SF 959

1st Engrossment - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; revising the data and research 
  1.3             initiatives of MinnesotaCare; amending Minnesota 
  1.4             Statutes 1994, sections 13.99, by adding a 
  1.5             subdivision; 62J.04, subdivision 3; 62J.06; 62J.212; 
  1.6             62J.37; 62J.38; 62J.40; 62J.41, subdivisions 1 and 2; 
  1.7             62J.54; 62J.55; 62J.58; 62Q.03, subdivisions 1, 6, 7, 
  1.8             8, 9, 10, and by adding subdivisions; 214.16, 
  1.9             subdivisions 2 and 3; and 295.57; proposing coding for 
  1.10            new law in Minnesota Statutes, chapter 62J; repealing 
  1.11            Minnesota Statutes 1994, sections 62J.30; 62J.31; 
  1.12            62J.32; 62J.33; 62J.34; 62J.35; 62J.41, subdivisions 3 
  1.13            and 4; 62J.44; and 62J.45. 
  1.14  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.15     Section 1.  Minnesota Statutes 1994, section 13.99, is 
  1.16  amended by adding a subdivision to read: 
  1.17     Subd. 115.  [HEALTH DATA INSTITUTE DATA.] Data created, 
  1.18  collected, received, maintained, or disseminated by the 
  1.19  Minnesota health data institute established under section 
  1.20  62J.451 are classified under section 62J.452; access to and 
  1.21  disclosure of such data are governed by section 62J.452. 
  1.22     Sec. 2.  Minnesota Statutes 1994, section 62J.04, 
  1.23  subdivision 3, is amended to read: 
  1.24     Subd. 3.  [COST CONTAINMENT DUTIES.] After obtaining the 
  1.25  advice and recommendations of the Minnesota health care 
  1.26  commission, the commissioner shall: 
  1.27     (1) establish statewide and regional limits on growth in 
  1.28  total health care spending under this section, monitor regional 
  1.29  and statewide compliance with the spending limits, and take 
  2.1   action to achieve compliance to the extent authorized by the 
  2.2   legislature; 
  2.3      (2) divide the state into no fewer than four regions, with 
  2.4   one of those regions being the Minneapolis/St. Paul metropolitan 
  2.5   statistical area but excluding Chisago, Isanti, Wright, and 
  2.6   Sherburne counties, for purposes of fostering the development of 
  2.7   regional health planning and coordination of health care 
  2.8   delivery among regional health care systems and working to 
  2.9   achieve spending limits; 
  2.10     (3) provide technical assistance to regional coordinating 
  2.11  boards; 
  2.12     (4) monitor the quality of health care throughout the 
  2.13  state, conduct consumer satisfaction surveys, and take action as 
  2.14  necessary to ensure an appropriate level of quality; 
  2.15     (5) issue recommendations regarding uniform billing forms, 
  2.16  uniform electronic billing procedures and data interchanges, 
  2.17  patient identification cards, and other uniform claims and 
  2.18  administrative procedures for health care providers and private 
  2.19  and public sector payers.  In developing the recommendations, 
  2.20  the commissioner shall review the work of the work group on 
  2.21  electronic data interchange (WEDI) and the American National 
  2.22  Standards Institute (ANSI) at the national level, and the work 
  2.23  being done at the state and local level.  The commissioner may 
  2.24  adopt rules requiring the use of the Uniform Bill 82/92 form, 
  2.25  the National Council of Prescription Drug Providers (NCPDP) 3.2 
  2.26  electronic version, the Health Care Financing Administration 
  2.27  1500 form, or other standardized forms or procedures; 
  2.28     (6) undertake health planning responsibilities as provided 
  2.29  in section 62J.15; 
  2.30     (7) monitor and promote the development and implementation 
  2.31  of practice parameters; 
  2.32     (8) authorize, fund, or promote research and 
  2.33  experimentation on new technologies and health care procedures; 
  2.34     (9)  designate referral centers for specialized and 
  2.35  high-cost procedures and treatment and establish minimum 
  2.36  standards and requirements for particular procedures or 
  3.1   treatment; 
  3.2      (10) (8) within the limits of appropriations for these 
  3.3   purposes, administer or contract for statewide consumer 
  3.4   education and wellness programs that will improve the health of 
  3.5   Minnesotans and increase individual responsibility relating to 
  3.6   personal health and the delivery of health care services, 
  3.7   undertake prevention programs including initiatives to improve 
  3.8   birth outcomes, expand childhood immunization efforts, and 
  3.9   provide start-up grants for worksite wellness programs; and 
  3.10     (11) administer the data analysis unit; and 
  3.11     (12) (9) undertake other activities to monitor and oversee 
  3.12  the delivery of health care services in Minnesota with the goal 
  3.13  of improving affordability, quality, and accessibility of health 
  3.14  care for all Minnesotans. 
  3.15     Sec. 3.  Minnesota Statutes 1994, section 62J.06, is 
  3.16  amended to read: 
  3.17     62J.06 [IMMUNITY FROM LIABILITY.] 
  3.18     No member of the Minnesota health care commission 
  3.19  established under section 62J.05, regional coordinating boards 
  3.20  established under section 62J.09, or the health 
  3.21  planning technology advisory committee established under section 
  3.22  62J.15, data collection advisory committee established under 
  3.23  section 62J.30, or practice parameter advisory committee 
  3.24  established under section 62J.32 shall be held civilly or 
  3.25  criminally liable for an act or omission by that person if the 
  3.26  act or omission was in good faith and within the scope of the 
  3.27  member's responsibilities under this chapter. 
  3.28     Sec. 4.  Minnesota Statutes 1994, section 62J.212, is 
  3.29  amended to read: 
  3.30     62J.212 [COLLABORATION ON PUBLIC HEALTH GOALS.] 
  3.31     The commissioner may increase regional spending limits if 
  3.32  public health goals for that region are achieved.  The 
  3.33  commissioner shall establish specific public health goals 
  3.34  including, but not limited to, increased delivery of prenatal 
  3.35  care, improved birth outcomes, and expanded childhood 
  3.36  immunizations.  The commissioner shall consider the community 
  4.1   public health goals and the input of the statewide advisory 
  4.2   committee on community health in establishing the statewide 
  4.3   goals. 
  4.4      Sec. 5.  [62J.2930] [INFORMATION CLEARINGHOUSE.] 
  4.5      Subdivision 1.  [ESTABLISHMENT.] The commissioner of health 
  4.6   shall establish an information clearinghouse within the 
  4.7   department of health to facilitate the ability of consumers, 
  4.8   employers, providers, health plan companies, and others to 
  4.9   obtain information on health reform activities in Minnesota.  
  4.10  The commissioner shall make available through the clearinghouse 
  4.11  updates on federal and state health reform activities, including 
  4.12  information developed or collected by the department of health 
  4.13  on cost containment or other research initiatives, the 
  4.14  development of integrated service networks, and voluntary 
  4.15  purchasing pools, action plans submitted by health plan 
  4.16  companies, reports or recommendations of the health technology 
  4.17  advisory committee and other entities on technology assessments, 
  4.18  and reports or recommendations from other formal committees 
  4.19  applicable to health reform activities.  The clearinghouse shall 
  4.20  also refer requesters to sources of further information or 
  4.21  assistance.  The clearinghouse is subject to chapter 13. 
  4.22     Subd. 2.  [INFORMATION ON HEALTH PLAN COMPANIES.] The 
  4.23  information clearinghouse shall provide information on all 
  4.24  health plan companies operating in a specific geographic area to 
  4.25  consumers and purchasers who request it. 
  4.26     Subd. 3.  [COORDINATION.] To the extent possible, the 
  4.27  commissioner shall coordinate the activities of the 
  4.28  clearinghouse with the activities of the Minnesota health data 
  4.29  institute. 
  4.30     Sec. 6.  [62J.301] [RESEARCH AND DATA INITIATIVES.] 
  4.31     Subdivision 1.  [DEFINITIONS.] For purposes of sections 
  4.32  62J.2930 to 62J.42, the following definitions apply: 
  4.33     (a) "Health outcomes data" means data used in research 
  4.34  designed to identify and analyze the outcomes and costs of 
  4.35  alternative interventions for a given clinical condition, in 
  4.36  order to determine the most appropriate and cost-effective means 
  5.1   to prevent, diagnose, treat, or manage the condition, or in 
  5.2   order to develop and test methods for reducing inappropriate or 
  5.3   unnecessary variations in the type and frequency of 
  5.4   interventions. 
  5.5      (b) "Encounter level data" means data related to the 
  5.6   utilization of health care services by, and the provision of 
  5.7   health care services to individual patients, enrollees, or 
  5.8   insureds, including claims data, abstracts of medical records, 
  5.9   and data from patient interviews and patient surveys. 
  5.10     Subd. 2.  [STATEMENT OF PURPOSE.] The commissioner of 
  5.11  health shall conduct data and research initiatives in order to 
  5.12  monitor and improve the efficiency and effectiveness of health 
  5.13  care in Minnesota. 
