SF 2106

as introduced - 88th Legislature (2013 - 2014) Posted on 03/13/2014 09:15am

A bill for an act
relating to health; modifying the use of the all-payer claims data; convening a
work group to make recommendations on expanded uses of the all-payer claims
database; amending Minnesota Statutes 2012, section 62U.04, subdivisions 2,
3, 3b, 3c, 3d, 4, 5, by adding subdivisions; repealing Minnesota Statutes 2012,
section 62U.04, subdivision 7.

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

Section 1.

Minnesota Statutes 2012, section 62U.04, subdivision 2, is amended to read:

Subd. 2.

Calculation of health care costs and quality.

The commissioner of health
shall develop a uniform method of calculating providers' relative cost of care, defined as a
measure of health care spending including resource use and unit prices, and relative quality
of care. In developing this method, the commissioner must address the following issues:

(1) provider attribution of costs and quality;

(2) appropriate adjustment for outlier or catastrophic cases;

(3) appropriate risk adjustment to reflect differences in the demographics and health
status across provider patient populations, using generally accepted and transparent risk
adjustment methodologies and case mix adjustment;

(4) specific types of providers that should be included in the calculation;

(5) specific types of services that should be included in the calculation;

(6) appropriate adjustment for variation in payment rates;

(7) the appropriate provider level for analysis;

(8) payer mix adjustments, including variation across providers in the percentage of
revenue received from government programs; and

(9) other factors that the commissioner deleted text begin and the advisory committee, established
under subdivision 3, determine deleted text end new text begin determines new text end are needed to ensure validity and comparability
of the analysis.

Sec. 2.

Minnesota Statutes 2012, section 62U.04, subdivision 3, is amended to read:

Subd. 3.

Provider peer grouping; system development deleted text begin ; advisory committee deleted text end .

deleted text begin (a)
deleted text end The commissioner shall develop a peer grouping system for providers that incorporates
both provider risk-adjusted cost of care and quality of care, and for specific conditions
as determined by the commissioner. 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.

deleted text begin (b) The commissioner shall establish an advisory committee comprised of
representatives of health care providers, health plan companies, consumers, state agencies,
employers, academic researchers, and organizations that work to improve health care
quality in Minnesota. The advisory committee shall meet no fewer than three times
per year. The commissioner shall consult with the advisory committee in developing
and administering the peer grouping system, including but not limited to the following
activities:
deleted text end

deleted text begin (1) establishing peer groups;
deleted text end

deleted text begin (2) selecting quality measures;
deleted text end

deleted text begin (3) recommending thresholds for completeness of data and statistical significance
for the purposes of public release of provider peer grouping results;
deleted text end

deleted text begin (4) considering whether adjustments are necessary for facilities that provide medical
education, level 1 trauma services, neonatal intensive care, or inpatient psychiatric care;
deleted text end

deleted text begin (5) recommending inclusion or exclusion of other costs; and
deleted text end

deleted text begin (6) adopting patient attribution and quality and cost-scoring methodologies.
deleted text end

Sec. 3.

Minnesota Statutes 2012, section 62U.04, subdivision 3b, is amended to read:

Subd. 3b.

Provider peer grouping; appeals process.

The commissioner shall
establish a process to resolve disputes from providers regarding the accuracy of the data
used to develop analyses or reports or errors in the application of standards or methodology
established by the commissioner deleted text begin in consultation with the advisory committee deleted text end . When a
provider submits an appeal, the provider shall:

(1) clearly indicate the reason or reasons for the appeal;

(2) provide any evidence, calculations, or documentation to support the reason
for the appeal; and

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

The commissioner shall cooperate with the provider during the data review period
specified in subdivisions 3a and 3c by giving the provider information necessary for the
preparation of an appeal.

If a provider does not meet the requirements of this subdivision, a provider's appeal
shall be considered withdrawn. The commissioner shall not publish peer grouping results
for a provider until the appeal has been resolved.

Sec. 4.

Minnesota Statutes 2012, section 62U.04, subdivision 3c, is amended to read:

Subd. 3c.

Provider peer grouping; publication of information for the public.

(a)
The commissioner may publicly release summary data related to the peer grouping system
as long as the data do not contain information or descriptions from which the identity of
individual hospitals, clinics, or other providers may be discerned.

(b) The commissioner may publicly release analyses or results related to the peer
grouping system that identify hospitals, clinics, or other providers only if the following
criteria are met:

(1) the results, data, and summaries, including any graphical depictions of provider
performance, have been distributed to providers at least 120 days prior to publication;

(2) the commissioner has provided an opportunity for providers to verify and review
data for which the provider is the subject consistent with the recommendations developed
pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner;

(3) the results meet thresholds of validity, reliability, statistical significance,
representativeness, and other standards that reflect the recommendations of the advisory
committee, established under subdivision 3; and

(4) any public report or other usage of the analyses, reports, or data used by the
state clearly notifies consumers about how to use and interpret the results, including
any limitations of the data and analyses.

(c) After publishing the first public report, the commissioner shall, no less frequently
than annually, publish information on providers' total cost, total resource use, total
quality, and the results of the total care portion of the peer grouping process, as well
as information on providers' condition-specific cost, condition-specific resource use,
and 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,
including case mix adjustments.

deleted text begin (d) The commissioner shall convene a work group comprised of representatives
of physician clinics, hospitals, their respective statewide associations, and other
relevant stakeholder organizations to make recommendations on data to be made
available to hospitals and physician clinics to allow for verification of the accuracy and
representativeness of the provider peer grouping results.
deleted text end

Sec. 5.

Minnesota Statutes 2012, section 62U.04, subdivision 3d, is amended to read:

Subd. 3d.

