organizations,
including, but not limited to, Minnesota Community Measurement and specialty societies;

(4) place a priority on measures of health care outcomes, rather than process
measures, wherever possible; deleted text begin and
deleted text end

(5) incorporate measures for primary care, including preventive services, coronary
artery and heart disease, diabetes, asthma, depression, and other measures as determined
by the commissioner new text begin ; and
new text end

new text begin (6) effective July 1, 2016, be stratified by race, ethnicity, preferred language, and
country of origin. On or after January 1, 2018, the commissioner may require measures
to be stratified by other sociodemographic factors that according to reliable data are
correlated with health disparities and have an impact on performance on quality or cost
indicators. The commissioner shall consider, among other factors, poverty, homelessness,
household size and composition, zip code, disability, gender identity, and sexual
orientation. New methods of stratifying data must be tested and evaluated through pilot
projects prior to adding them to the statewide system. In determining whether to add
additional sociodemographic factors and developing the methodology to be used, the
commissioner shall consider the reporting burden on providers and determine whether
there are alternative sources of data that could be used. The commissioner shall ensure
that categories and data collection methods are developed in consultation with those
communities impacted by health disparities using culturally appropriate community
engagement principles and methods. The commissioner shall implement this clause in
coordination with the contracting entity retained under section 62U.02, subdivision 4, in
order to build upon the data stratification methodology that has been developed and tested
by the entity. Nothing in this clause expands or changes the commissioner's authority to
collect, analyze, or report health care data. Any data collected to implement this clause
must be data that is available or is authorized to be collected under other laws. Nothing
in this clause grants authority to the commissioner to collect or analyze patient-level or
patient-specific data of the patient characteristics identified under this clause new text end .

(b) The measures shall be reviewed at least annually by the commissioner.

Sec. 2.

Minnesota Statutes 2014, section 62U.02, subdivision 2, is amended to read:

Subd. 2.

Quality incentive payments.

(a) By July 1, 2009, the commissioner
shall develop a system of quality incentive payments under which providers are eligible
for quality-based payments that are in addition to existing payment levels, based upon
a comparison of provider performance against specified targets, and improvement over
time. The targets must be based upon and consistent with the quality measures established
under subdivision 1.

(b) To the extent possible, the payment system must adjust for variations in patient
population in order to reduce incentives to health care providers to avoid high-risk patients
or populations new text begin , including those with risk factors related to race, ethnicity, language,
country of origin, and sociodemographic factors new text end .

(c) The requirements of section 62Q.101 do not apply under this incentive payment
system.

Sec. 3.

Minnesota Statutes 2014, section 62U.02, subdivision 3, is amended to read:

Subd. 3.

Quality transparency.

new text begin (a) new text end The commissioner shall establish standards for
measuring health outcomes, establish a system for risk adjusting quality measures, and
issue annual public reports on provider quality beginning July 1, 2010.

new text begin (b) Effective July 1, 2017, the risk adjustment system established under this
subdivision shall adjust for patient characteristics identified under subdivision 1,
paragraph (a), clause (6), that are correlated with health disparities and have an impact on
performance on cost and quality measures. The risk adjustment method may consist of
reporting based on an actual-to-expected comparison that reflects the characteristics of the
patient population served by the clinic or hospital. The commissioner shall implement
this paragraph in coordination with any contracting entity retained under section 62U.02,
subdivision 4.
new text end

new text begin (c) new text end By January 1, 2010, physician clinics and hospitals shall submit standardized
electronic information on the outcomes and processes associated with patient care to
the commissioner or the commissioner's designee. In addition to measures of care
processes and outcomes, the report may include other measures designated by the
commissioner, including, but not limited to, care infrastructure and patient satisfaction.
The commissioner shall ensure that any quality data reporting requirements established
under this subdivision are not duplicative of publicly reported, communitywide quality
reporting activities currently under way in Minnesota. Nothing in this subdivision is
intended to replace or duplicate current privately supported activities related to quality
measurement and reporting in Minnesota.

Sec. 4.

Minnesota Statutes 2014, section 62U.02, subdivision 4, is amended to read:

Subd. 4.

Contracting.

The commissioner may contract with a private entity or
consortium of private entities to complete the tasks in subdivisions 1 to 3. The private
entity or consortium must be nonprofit and have governance that includes representatives
from the following stakeholder groups: health care providers new text begin , including providers serving
high concentrations of patients and communities impacted by health disparities new text end , health
plan companies, consumers new text begin , including consumers representing groups who experience
health disparities new text end , employers or other health care purchasers, and state government. 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.