  5.14     Subd. 3.  [GENERAL DUTIES.] The commissioner shall: 
  5.15     (1) collect and maintain data which enable population-based 
  5.16  monitoring and trending of the access, utilization, quality, and 
  5.17  cost of health care services within Minnesota; 
  5.18     (2) collect and maintain data for the purpose of estimating 
  5.19  total Minnesota health care expenditures and trends; 
  5.20     (3) collect and maintain data for the purposes of setting 
  5.21  limits under section 62J.04, and measuring growth limit 
  5.22  compliance; 
  5.23     (4) conduct applied research using existing and new data 
  5.24  and promote applications based on existing research; 
  5.25     (5) develop and implement data collection procedures to 
  5.26  ensure a high level of cooperation from health care providers 
  5.27  and health plan companies, as defined in section 62Q.01, 
  5.28  subdivision 4; 
  5.29     (6) work closely with health plan companies and health care 
  5.30  providers to promote improvements in health care efficiency and 
  5.31  effectiveness; and 
  5.32     (7) participate as a partner or sponsor of private sector 
  5.33  initiatives that promote publicly disseminated applied research 
  5.34  on health care delivery, outcomes, costs, quality, and 
  5.35  management. 
  5.36     Subd. 4.  [INFORMATION TO BE COLLECTED.] (a) The data 
  6.1   collected may include health outcomes data, patient functional 
  6.2   status, and health status.  The data collected may include 
  6.3   information necessary to measure and make adjustments for 
  6.4   differences in the severity of patient condition across 
  6.5   different health care providers, and may include data obtained 
  6.6   directly from the patient or from patient medical records, as 
  6.7   provided in section 62J.321, subdivision 1. 
  6.8      (b) The commissioner may: 
  6.9      (1) collect the encounter level data required for the 
  6.10  research and data initiatives of sections 62J.301 to 62J.42, 
  6.11  using, to the greatest extent possible, standardized forms and 
  6.12  procedures; and 
  6.13     (2) process the data collected to ensure validity, 
  6.14  consistency, accuracy, and completeness, and as appropriate, 
  6.15  merge data collected from different sources. 
  6.16     (c) For purposes of estimating total health care spending 
  6.17  and forecasting rates of growth in health care spending, the 
  6.18  commissioner may collect from health care providers data on 
  6.19  patient revenues and health care spending during a time period 
  6.20  specified by the commissioner.  The commissioner may also 
  6.21  collect data on health care revenues and spending from group 
  6.22  purchasers of health care.  Health care providers and group 
  6.23  purchasers doing business in the state shall provide the data 
  6.24  requested by the commissioner at the times and in the form 
  6.25  specified by the commissioner.  Professional licensing boards 
  6.26  and state agencies responsible for licensing, registering, or 
  6.27  regulating providers and group purchasers shall cooperate fully 
  6.28  with the commissioner in achieving compliance with the reporting 
  6.29  requirements. 
  6.30     Subd. 5.  [NONLIMITING.] Nothing in this section shall be 
  6.31  construed to limit the powers granted to the commissioner of 
  6.32  health under chapter 62D, 62N, 144, or 144A. 
  6.33     Sec. 7.  [62J.311] [ANALYSIS AND USE OF DATA.] 
  6.34     Subdivision 1.  [DATA ANALYSIS.] The commissioner shall 
  6.35  analyze the data collected to: 
  6.36     (1) assist the state in developing and refining its health 
  7.1   policy in the areas of access, utilization, quality, and cost; 
  7.2      (2) assist the state in promoting efficiency and 
  7.3   effectiveness in the financing and delivery of health services; 
  7.4      (3) monitor and track accessibility, utilization, quality, 
  7.5   and cost of health care services within the state; 
  7.6      (4) evaluate the impact of health care reform activities; 
  7.7      (5) assist the state in its public health activities; and 
  7.8      (6) evaluate and determine the most appropriate methods for 
  7.9   ongoing data collection. 
  7.10     Subd. 2.  [CRITERIA FOR DATA AND RESEARCH INITIATIVES.] (a) 
  7.11  Data and research initiatives by the commissioner must: 
  7.12     (1) serve the needs of the general public, public sector 
  7.13  health care programs, employers and other purchasers of health 
  7.14  care, health care providers, including providers serving large 
  7.15  numbers of people with low-income, and health plan companies as 
  7.16  applicable; 
  7.17     (2) be based on scientifically sound and statistically 
  7.18  valid methods; 
  7.19     (3) be statewide in scope, to the extent feasible, in order 
  7.20  to benefit health care purchasers and providers in all parts of 
  7.21  Minnesota and to ensure broad and representative health care 
  7.22  data for research comparisons and applications; 
  7.23     (4) emphasize data that is useful, relevant, and 
  7.24  nonredundant of existing data.  The initiatives may duplicate 
  7.25  existing private data collection activities, if necessary to 
  7.26  ensure that the data collected will be in the public domain; 
  7.27     (5) be structured to minimize the administrative burden on 
  7.28  health plan companies, health care providers, and the health 
  7.29  care delivery system, and minimize any privacy impact on 
  7.30  individuals; and 
  7.31     (6) promote continuous improvement in the efficiency and 
  7.32  effectiveness of health care delivery. 
  7.33     (b) Data and research initiatives related to public sector 
  7.34  health care programs must: 
  7.35     (1) assist the state's current health care financing and 
  7.36  delivery programs to deliver and purchase health care in a 
  8.1   manner that promotes improvements in health care efficiency and 
  8.2   effectiveness; 
  8.3      (2) assist the state in its public health activities, 
  8.4   including the analysis of disease prevalence and trends and the 
  8.5   development of public health responses; 
  8.6      (3) assist the state in developing and refining its overall 
  8.7   health policy, including policy related to health care costs, 
  8.8   quality, and access; and 
  8.9      (4) provide data that allows the evaluation of state health 
  8.10  care financing and delivery programs. 
  8.11     Sec. 8.  [62J.321] [DATA COLLECTION AND PROCESSING 
  8.12  PROCEDURES.] 
  8.13     Subdivision 1.  [DATA COLLECTION.] (a) The commissioner 
  8.14  shall collect data from health care providers, health plan 
  8.15  companies, and individuals in the most cost-effective manner, 
  8.16  which does not unduly burden them.  The commissioner may require 
  8.17  health care providers and health plan companies to collect and 
  8.18  provide patient health records and claim files, and cooperate in 
  8.19  other ways with the data collection process.  The commissioner 
  8.20  may also require health care providers and health plan companies 
  8.21  to provide mailing lists of patients.  Patient consent shall not 
  8.22  be required for the release of data to the commissioner pursuant 
  8.23  to sections 62J.301 to 62J.42 by any group purchaser, health 
  8.24  plan company, health care provider; or agent, contractor, or 
  8.25  association acting on behalf of a group purchaser or health care 
  8.26  provider.  Any group purchaser, health plan company, health care 
  8.27  provider; or agent, contractor, or association acting on behalf 
  8.28  of a group purchaser or health care provider, that releases data 
  8.29  to the commissioner in good faith pursuant to sections 62J.301 
  8.30  to 62J.42 shall be immune from civil liability and criminal 
  8.31  prosecution. 
  8.32     (b) When a group purchaser, health plan company, or health 
  8.33  care provider submits patient identifying data, as defined in 
  8.34  section 62J.451, to the commissioner pursuant to sections 
  8.35  62J.301 to 62J.42, and the data is submitted to the commissioner 
  8.36  in electronic form, or through other electronic means including, 
  9.1   but not limited to, the electronic data interchange system 
  9.2   defined in section 62J.451, the group purchaser, health plan 
  9.3   company, or health care provider shall submit the patient 
  9.4   identifying data in encrypted form, using an encryption method 
  9.5   specified by the commissioner.  Submission of encrypted data as 
  9.6   provided in this paragraph satisfies the requirements of section 
  9.7   144.335, subdivision 3b. 
  9.8      (c) The commissioner shall require all health care 
  9.9   providers, group purchasers, and state agencies to use a 
  9.10  standard patient identifier and a standard identifier for 
  9.11  providers and health plan companies when reporting data under 
  9.12  this chapter.  The commissioner must encrypt patient identifiers 
  9.13  to prevent identification of individual patients and to enable 
  9.14  release of otherwise private data to researchers, providers, and 
  9.15  group purchasers in a manner consistent with chapter 13 and 
  9.16  sections 62J.55 and 144.335.  This encryption must ensure that 
  9.17  any data released must be in a form that makes it impossible to 
  9.18  identify individual patients.  
  9.19     Subd. 2.  [FAILURE TO PROVIDE DATA.] The intentional 
  9.20  failure to provide the data requested under this chapter is 
  9.21  grounds for disciplinary or regulatory action against a 
  9.22  regulated provider or group purchaser.  The commissioner may 
  9.23  assess a fine against a provider or group purchaser who refuses 
  9.24  to provide data required by the commissioner.  If a provider or 
  9.25  group purchaser refuses to provide the data required, the 
  9.26  commissioner may obtain a court order requiring the provider or 
  9.27  group purchaser to produce documents and allowing the 
  9.28  commissioner to inspect the records of the provider or group 
  9.29  purchaser for purposes of obtaining the data required. 