Provider peer grouping; standards for dissemination and publication.

(a) Prior to disseminating data to providers under subdivision 3a or publishing information
under subdivision 3c, the commissioner deleted text begin , in consultation with the advisory committee,
deleted text end shall ensure the scientific and statistical validity and reliability of the results according
to the standards described in paragraph (b). If additional time is needed to establish the
scientific validity, statistical significance, and reliability of the results, the commissioner
may delay the dissemination of data to providers under subdivision 3a, or the publication
of information under subdivision 3c.

The commissioner must disseminate the information to providers under subdivision 3a at
least 120 days before publishing results under subdivision 3c.

(b) The commissioner's assurance of valid, timely, and reliable clinic and hospital
peer grouping performance results shall include, at a minimum, the following:

(1) use of the best available evidence, research, and methodologies; and

(2) establishment of explicit minimum reliability thresholds for both quality and
costs 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.

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 deleted text begin the advisory committee and deleted text end 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.

Sec. 6.

Minnesota Statutes 2012, section 62U.04, subdivision 4, is amended to read:

Subd. 4.

Encounter data.

(a) Beginning July 1, 2009, and every six months
thereafter, all health plan companies and third-party administrators shall submit encounter
data 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; 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) deleted text begin The commissioner or the commissioner's designee shall only use the data
submitted under paragraph (a) to carry out its 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.
deleted text end

deleted text begin (c) deleted text end 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.

deleted text begin (d) deleted text end new text begin (c) new text end The commissioner or the commissioner's designee shall not publish analyses
or reports that identify, or could potentially identify, individual patients.

Sec. 7.

Minnesota Statutes 2012, section 62U.04, subdivision 5, is amended to read:

Subd. 5.

Pricing data.

(a) Beginning July 1, 2009, and annually on January 1
thereafter, all health plan companies and third-party administrators shall submit 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. The data shall be submitted in the form and manner specified by the
commissioner of health.

(b) deleted text begin The commissioner or the commissioner's designee shall only use the data
submitted under this subdivision to carry out its 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 deleted text end .

deleted text begin (c) deleted text end 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. 8.

Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
to read:

new text begin Subd. 10. new text end

new text begin Suspension. new text end

new text begin Notwithstanding subdivisions 3 to 3d, the commissioner
shall suspend the development and implementation of the provider peer grouping system
required under this section.
new text end

Sec. 9.

Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
to read:

new text begin Subd. 11. new text end

new text begin Restricted uses of the all-payer claims data. new text end

new text begin (a) The commissioner
or the commissioner's designee shall only use the data submitted under subdivisions 4
and 5 for the following purposes:
new text end

new text begin (1) to evaluate the performance of the health care home program, including the
use of aggregate data to measure the impact of health care homes on health care costs,
quality, and utilization;
new text end

new text begin (2) to study, in collaboration with the Reducing Avoidable Readmissions Effectively
(RARE) campaign, hospital readmission trends and rates;
new text end

new text begin (3) to analyze variations in health care costs, quality, and utilization based on
geographical areas, delivery models, or populations; and
new text end

new text begin (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.
new text end

new text begin (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.
new text end

Sec. 10. new text begin ALL-PAYER CLAIMS DATABASE WORK GROUP.
new text end

new text begin (a) The commissioner of health shall convene a work group to develop a framework
for the expanded use of the all-payer claims database established under Minnesota
Statutes, section 62U.04. The work group shall develop recommendations based on the
following questions:
new text end

new text begin (1) what should the parameters be for allowable uses of the all-payer claims data
collected under Minnesota Statutes, section 62U.04, beyond the uses authorized in
Minnesota Statutes, section 62U.04, subdivision 11;
new text end

new text begin (2) what should be the criteria and processes for evaluating the all-payer claims
data requests;
new text end

new text begin (3) what type of advisory or governing body should guide the release of data from
the all-payer claims database;
new text end

new text begin (4) what type of funding or fee structure would be needed to support the expanded use
of all-payer claims data. Should the funding structure be stratified based on the proposed
use, type of requesting organization, type or scope of data requested, or other criteria;
new text end

new text begin (5) what should the mechanisms be by which the data would be released or accessed,
including the necessary information technology infrastructure to support the expanded use
of the data under different assumptions related to the number of potential requests and
manner of access;
new text end

new text begin (6) what are the appropriate privacy and security protections needed for the
expanded use of the all-payer claims database; and
new text end

new text begin (7) what additional resources might be needed to support the expanded use of the
all-payer claims database, including expected resources related to information technology
infrastructure, review of proposals, maintenance of data use agreements, staffing an
advisory body, or other new efforts.
new text end

new text begin (b) The commissioner of health shall appoint the members to the work group
as follows:
new text end

new text begin (1) two members recommended by the Minnesota Medical Association;
new text end

new text begin (2) two members recommended by the Minnesota Hospital Association;
new text end

new text begin (3) two members recommended by the Minnesota Council of Health Plans;
new text end

new text begin (4) one member who is a data practices expert from the Department of Administration;
new text end

new text begin (5) three members appointed by the commissioner who are academic researchers
from the University of Minnesota with expertise in claims database analysis; and
new text end

new text begin (6) three members representing consumers appointed by the commissioner of health.
new text end

new text begin (c) The commissioner of health shall submit a report on the recommendations of
the work group to the chairs and ranking minority members of the legislative committees
and divisions with jurisdiction over health and human services, judiciary, and civil law by
February 1, 2015.
new text end

Sec. 11. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2012, section 62U.04, subdivision 7, new text end new text begin is repealed.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective the day following final enactment.
new text end