Sec. 5.

Minnesota Statutes 2014, section 256B.072, is amended to read:

256B.072 PERFORMANCE REPORTING AND QUALITY IMPROVEMENT
SYSTEM.

(a) The commissioner of human services shall establish a performance reporting
system for health care providers who provide health care services to public program
recipients covered under chapters 256B, 256D, and 256L, reporting separately for
managed care and fee-for-service recipients.

(b) The measures used for the performance reporting system for medical groups
shall include measures of care for asthma, diabetes, hypertension, and coronary artery
disease and measures of preventive care services. The measures used for the performance
reporting system for inpatient hospitals shall include measures of care for acute myocardial
infarction, heart failure, and pneumonia, and measures of care and prevention of surgical
infections. In the case of a medical group, the measures used shall be consistent with
measures published by nonprofit Minnesota or national organizations that produce and
disseminate health care quality measures or evidence-based health care guidelines. In
the case of inpatient hospital measures, the commissioner shall appoint the Minnesota
Hospital Association and Stratis Health to advise on the development of the performance
measures to be used for hospital reporting. To enable a consistent measurement process
across the community, the commissioner may use measures of care provided for patients in
addition to those identified in paragraph (a). The commissioner shall ensure collaboration
with other health care reporting organizations so that the measures described in this
section are consistent with those reported by those organizations and used by other
purchasers in Minnesota.

(c) The commissioner may require providers to submit information in a required
format to a health care reporting organization or to cooperate with the information collection
procedures of that organization. The commissioner may collaborate with a reporting
organization to collect information reported and to prevent duplication of reporting.

(d) By October 1, 2007, and annually thereafter, the commissioner shall report
through a public Web site the results by medical groups and hospitals, where possible,
of the measures under this section, and shall compare the results by medical groups and
hospitals for patients enrolled in public programs to patients enrolled in private health
plans. To achieve this reporting, the commissioner may collaborate with a health care
reporting organization that operates a Web site suitable for this purpose.

new text begin (e) Performance measures must be stratified as provided under section 62U.02,
subdivision 1, paragraph (a), clause (6), and risk-adjusted as specified in section 62U.02,
subdivision 3, paragraph (b).
new text end

Sec. 6. new text begin HEALTH DISPARITIES PAYMENT ENHANCEMENT.
new text end

new text begin The commissioner of human services shall develop a methodology to pay a
higher payment rate for health care providers and services that takes into consideration
the higher cost, complexity, and resources needed to serve patients and populations
who experience the greatest health disparities in order to achieve the same health and
quality outcomes that are achieved for other patients and populations. In developing
the methodology, the commissioner shall take into consideration all existing payment
methods and rates, including add-on or enhanced rates paid to providers serving high
concentrations of low-income patients or populations or providing access in underserved
regions or populations. The new methodology must not result in a net decrease in total
payment from all sources for those providers who qualify for additional add-on payments
or enhanced payments, including, but not limited to, critical access dental, community
clinic add-ons, federally qualified health centers payment rates, and disproportionate share
payments. The commissioner shall develop the methodology in consultation with affected
stakeholders, including communities impacted by health disparities, using culturally
appropriate methods of community engagement. The proposed methodology must include
recommendations for how the methodology could be incorporated into payment methods
used in both fee-for-service and managed care plans. The commissioner shall submit
a report and recommendations, and draft legislative language to implement the new
methodology to the chairs and ranking minority members of the legislative committees
with jurisdiction over health care policy and finance by December 15, 2015, including the
proposed methodology for providing a health disparities payment adjustment.
new text end

Sec. 7. new text begin APPROPRIATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Commissioner of health. new text end

new text begin $....... is appropriated for the biennium
ending June 30, 2017, from the general fund to the commissioner of health for the
following:
new text end

new text begin (1) the development of the quality incentive payment system specified in Minnesota
Statutes, section 62U.02, subdivision 1, paragraph (a), clause (6);
new text end

new text begin (2) the development of the risk adjustment system specified in Minnesota Statutes,
section 62U.02, subdivision 3, paragraph (b); and
new text end

new text begin (3) community engagement with those communities impacted by health disparities.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner of human services. new text end

new text begin $....... is appropriated for the biennium
ending June 30, 2017, from the general fund to the commissioner of human services for
the modification of provider performance measures under Minnesota Statutes, section
256B.072, paragraph (e), to implement stratification and risk adjustment methods.
new text end