  9.30     Subd. 3.  [DATA COLLECTION AND REVIEW.] Data collection 
  9.31  must continue for a sufficient time to permit:  adequate 
  9.32  analysis by researchers and appropriate providers, including 
  9.33  providers who will be impacted by the data; feedback to 
  9.34  providers; monitoring for changes in practice patterns; and the 
  9.35  data and research criteria of section 62J.311, subdivision 2, to 
  9.36  be fulfilled. 
 10.1      Subd. 4.  [USE OF EXISTING DATA.] (a) The commissioner 
 10.2   shall negotiate with private sector organizations currently 
 10.3   collecting health care data of interest to the commissioner to 
 10.4   obtain required data in a cost-effective manner and minimize 
 10.5   administrative costs.  The commissioner shall attempt to 
 10.6   establish links between the health care data collected to 
 10.7   fulfill sections 62J.301 to 62J.42 and existing private sector 
 10.8   data and shall consider and implement methods to streamline data 
 10.9   collection in order to reduce public and private sector 
 10.10  administrative costs. 
 10.11     (b) The commissioner shall use existing public sector data, 
 10.12  such as those existing for medical assistance and Medicare, to 
 10.13  the greatest extent possible.  The commissioner shall establish 
 10.14  links between existing public sector data and consider and 
 10.15  implement methods to streamline public sector data collection in 
 10.16  order to reduce public and private sector administrative costs. 
 10.17     Subd. 5.  [DATA CLASSIFICATION.] (a) Data collected to 
 10.18  fulfill the data and research initiatives authorized by sections 
 10.19  62J.301 to 62J.42 that identify individual patients or providers 
 10.20  are private data on individuals.  Data not on individuals are 
 10.21  nonpublic data.  The commissioner shall establish procedures and 
 10.22  safeguards to ensure that data released by the commissioner is 
 10.23  in a form that does not identify specific patients, providers, 
 10.24  employers, individual or group purchasers, or other specific 
 10.25  individuals and organizations, except with the permission of the 
 10.26  affected individual or organization, or as permitted elsewhere 
 10.27  in this chapter. 
 10.28     (b) Raw unaggregated data collected from household and 
 10.29  employer surveys used by the commissioner to monitor the number 
 10.30  of uninsured individuals, reasons for lack of insurance 
 10.31  coverage, and to evaluate the effectiveness of health care 
 10.32  reform, are subject to the same data classifications as data 
 10.33  collected pursuant to sections 62J.301 to 62J.42. 
 10.34     (c) Notwithstanding sections 13.03, subdivisions 6 to 8; 
 10.35  13.10, subdivisions 1 to 4; and 138.17, data received by the 
 10.36  commissioner pursuant to sections 62J.301 to 62J.42, shall 
 11.1   retain the classification designated under this section and 
 11.2   shall not be disclosed other than pursuant to this section. 
 11.3      (d) Summary data collected to fulfill the data and research 
 11.4   initiatives authorized by sections 62J.301 to 62J.42 may be 
 11.5   disseminated under section 13.05, subdivision 7.  For the 
 11.6   purposes of this section, summary data includes nonpublic data 
 11.7   not on individuals. 
 11.8      (e) Notwithstanding paragraph (a), the commissioner may 
 11.9   publish nonpublic or private data collected pursuant to sections 
 11.10  62J.301 to 62J.42 on health care costs and spending, quality and 
 11.11  outcomes, and utilization for health care institutions, 
 11.12  individual health care professionals and groups of health care 
 11.13  professionals, group purchasers, and integrated service 
 11.14  networks, with a description of the methodology used for 
 11.15  analysis.  The commissioner may not make public any patient 
 11.16  identifying information except as specified in statute.  The 
 11.17  commissioner shall not reveal the name of an institution, group 
 11.18  of professionals, individual health care professional, group 
 11.19  purchaser, or integrated service network until after the 
 11.20  institution, group of professionals, individual health care 
 11.21  professional, group purchaser, or integrated service network has 
 11.22  had 21 days to review the data and comment.  The commissioner 
 11.23  shall include comments received in the release of the data. 
 11.24     (f) A provider or group purchaser may contest whether the 
 11.25  data meets the criteria of section 62J.311, subdivision 2, 
 11.26  paragraph (a), clause (2), in accordance with a contested case 
 11.27  proceeding as set forth in sections 14.57 to 14.62, subject to 
 11.28  appeal in accordance with sections 14.63 to 14.68.  To obtain a 
 11.29  contested case hearing, the provider or group purchaser must 
 11.30  make a written request to the commissioner before the end of the 
 11.31  time period for review and comment.  Within ten days of the 
 11.32  assignment of an administrative law judge, the provider or group 
 11.33  purchaser shall make a clear showing to the administrative law 
 11.34  judge of probable success in a hearing on the merits and likely 
 11.35  irreparable injury to the provider or group purchaser if the 
 11.36  data is published.  If the administrative law judge determines 
 12.1   that the provider or group purchaser has made such a showing, 
 12.2   the data shall remain private or nonpublic during the contested 
 12.3   case proceeding and appeal.  If the administrative law judge 
 12.4   determines that the provider or group purchaser has not made 
 12.5   such a showing, the commissioner may publish the data 
 12.6   immediately, with comments received in the release of the data.  
 12.7   The contested case proceeding and subsequent appeal is not an 
 12.8   exclusive remedy and any person may seek a remedy pursuant to 
 12.9   section 13.08, subdivisions 1 to 4, or as otherwise authorized 
 12.10  by law. 
 12.11     Subd. 6.  [RULEMAKING.] The commissioner may adopt rules to 
 12.12  implement sections 62J.301 to 62J.452. 
 12.13     Subd. 7.  [FEDERAL AND OTHER GRANTS.] The commissioner may 
 12.14  seek federal funding, and funding from private and other 
 12.15  nonstate sources, for data and research initiatives. 
 12.16     Subd. 8.  [CONTRACTS AND GRANTS.] To carry out the duties 
 12.17  assigned in sections 62J.301 to 62J.42, the commissioner may 
 12.18  contract with or provide grants to private sector entities.  Any 
 12.19  contract or grant must require the private sector entity to 
 12.20  maintain the data which it receives according to the statutory 
 12.21  provisions applicable to the data. 
 12.22     Sec. 9.  [62J.322] [PROVIDER INFORMATION PILOT STUDY.] 
 12.23     The commissioner shall develop a pilot study to collect 
 12.24  comparative data from health care providers on opportunities and 
 12.25  barriers to the provision of quality, cost-effective health 
 12.26  care.  The provider information pilot study shall include 
 12.27  providers in community integrated service networks, integrated 
 12.28  service networks, health maintenance organizations, preferred 
 12.29  provider organizations, indemnity insurance plans, public 
 12.30  programs, and other health plan companies.  Health plan 
 12.31  companies and group purchasers shall provide to the commissioner 
 12.32  providers' names, health plan assignment, and other appropriate 
 12.33  data necessary for the commissioner to conduct the study.  The 
 12.34  provider information pilot study shall examine factors that 
 12.35  increase and hinder access to the provision of quality, 
 12.36  cost-effective health care.  The study may examine: 
 13.1      (1) administrative barriers and facilitators; 
 13.2      (2) time spent obtaining permission for appropriate and 
 13.3   necessary treatments; 
 13.4      (3) latitude to order appropriate and necessary tests, 
 13.5   pharmaceuticals, and referrals to specialty providers; 
 13.6      (4) assistance available for decreasing administrative and 
 13.7   other routine paperwork activities; 
 13.8      (5) continuing education opportunities provided; 
 13.9      (6) access to readily available information on diagnoses, 
 13.10  diseases, outcomes, and new technologies; 
 13.11     (7) continuous quality improvement activities; 
 13.12     (8) inclusion in administrative decision making; 
 13.13     (9) access to social services and other services that 
 13.14  facilitate continuity of care; 
 13.15     (10) economic incentives and disincentives; 
 13.16     (11) peer review procedures; and 
 13.17     (12) the prerogative to address public health needs. 
 13.18     In selecting additional data for collection, the 
 13.19  commissioner shall consider the:  (i) statistical validity of 
 13.20  the data; (ii) public need for the data; (iii) estimated expense 
 13.21  of collecting and reporting the data; and (iv) usefulness of the 
 13.22  data to identify barriers and opportunities to improve quality 
 13.23  care provision within health plan companies. 
 13.24     Sec. 10.  Minnesota Statutes 1994, section 62J.37, is 
 13.25  amended to read: 
 13.26     62J.37 [COST CONTAINMENT DATA FROM INTEGRATED SERVICE 
 13.27  NETWORKS.] 
 13.28     The commissioner shall require integrated service networks 
 13.29  operating under section 62N.06, subdivision 1, to submit data on 
 13.30  health care spending and revenue for calendar year 1994 1996 by 
 13.31  February 15, 1995 April 1, 1997.  Each February 15 April 1 
 13.32  thereafter, integrated service networks shall submit to the 
 13.33  commissioner data on health care spending and revenue for the 
 13.34  preceding calendar year.  The data must be provided in the form 
 13.35  specified by the commissioner.  To the extent that an integrated 
 13.36  service network is operated by a group purchaser under section 
 14.1   62N.06, subdivision 2, the integrated service network is exempt 
 14.2   from this section and the group purchaser must provide data on 
 14.3   the integrated service network under section 62J.38. 
 14.4      Sec. 11.  Minnesota Statutes 1994, section 62J.38, is 
 14.5   amended to read: 
 14.6      62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 
 14.7      (a) The commissioner shall require group purchasers to 
 14.8   submit detailed data on total health care spending for calendar 
 14.9   years 1990, 1991, and 1992, and for each calendar year 1993 and 
 14.10  successive calendar years.  Group purchasers shall submit data 
 14.11  for the 1993 calendar year by April 1, 1994, and each April 1 
 14.12  thereafter shall submit data for the preceding calendar year. 
 14.13     (b) The commissioner shall require each group purchaser to 
 14.14  submit data on revenue, expenses, and member months, as 
 14.15  applicable.  Revenue data must distinguish between premium 
 14.16  revenue and revenue from other sources and must also include 
 14.17  information on the amount of revenue in reserves and changes in 
 14.18  reserves.  Expenditure data, including raw data from claims, 
 14.19  must may be provided separately for the following categories or 
 14.20  for other categories required by the commissioner:  physician 
 14.21  services, dental services, other professional services, 
 14.22  inpatient hospital services, outpatient hospital services, 
 14.23  emergency and out-of-area care, pharmacy services and 
 14.24  prescription drugs other nondurable medical goods, mental health 
 14.25  services, and chemical dependency services, other expenditures, 
 14.26  subscriber liability, and administrative costs.  The 
 14.27  commissioner may require each group purchaser to submit any 
 14.28  other data, including data in unaggregated form, for the 
 14.29  purposes of developing spending estimates, setting spending 
 14.30  limits, and monitoring actual spending and costs. 
 14.31     (c) The commissioner may collect information on: 
 14.32     (1) premiums, benefit levels, managed care procedures, and 
 14.33  other features of health plan companies; 
 14.34     (2) prices, provider experience, and other information for 
 14.35  services less commonly covered by insurance or for which 
 14.36  patients commonly face significant out-of-pocket expenses; and 
 15.1      (3) information on health care services not provided 
 15.2   through health plan companies, including information on prices, 
 15.3   costs, expenditures, and utilization. 
 15.4      (c) State agencies and (d) All other group purchasers shall 
 15.5   provide the required data using a uniform format and uniform 
 15.6   definitions, as prescribed by the commissioner. 
 15.7      Sec. 12.  Minnesota Statutes 1994, section 62J.40, is 
 15.8   amended to read: 
 15.9      62J.40 [COST CONTAINMENT DATA FROM STATE AGENCIES AND OTHER 
 15.10  GOVERNMENTAL UNITS.] 
 15.11     In addition to providing the data required under section 
 15.12  62J.38, the commissioners of human services, commerce, labor and 
 15.13  industry, and employee relations and (a) All other state 
 15.14  departments or agencies that administer one or more health care 
 15.15  programs shall provide to the commissioner of health any 
 15.16  additional data on the health care programs they administer that 
 15.17  is requested by the commissioner of health, including data in 
 15.18  unaggregated form, for purposes of developing estimates of 
 15.19  spending, setting spending limits, and monitoring actual 
 15.20  spending.  The data must be provided at the times and in the 
 15.21  form specified by the commissioner of health. 
 15.22     (b) For purposes of estimating total health care spending 
 15.23  as provided in section 62J.301, subdivision 4, paragraph (c), 
 15.24  all local governmental units shall provide expenditure data to 
 15.25  the commissioner.  The commissioner shall consult with 
 15.26  representatives of the affected local government units in 
 15.27  establishing definitions, reporting formats, and reporting time 
 15.28  frames.  As much as possible, the data shall be collected in a 
 15.29  manner that ensures that the data collected is consistent with 
 15.30  data collected from the private sector and minimizes the 
 15.31  reporting burden to local government. 
 15.32     Sec. 13.  Minnesota Statutes 1994, section 62J.41, 
 15.33  subdivision 1, is amended to read: 
 15.34     Subdivision 1.  [COST CONTAINMENT DATA TO BE COLLECTED FROM 
 15.35  PROVIDERS.] The commissioner shall require health care providers 
 15.36  to collect and provide both patient specific information and 
 16.1   descriptive and financial aggregate data on: 
 16.2      (1) the total number of patients served; 
 16.3      (2) the total number of patients served by state of 
 16.4   residence and Minnesota county; 
 16.5      (3) the site or sites where the health care provider 
 16.6   provides services; 
 16.7      (4) the number of individuals employed, by type of 
 16.8   employee, by the health care provider; 
 16.9      (5) the services and their costs for which no payment was 
 16.10  received; 
 16.11     (6) total revenue by type of payer or by groups of payers, 
 16.12  including but not limited to, revenue from Medicare, medical 
 16.13  assistance, MinnesotaCare, nonprofit health service plan 
 16.14  corporations, commercial insurers, integrated service networks, 
 16.15  health maintenance organizations, and individual patients; 
 16.16     (7) revenue from research activities; 
 16.17     (8) revenue from educational activities; 
 16.18     (9) revenue from out-of-pocket payments by patients; 
 16.19     (10) revenue from donations; and 
 16.20     (11) any other data required by the commissioner, including 
 16.21  data in unaggregated form, for the purposes of developing 
 16.22  spending estimates, setting spending limits, monitoring actual 
 16.23  spending, and monitoring costs and quality.  
 16.24  The commissioner may, by rule, modify the data submission 
 16.25  categories listed above if the commissioner determines that this 
 16.26  will reduce the reporting burden on providers without having a 
 16.27  significant negative effect on necessary data collection efforts.
 16.28     Sec. 14.  Minnesota Statutes 1994, section 62J.41, 
 16.29  subdivision 2, is amended to read: 
 16.30     Subd. 2.  [ANNUAL MONITORING AND ESTIMATES.] The 
 16.31  commissioner shall require health care providers to submit the 
 16.32  required data for the period July 1, 1993 to December 31, 1993, 
 16.33  by April 1, 1994.  Health care providers shall submit data for 
 16.34  the 1994 calendar year by April 1, 1995, and each April 1 
 16.35  thereafter shall submit data for the preceding calendar year.  
 16.36  The commissioner of revenue may collect health care service 
 17.1   revenue data from health care providers, if the commissioner of 
 17.2   revenue and the commissioner agree that this is the most 
 17.3   efficient method of collecting the data.  The commissioner of 
 17.4   revenue shall provide any data collected to the commissioner of 
 17.5   health commissioners of health and revenue shall have the 
 17.6   authority to share data collected pursuant to this section. 
 17.7      Sec. 15.  [62J.451] [MINNESOTA HEALTH DATA INSTITUTE.] 
 17.8      Subdivision 1.  [STATEMENT OF PURPOSE.] It is the intention 
 17.9   of the legislature to create a partnership between the public 
 17.10  and the private sectors for the coordination of efforts related 
 17.11  to the collection, analysis, and dissemination of cost, access, 
 17.12  quality, utilization, and other performance data, to the extent 
 17.13  administratively efficient and effective. 
 17.14     The Minnesota health data institute shall be a partnership 
 17.15  between the commissioner of health and a board of directors 
 17.16  representing group purchasers, health care providers, and 
 17.17  consumers. 
 17.18     Subd. 2.  [DEFINITIONS.] For purposes of this section and 
 17.19  section 62J.452, the following definitions apply.  
 17.20     (a) "Analysis" means the identification of selected data 
 17.21  elements, a description of the methodology used to select or 
 17.22  analyze those data elements, and any other commentary, 
 17.23  conclusions, or other descriptive material that the health data 
 17.24  institute determines is appropriately included, all of which is 
 17.25  undertaken by the health data institute for one or more of the 
 17.26  purposes or objectives set forth in subdivisions 1 and 3, or by 
 17.27  other authorized researchers pursuant to section 62J.452, 
 17.28  subdivision 6.  
 17.29     (b) "Board" means the board of directors of the health data 
 17.30  institute. 
 17.31     (c) "Database" means a compilation of selected data 
 17.32  elements by the health data institute for the purpose of 
 17.33  conducting an analysis or facilitating an analysis by another 
 17.34  party. 
 17.35     (d) "Electronic data interchange system" or "EDI system" 
 17.36  means the electronic data system developed, implemented, 
 18.1   maintained, or operated by the health data institute, as 
 18.2   permitted by subdivisions 3, clause (2), and 5, according to 
 18.3   standards adopted by the health data institute. 
 18.4      (e) "Encounter level data" means data related to the 
 18.5   utilization of health care services by, and the provision of 
 18.6   health care services to, individual patients, enrollees, or 
 18.7   insureds, including claims data, abstracts of medical records, 
 18.8   and data from patient interviews and patient surveys. 
 18.9      (f) "Group purchaser" has the definition provided in 
 18.10  section 62J.03, subdivision 6. 
 18.11     (g) "Health data institute" means the public-private 
 18.12  partnership between the commissioner of health and the board of 
 18.13  directors established under this section. 
 18.14     (h) "Health plan company" has the definition provided in 
 18.15  section 62Q.01, subdivision 4. 
 18.16     (i) "Industry participant" means any group purchaser, 
 18.17  employers with employee health benefit plans, regardless of the 
 18.18  manner in which benefits are provided or paid for under the 
 18.19  plan, provider, or state agency or political subdivision, with 
 18.20  the exception of professional licensing boards or law 
 18.21  enforcement agencies. 
 18.22     (j) "Industry participant identifying data" means any data 
 18.23  that identifies a specific industry participant directly, or 
 18.24  which identifies characteristics which reasonably could uniquely 
 18.25  identify such specific industry participant circumstantially.  
 18.26  For purposes of this definition, an industry participant is not 
 18.27  "directly identified" by the use of a unique identification 
 18.28  number, provided that the number is coded or encrypted through a 
 18.29  reliable system that can reasonably assure that such numbers 
 18.30  cannot be traced back by an unauthorized person to determine the 
 18.31  identity of an industry participant with a particular number. 
 18.32     (k) "Patient" is an individual as defined in section 13.02, 
 18.33  subdivision 8, except that "patient" does not include any 
 18.34  industry participant acting as an industry participant rather 
 18.35  than as a consumer of health care services or coverage. 
 18.36     (l) "Patient identifying data" means data that identifies a 
 19.1   patient directly, or which identifies characteristics which 
 19.2   reasonably could uniquely identify such specific patients 
 19.3   circumstantially.  For purposes of this definition, a patient is 
 19.4   not "directly identified" by the use of a unique identification 
 19.5   number, provided that the number is coded or encrypted through a 
 19.6   reliable system that can reasonably assure that such numbers 
 19.7   cannot be traced back by an unauthorized person to determine the 
 19.8   identity of a patient with a particular number. 
 19.9      (m) "Performance" means the degree to which a health plan 
 19.10  company, provider organization, or other entity delivers 
 19.11  quality, cost-effective services compared to other similar 
 19.12  entities, or to a given level of care set as a goal to be 
 19.13  attained. 
 19.14     (n) "Provider" or "health care provider" has the meaning 
 19.15  given in section 62J.03, subdivision 8. 
 19.16     (o) "Roster data" with regard to the enrollee of a health 
 19.17  plan company or group purchaser means an enrollee's name, 
 19.18  address, telephone number, date of birth, gender, and enrollment 
 19.19  status under a group purchaser's health plan.  "Roster data" 
 19.20  with regard to a patient of a provider means the patient's name, 
 19.21  address, telephone number, date of birth, gender, and date or 
 19.22  dates treated, including, if applicable, the date of admission 
 19.23  and the date of discharge. 
 19.24     Subd. 3.  [OBJECTIVES OF THE HEALTH DATA INSTITUTE.] (a) 
 19.25  The health data institute shall: 
 19.26     (1) develop a data collection plan that provides 
 19.27  coordination for public and private sector data collection 
 19.28  efforts related to the performance measurement and improvement 
 19.29  of the health care delivery system; 
 19.30     (2) establish an electronic data interchange system that 
 19.31  may be used by the public and private sectors to exchange health 
 19.32  care data in a cost-efficient manner; 
 19.33     (3) develop a mechanism to collect, analyze, and 
 19.34  disseminate information for comparing the cost and quality of 
 19.35  health care delivery system components, including health plan 
 19.36  companies and provider organizations; 
 20.1      (4) develop policies and procedures to protect the privacy 
 20.2   of individual-identifiable data, and to assure appropriate 
 20.3   access to and disclosure of information specific to individual 
 20.4   health plan companies and provider organizations collected 
 20.5   pursuant to this section; and 
 20.6      (5) use and build upon existing data sources and 
 20.7   performance measurement efforts, and improve upon these existing 
 20.8   data sources and measurement efforts through the integration of 
 20.9   data systems and the standardization of concepts, to the 
 20.10  greatest extent possible. 
 20.11     (b) In carrying out its responsibilities, the health data 
 20.12  institute may contract with private sector organizations 
 20.13  currently collecting data on specific health-related areas of 
 20.14  interest to the health data institute, in order to achieve 
 20.15  maximum efficiency and cost-effectiveness.  The health data 
 20.16  institute may establish links between the data collected and 
 20.17  maintained by the health data institute and private sector data 
 20.18  through the health data institute's electronic data interchange 
 20.19  system, and may implement methods to streamline data collection 
 20.20  in order to reduce public and private sector administrative 
 20.21  costs.  The health data institute may use or establish links 
 20.22  with public sector data, such as that existing for medical 
 20.23  assistance and Medicare, to the extent permitted by state and 
 20.24  federal law.  The health data institute may also recommend 
 20.25  methods to streamline public sector data collection in order to 
 20.26  reduce public and private sector administrative costs. 
 20.27     (c) Any contract with a private sector entity must require 
 20.28  the private sector entity to maintain the data collected 
 20.29  according to the applicable data privacy provisions, as provided 
 20.30  in section 62J.452. 
 20.31     Subd. 4.  [DATA COLLECTION PLAN.] (a) The health data 
 20.32  institute shall develop a plan that: 
 20.33     (1) identifies the health care data needs of consumers, 
 20.34  group purchasers, providers, and the state regarding the 
 20.35  performance of health care delivery system components including 
 20.36  health plan companies and provider organizations; 
 21.1      (2) specifies data collection objectives, strategies, 
 21.2   priorities, cost estimates, administrative and operational 
 21.3   guidelines, and implementation timelines for the health data 
 21.4   institute; and 
 21.5      (3) identifies the data needed for the health data 
 21.6   institute to carry out the duties assigned in this section.  The 
 21.7   plan must take into consideration existing data sources and data 
 21.8   sources that can easily be made uniform for links to other data 
 21.9   sets. 
 21.10     (b) This plan shall be updated on an annual basis. 
 21.11     Subd. 5.  [HEALTH CARE ELECTRONIC DATA INTERCHANGE 
 21.12  SYSTEM.] (a) The health data institute shall establish an 
 21.13  electronic data interchange system that electronically 
 21.14  transmits, collects, archives, and provides users of data with 
 21.15  the data necessary for their specific interests, in order to 
 21.16  promote a high quality, cost-effective, consumer-responsive 
 21.17  health care system.  This public-private information system 
 21.18  shall be developed to make health care claims processing and 
 21.19  financial settlement transactions more efficient and to provide 
 21.20  an efficient, unobtrusive method for meeting the shared 
 21.21  electronic data interchange needs of consumers, group 
 21.22  purchasers, providers, and the state. 
 21.23     (b) The health data institute shall operate the Minnesota 
 21.24  center for health care electronic data interchange established 
 21.25  in section 62J.57, and shall integrate the goals, objectives, 
 21.26  and activities of the center with those of the health data 
 21.27  institute's electronic data interchange system. 
 21.28     Subd. 6.  [PERFORMANCE MEASUREMENT INFORMATION.] (a) The 
 21.29  health data institute shall develop and implement a performance 
 21.30  measurement plan to analyze and disseminate health care data to 
 21.31  address the needs of consumers, group purchasers, providers, and 
 21.32  the state for performance measurement at various levels of the 
 21.33  health care system in the state.  The plan shall include a 
 21.34  mechanism to: 
 21.35     (1) provide comparative information to consumers, 
 21.36  purchasers, and policymakers for use in performance assessment 
 22.1   of health care system components, including health plan 
 22.2   companies and provider organizations; 
 22.3      (2) complement and enhance, but not replace, existing 
 22.4   internal performance improvement efforts of health care 
 22.5   providers and plans; and 
 22.6      (3) reduce unnecessary administrative costs in the health 
 22.7   care system by eliminating duplication in the collection of data 
 22.8   for both evaluation and improvement efforts. 
 22.9      (b) Performance measurement at the provider organization 
 22.10  level may be conducted on a condition-specific basis.  Criteria 
 22.11  for selecting conditions for measurement may include: 
 22.12     (1) relevance to consumers and purchasers; 
 22.13     (2) prevalence of conditions; 
 22.14     (3) costs related to diagnosis and treatment; 
 22.15     (4) demonstrated efficacy of treatments; 
 22.16     (5) evidence of variability in management; 
 22.17     (6) existence of risk adjustment methodologies to control 
 22.18  for patient and other risk factors contributing to variation in 
 22.19  cost and quality; 
 22.20     (7) existence of practice guidelines related to the 
 22.21  condition; and 
 22.22     (8) relevance of the condition to public health goals. 
 22.23     (c) Performance measurement on a condition-specific basis 
 22.24  may consider multiple dimensions of performance, including, but 
 22.25  not limited to: 
 22.26     (1) accessibility; 
 22.27     (2) appropriateness; 
 22.28     (3) effectiveness, including clinical outcomes, patient 
 22.29  satisfaction, and functional status; and 
 22.30     (4) efficiency. 
 22.31     (d) Collection of data for condition-specific performance 
 22.32  measurement may be conducted at the patient level.  
 22.33  Encounter-level data collected for this purpose may include 
 22.34  unique identifiers for patients, providers, payers, and 
 22.35  employers in order to link episodes of care across care settings 
 22.36  and over time.  The health data institute must encrypt patient 
 23.1   identifiers to prevent identification of individual patients and 
 23.2   to enable release of otherwise private data to researchers, 
 23.3   providers, and group purchasers in a manner consistent with 
 23.4   chapter 13 and sections 62J.452 and 144.335. 
 23.5      Subd. 6a.  [HEALTH PLAN COMPANY PERFORMANCE 
 23.6   MEASUREMENT.] As part of the performance measurement plan 
 23.7   specified in subdivision 6, the health data institute shall 
 23.8   develop a mechanism to assess the performance of health plan 
 23.9   companies, and to disseminate this information through reports 
 23.10  and other means to consumers, purchasers, policymakers, and 
 23.11  other interested parties, consistent with the data policies 
 23.12  specified in section 62J.452.  
 23.13     Subd. 6b.  [CONSUMER SURVEYS.] (a) The health data 
 23.14  institute shall develop and implement a mechanism for collecting 
 23.15  comparative data on consumer perceptions of the health care 
 23.16  system, including consumer satisfaction, through adoption of a 
 23.17  standard consumer survey.  This survey shall include enrollees 
 23.18  in community integrated service networks, integrated service 
 23.19  networks, health maintenance organizations, preferred provider 
 23.20  organizations, indemnity insurance plans, public programs, and 
 23.21  other health plan companies.  The health data institute, in 
 23.22  consultation with the health care commission, shall determine a 
 23.23  mechanism for the inclusion of the uninsured.  This consumer 
 23.24  survey may be conducted every two years.  A focused survey may 
 23.25  be conducted on the off years.  Health plan companies and group 
 23.26  purchasers shall provide to the health data institute roster 
 23.27  data as defined in subdivision 2, including the names, 
 23.28  addresses, and telephone numbers of enrollees and former 
 23.29  enrollees and other data necessary for the completion of this 
 23.30  survey.  This roster data provided by the health plan companies 
 23.31  and group purchasers is classified as provided under section 
 23.32  62J.452.  The health data institute may analyze and prepare 
 23.33  findings from the raw, unaggregated data, and the findings from 
 23.34  this survey may be included in the health plan company 
 23.35  performance reports specified in subdivision 6a, and in other 
 23.36  reports developed and disseminated by the health data institute 
 24.1   and the commissioner.  The raw, unaggregated data is classified 
 24.2   as provided under section 62J.452, and may be made available by 
 24.3   the health data institute to the extent permitted under section 
 24.4   62J.452.  The health data institute shall provide raw, 
 24.5   unaggregated data to the commissioner.  The survey may include 
 24.6   information on the following subjects: 
 24.7      (1) enrollees' overall satisfaction with their health care 
 24.8   plan; 
 24.9      (2) consumers' perception of access to emergency, urgent, 
 24.10  routine, and preventive care, including locations, hours, 
 24.11  waiting times, and access to care when needed; 
 24.12     (3) premiums and costs; 
 24.13     (4) technical competence of providers; 
 24.14     (5) communication, courtesy, respect, reassurance, and 
 24.15  support; 
 24.16     (6) choice and continuity of providers; 
 24.17     (7) continuity of care; 
 24.18     (8) outcomes of care; 
 24.19     (9) services offered by the plan, including range of 
 24.20  services, coverage for preventive and routine services, and 
 24.21  coverage for illness and hospitalization; 
 24.22     (10) availability of information; and 
 24.23     (11) paperwork. 
 24.24     (b) The health data institute shall appoint a consumer 
 24.25  advisory group which shall consist of 13 individuals, 
 24.26  representing enrollees from public and private health plan 
 24.27  companies and programs and two uninsured consumers, to advise 
 24.28  the health data institute on issues of concern to consumers.  
 24.29  The advisory group must have at least one member from each 
 24.30  regional coordinating board region of the state.  The advisory 
 24.31  group expires June 30, 1996. 
 24.32     Subd. 6c.  [PROVIDER ORGANIZATION PERFORMANCE MEASUREMENT.] 
 24.33  As part of the performance measurement plan specified in 
 24.34  subdivision 6, the health data institute shall develop a 
 24.35  mechanism to assess the performance of hospitals and other 
 24.36  provider organizations, and to disseminate this information to 
 25.1   consumers, purchasers, policymakers, and other interested 
 25.2   parties, consistent with the data policies specified in section 
 25.3   62J.452.  Data to be collected may include structural 
 25.4   characteristics including staff-mix and nurse-patient ratios.  
 25.5   In selecting additional data for collection, the health data 
 25.6   institute may consider: 
 25.7      (1) feasibility and statistical validity of the indicator; 
 25.8      (2) purchaser and public demand for the indicator; 
 25.9      (3) estimated expense of collecting and reporting the 
 25.10  indicator; and 
 25.11     (4) usefulness of the indicator for internal improvement 
 25.12  purposes. 
 25.13     Subd. 7.  [DISSEMINATION OF REPORTS; OTHER 
 25.14  INFORMATION.] (a) The health data institute shall establish a 
 25.15  mechanism for the dissemination of reports and other information 
 25.16  to consumers, group purchasers, health plan companies, 
 25.17  providers, and the state.  When applicable, the health data 
 25.18  institute shall coordinate its dissemination of information 
 25.19  responsibilities with those of the commissioner, to the extent 
 25.20  administratively efficient and effective. 
 25.21     (b) The health data institute may require those requesting 
 25.22  data from its databases to contribute toward the cost of data 
 25.23  collection through the payments of fees. 
 25.24     (c) The health data institute shall not allow a group 
 25.25  purchaser or health care provider to use or have access to the 
 25.26  electronic data interchange system or to access data under 
 25.27  section 62J.452, subdivision 6 or 7, unless the group purchaser 
 25.28  or health care provider cooperates with the data collection 
 25.29  efforts of the health data institute by submitting or making 
 25.30  available through the EDI system or other means all data 
 25.31  requested by the health data institute.  The health data 
 25.32  institute shall prohibit group purchasers and health care 
 25.33  providers from transferring, providing, or sharing data obtained 
 25.34  from the health data institute under section 62J.452, 
 25.35  subdivision 6 or 7, with a group purchaser or health care 
 25.36  provider that does not cooperate with the data collection 
 26.1   efforts of the health data institute. 
 26.2      Subd. 8.  [ANNUAL REPORT.] (a) The health data institute 
 26.3   shall submit to the chairs of the senate joint crime prevention 
 26.4   and judiciary subcommittee on privacy, the house judiciary 
 26.5   committee, the legislative commission on health care access, the 
 26.6   commissioner, and the governor a report on the activities of the 
 26.7   health data institute by February 1 of each year beginning 
 26.8   February 1, 1996.  The report shall include: 
 26.9      (1) a description of the data initiatives undertaken by the 
 26.10  health data institute, including a statement of the purpose and 
 26.11  a summary of the results of the initiative; 
 26.12     (2) a description of the steps taken by the health data 
 26.13  institute to comply with the confidentiality requirements of 
 26.14  this section and other applicable laws, and of the health data 
 26.15  institute's internal policies and operating procedures relating 
 26.16  to data privacy and confidentiality; and 
 26.17     (3) a description of the actions taken by the health data 
 26.18  institute to ensure that the EDI system being established 
 26.19  pursuant to section 62J.451, subdivision 3, clause (2), and 
 26.20  subdivision 5, protects the confidentiality requirements of this 
 26.21  section and other applicable laws. 
 26.22     (b) If the health data institute amends or adopts an 
 26.23  internal policy or operating procedure relating to data privacy 
 26.24  and confidentiality, it shall submit copies of such policy or 
 26.25  procedure within 30 days of its adoption to the public officials 
 26.26  identified in this subdivision. 
 26.27     Subd. 9.  [BOARD OF DIRECTORS.] The health data institute 
 26.28  is governed by a 20-member board of directors consisting of the 
 26.29  following members: 
 26.30     (1) two representatives of hospitals, one appointed by the 
 26.31  Minnesota Hospital Association and one appointed by the 
 26.32  Metropolitan HealthCare Council, to reflect a mix of urban and 
 26.33  rural institutions; 
 26.34     (2) four representatives of health carriers, two appointed 
 26.35  by the Minnesota council of health maintenance organizations, 
 26.36  one appointed by Blue Cross and Blue Shield of Minnesota, and 
 27.1   one appointed by the Insurance Federation of Minnesota; 
 27.2      (3) two consumer members, one appointed by the 
 27.3   commissioner, and one appointed by the AFL-CIO as a labor union 
 27.4   representative; 
 27.5      (4) five group purchaser representatives appointed by the 
 27.6   Minnesota consortium of health care purchasers to reflect a mix 
 27.7   of urban and rural, large and small, and self-insured 
 27.8   purchasers; 
 27.9      (5) two physicians appointed by the Minnesota Medical 
 27.10  Association, to reflect a mix of urban and rural practitioners; 
 27.11     (6) one representative of teaching and research 
 27.12  institutions, appointed jointly by the Mayo Foundation and the 
 27.13  Minnesota Association of Public Teaching Hospitals; 
 27.14     (7) one nursing representative appointed by the Minnesota 
 27.15  Nurses Association; and 
 27.16     (8) three representatives of state agencies, one member 
 27.17  representing the department of employee relations, one member 
 27.18  representing the department of human services, and one member 
 27.19  representing the department of health. 
 27.20     Subd. 10.  [TERMS; COMPENSATION; REMOVAL; AND VACANCIES.] 
 27.21  The board is governed by section 15.0575. 
 27.22     Subd. 11.  [STATUTORY GOVERNANCE.] The health data 
 27.23  institute is subject to chapter 13 and section 471.705. 
 27.24     Subd. 12.  [STAFF.] The board may hire an executive 
 27.25  director.  The executive director and other health data 
 27.26  institute staff are not state employees but are covered by 
 27.27  section 3.736.  The executive director and other health data 
 27.28  institute staff may participate in the following plans for 
 27.29  employees in the unclassified service until January 1, 1996:  
 27.30  the state retirement plan, the state deferred compensation plan, 
 27.31  and the health, dental, and life insurance plans.  The attorney 
 27.32  general shall provide legal services to the board. 
 27.33     Subd. 13.  [FEDERAL AND OTHER GRANTS.] The health data 
 27.34  institute may seek federal funding, and funding from private and 
 27.35  other nonstate sources for the initiative required by the board. 
 27.36     Subd. 14.  [CONTRACTS.] To carry out the duties assigned in 
 28.1   this section, the health data institute may contract with 
 28.2   private sector entities.  Any contract must require the private 
 28.3   sector entity to maintain the data which it receives according 
 28.4   to the statutory provisions applicable to the data and any other 
 28.5   applicable provision specified in section 62J.452. 
 28.6      Subd. 15.  [NONLIMITING.] Nothing in this section shall be 
 28.7   construed to limit the powers granted to the commissioner of 
 28.8   health in chapter 62D, 62N, 144, or 144A. 
 28.9      Sec. 16.  [62J.452] [PROTECTION OF PRIVACY AND 
 28.10  CONFIDENTIALITY OF HEALTH CARE DATA.] 
 28.11     Subdivision 1.  [STATEMENT OF PURPOSE.] The health data 
 28.12  institute shall adopt data collection, analysis, and 
 28.13  dissemination policies that reflect the importance of protecting 
 28.14  the right of privacy of patients in their health care data in 
 28.15  connection with each data initiative that the health data 
 28.16  institute intends to undertake. 
 28.17     Subd. 2.  [DATA CLASSIFICATIONS.] (a) Data collected, 
 28.18  obtained, received, or created by the health data institute 
 28.19  shall be private or nonpublic, as applicable, unless given a 
 28.20  different classification in this subdivision.  Data classified 
 28.21  as private or nonpublic under this subdivision may be released 
 28.22  or disclosed only as permitted under this subdivision and under 
 28.23  the other subdivisions referenced in this subdivision.  For 
 28.24  purposes of this section, data that identify individual patients 
 28.25  or industry participants are private data on individuals or 
 28.26  nonpublic data, as appropriate.  Data not on individuals are 
 28.27  nonpublic data.  Notwithstanding sections 13.03, subdivisions 6 
 28.28  to 8; 13.10, subdivisions 1 to 4; and 138.17, data received by 
 28.29  the health data institute shall retain the classification 
 28.30  designated under this chapter and shall not be disclosed other 
 28.31  than pursuant to this chapter.  Nothing in this subdivision 
 28.32  prevents patients from gaining access to their health record 
 28.33  information pursuant to section 144.335. 
 28.34     (b) When industry participants, as defined in section 
 28.35  62J.451, are required by statute to provide patient identifying 
 28.36  data to the commissioner pursuant to this chapter or to the 
 29.1   health data institute pursuant to section 62J.451, they shall be 
 29.2   able to provide the data with or without patient consent, and 
 29.3   may not be held liable for doing so. 
 29.4      (c) When an industry participant submits patient 
 29.5   identifying data to the health data institute, and the data is 
 29.6   submitted to the health data institute in electronic form, or 
 29.7   through other electronic means including, but not limited to, 
 29.8   the electronic data interchange system defined in section 
 29.9   62J.451, the industry participant shall submit the patient 
 29.10  identifying data in encrypted form, using an encryption method 
 29.11  supplied or specified by the health data institute.  Submission 
 29.12  of encrypted data as provided in this paragraph satisfies the 
 29.13  requirements of section 144.335, subdivision 3b. 
 29.14     (d) Patient identifying data may be disclosed only as 
 29.15  permitted under subdivision 3. 
 29.16     (e) Industry participant identifying data which is not 
 29.17  patient identifying data may be disclosed only by being made 
 29.18  public in an analysis as permitted under subdivisions 4 and 5 or 
 29.19  through access to an approved researcher, industry participant, 
 29.20  or contractor as permitted under subdivision 6 or 7. 
 29.21     (f) Data that is not patient identifying data and not 
 29.22  industry participant identifying data is public data. 
 29.23     (g) Data that describes the finances, governance, internal 
 29.24  operations, policies or operating procedures of the health data 
 29.25  institute, and that does not identify patients or industry 
 29.26  participants or identifies them only in connection with their 
 29.27  involvement with the health data institute, is public data. 
 29.28     Subd. 3.  [PATIENT IDENTIFYING DATA.] (a) The health data 
 29.29  institute must not make public any analysis that contains 
 29.30  patient identifying data. 
 29.31     (b) The health data institute may disclose patient 
 29.32  identifying data only as follows: 
 29.33     (1) to research organizations that meet the requirements 
 29.34  set forth in subdivision 6, paragraph (a), but only to the 
 29.35  extent that such disclosure is also permitted by section 
 29.36  144.335, subdivision 3a, paragraph (a); or 
 30.1      (2) to a contractor of, or vendor of services to the health 
 30.2   data institute for the purposes of conducting a survey or 
 30.3   analysis, provided that such contractor or vendor agrees to 
 30.4   comply with all data privacy requirements applicable to the 
 30.5   health data institute, and to destroy or return to the health 
 30.6   data institute all copies of patient identifying data in the 
 30.7   possession of such contractor or vendor upon completion of the 
 30.8   contract. 
 30.9      Subd. 4.  [ANALYSIS TO BE MADE PUBLIC BY THE HEALTH DATA 
 30.10  INSTITUTE.] (a) Notwithstanding the classification under 
 30.11  subdivision 2 or other provision of state law of data included 
 30.12  or used in an analysis, the health data institute may make 
 30.13  public data in an analysis pursuant to this subdivision and 
 30.14  subdivision 5.  Such analysis may include industry participant 
 30.15  identifying data but must not include patient identifying data.  
 30.16  In making its determination as to whether to make an analysis or 
 30.17  the data used in the analysis public, the health data institute 
 30.18  shall consider and determine, in accordance with policies and 
 30.19  criteria developed by the health data institute, that the data 
 30.20  and analysis are sufficiently accurate, complete, reliable, 
 30.21  valid, and as appropriate, case-mixed and severity adjusted, and 
 30.22  statistically and clinically significant.  
 30.23     (b) Prior to making an analysis public, the health data 
 30.24  institute must provide to any industry participant identified in 
 30.25  the analysis an opportunity to use the fair hearing procedure 
 30.26  established under subdivision 5. 
 30.27     (c) Accompanying an analysis made public by the health data 
 30.28  institute, the health data institute shall also make public 
 30.29  descriptions of the database used in the analysis, the methods 
 30.30  of adjusting for case mix and severity, and assuring accuracy, 
 30.31  completeness, reliability, and statistical and clinical 
 30.32  significance, as appropriate, and appropriate uses of the 
 30.33  analysis and related analytical data, including precautionary 
 30.34  statements regarding the limitations of the analysis and related 
 30.35  analytical data. 
 30.36     Subd. 5.  [FAIR HEARING PROCEDURE PRIOR TO MAKING AN 
 31.1   ANALYSIS PUBLIC.] (a) The health data institute may not make 
 31.2   public an analysis that identifies an industry participant 
 31.3   unless the health data institute first complies with this 
 31.4   subdivision.  A draft of the portion of the analysis that 
 31.5   identifies an industry participant must be furnished upon an 
 31.6   industry participant's request to that industry participant 
 31.7   prior to making that portion of the analysis public.  Such draft 
 31.8   analysis is private or nonpublic, as applicable.  The industry 
 31.9   participants so identified have the right to a hearing, at which 
 31.10  the industry participants may object to or seek modification of 
 31.11  the analysis.  The cost of the hearing shall be borne by the 
 31.12  industry participant requesting the hearing. 
 31.13     (b) The health data institute shall establish the hearing 
 31.14  procedure in writing.  The hearing procedure shall include the 
 31.15  following: 
 31.16     (1) the provision of reasonable notice of the health data 
 31.17  institute's intention to make such analysis public; 
 31.18     (2) an opportunity for the identified industry participants 
 31.19  to submit written statements to the health data institute board 
 31.20  of directors or its designate, to be represented, and to append 
 31.21  a statement to such analysis to be included with it when and if 
 31.22  the analysis is made public; and 
 31.23     (3) access by the identified industry participants to 
 31.24  industry participant identifying data, but only as permitted by 
 31.25  subdivision 6 or 7. 
 31.26     (c) The health data institute shall make the hearing 
 31.27  procedure available in advance to industry participants which 
 31.28  are identified in an analysis.  The written hearing procedure is 
 31.29  public data.  The following data related to a hearing is public: 
 31.30     (1) the parties involved; 
 31.31     (2) the dates of the hearing; and 
 31.32     (3) a general description of the issue and the results of 
 31.33  the hearing; all other data relating to the hearing is private 
 31.34  or nonpublic. 
 31.35     Subd. 6.  [ACCESS BY APPROVED RESEARCHERS TO DATA THAT 
 31.36  IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 
 32.1   PATIENTS.] (a) The health data institute shall provide access to 
 32.2   industry participant identifying data, but not patient 
 32.3   identifying data, once those data are in analyzable form, upon 
 32.4   request to research organizations or individuals that: 
 32.5      (1) have as explicit goals research purposes that promote 
 32.6   individual or public health and the release of research results 
 32.7   to the public as determined by the health data institute 
 32.8   according to standards it adopts for evaluating such goals; 
 32.9      (2) enforce strict and explicit policies which protect the 
 32.10  confidentiality and integrity of data as determined by the 
 32.11  health data institute according to standards it adopts for 
 32.12  evaluating such policies; 
 32.13     (3) agree not to make public, redisclose, or transfer the 
 32.14  data to any other individual or organization, except as 
 32.15  permitted under paragraph (b); 
 32.16     (4) demonstrate a research purpose for the data that can be 
 32.17  accomplished only if the data are provided in a form that 
 32.18  identifies specific industry participants as determined by the 
 32.19  health data institute according to standards it adopts for 
 32.20  evaluating such research purposes; and 
 32.21     (5) agree to disclose analysis in a public forum or 
 32.22  publication only pursuant to subdivisions 4 and 5 and other 
 32.23  applicable statutes and the health data institute's operating 
 32.24  rules governing the making of an analysis public by the health 
 32.25  data institute. 
 32.26     (b) Contractors of entities that have access under 
 32.27  paragraph (a) may also have access to industry participant 
 32.28  identifying data, provided that the contract requires the 
 32.29  contractor to comply with the confidentiality requirements set 
 32.30  forth in this section and under any other statute applicable to 
 32.31  the entity. 
 32.32     Subd. 7.  [ACCESS BY INDUSTRY PARTICIPANTS TO DATA THAT 
 32.33  IDENTIFIES INDUSTRY PARTICIPANTS BUT DOES NOT IDENTIFY 
 32.34  PATIENTS.] (a) The health data institute may provide, to an 
 32.35  industry participant, data that identifies that industry 
 32.36  participant or other industry participants, to the extent 
 33.1   permitted under this subdivision.  An employer or an employer 
 33.2   purchasing group may receive data relating to care provided to 
 33.3   patients for which that employer acts as the payer.  A health 
 33.4   plan company may receive data relating to care provided to 
 33.5   enrollees of that health plan company.  A provider may receive 
 33.6   data relating to care provided to patients of that provider. 
 33.7      (b) An industry participant may receive data that 
 33.8   identifies that industry participant or other industry 
 33.9   participants and that relates to care purchased or provided by 
 33.10  industry participants other than the industry participant 
 33.11  seeking the data.  These data must be provided by the health 
 33.12  data institute only with appropriate authorization from all 
 33.13  industry participants identified. 
 33.14     (c) The health data institute must not provide access to 
 33.15  any data under this subdivision that is patient identifying data 
 33.16  as defined in section 62J.451, subdivision 2, paragraph (l), 
 33.17  even if providing that data would otherwise be allowed under 
 33.18  this subdivision. 
 33.19     (d) To receive data under this subdivision, an industry 
 33.20  participant must cooperate with the health data institute as 
 33.21  provided under section 62J.451, subdivision 7, paragraph (c). 
 33.22     (e) Contractors of entities that have access under 
 33.23  paragraph (b) may have access to industry participant 
 33.24  identifying data, provided that the contract requires the 
 33.25  contractor to comply with the confidentiality requirements set 
 33.26  forth in this section and under any other statute applicable to 
 33.27  the entity. 
 33.28     Subd. 8.  [STATUS OF DATA ON THE ELECTRONIC DATA 
 33.29  INTERCHANGE SYSTEM.] (a) Data created or generated by or in the 
 33.30  custody of an industry participant, and transferred 
 33.31  electronically by that industry participant to another industry 
 33.32  participant using the EDI system developed, implemented, 
 33.33  maintained, or operated by the health data institute, as 
 33.34  permitted by section 62J.451, subdivision 3, clause (2), and 
 33.35  subdivision 5, is not subject to this section or to chapter 13 
 33.36  except as provided below. 
 34.1      (b) Data created or generated by or in the custody of an 
 34.2   industry participant is subject to the privacy protections 
 34.3   applicable to the data, including, but not limited to, chapter 
 34.4   13 with respect to state agencies and political subdivisions, 
 34.5   the Minnesota insurance fair information reporting act with 
 34.6   respect to industry participants subject to it, and section 
 34.7   144.335, with respect to providers and other industry 
 34.8   participants subject to such section. 
 34.9      Subd. 9.  [AUTHORIZATION OF STATE AGENCIES AND POLITICAL 
 34.10  SUBDIVISIONS TO PROVIDE DATA.] (a) Notwithstanding any 
 34.11  limitation in chapter 13 or section 62J.321, subdivision 5, 
 34.12  regarding the disclosure of not public data, all state agencies 
 34.13  and political subdivisions, including, but not limited to, 
 34.14  municipalities, counties, and hospital districts may provide not 
 34.15  public data relating to health care costs, quality, or outcomes 
 34.16  to the health data institute for the purposes set forth in 
 34.17  section 62J.451.  
 34.18     (b) Data provided by the commissioner pursuant to paragraph 
 34.19  (a) of this subdivision may not include patient identifying data 
 34.20  as defined in section 62J.451, subdivision 2, paragraph (1).  
 34.21  For data provided by the commissioner of health pursuant to 
 34.22  paragraph (a), the health data institute and anyone receiving 
 34.23  the data from the health data institute, is prohibited from 
 34.24  unencrypting or attempting to link the data with other patient 
 34.25  identifying data sources. 
 34.26     (c) Any data provided to the health data institute pursuant 
 34.27  to paragraph (a) shall retain the same classification that it 
 34.28  had with the state agency or political subdivision that provided 
 34.29  it.  The authorization in this subdivision is subject to any 
 34.30  federal law restricting or prohibiting such disclosure of the 
 34.31  data described above. 
 34.32     (d) Notwithstanding any limitation in chapter 13 or 
 34.33  sections 62J.451 and 62J.452 regarding the disclosure of 
 34.34  nonpublic and private data, the health data institute may 
 34.35  provide nonpublic and private data to any state agency that is a 
 34.36  member of the board of the health data institute.  Any such data 
 35.1   provided to a state agency shall retain nonpublic or private 
 35.2   classification, as applicable. 
 35.3      Subd. 10.  [CIVIL REMEDIES.] Violation of any of the 
 35.4   confidentiality requirements set forth in subdivision 3; 4, 
 35.5   paragraph (a); 6; or 7, by the health data institute, its board 
 35.6   members, employees and contractors, any industry participant, or 
 35.7   by any other person shall be subject to section 13.08, 
 35.8   including, but not limited to, the immunities set forth in 
 35.9   section 13.08, subdivisions 5 and 6.  The health data institute 
 35.10  shall not be liable for exercising its discretion in a manner 
 35.11  that is not an abuse of discretion with respect to matters under 
 35.12  its discretion by this section or section 62J.451.  The health 
 35.13  data institute shall not be liable for the actions of persons 
 35.14  not under the direction and control of the health data 
 35.15  institute, where it has performed its responsibilities to 
 35.16  protect data privacy by complying with the requirements of this 
 35.17  section and other applicable laws with regard to the disclosure 
 35.18  of data.  The remedies set forth in this section do not preclude 
 35.19  any person from pursuing any other remedies authorized by law. 
 35.20     Subd. 11.  [PENALTIES.] (a) Any person who willfully 
 35.21  violates the confidentiality requirements set forth in 
 35.22  subdivision 3; 4, paragraph (a); 6; or 7, shall be guilty of a 
 35.23  misdemeanor. 
 35.24     (b) Any person who willfully violates the confidentiality 
 35.25  requirements of subdivision 3, 4, 6, 7, 8, or 9, by willfully 
 35.26  disclosing patient or industry participant identifying data for 
 35.27  compensation or remuneration of any kind or for the purpose of 
 35.28  damaging the reputation of any patient or industry participant 
 35.29  or any other malicious purpose, shall be guilty of a gross 
 35.30  misdemeanor. 
 35.31     Subd. 12.  [DISCOVERABILITY OF HEALTH DATA INSTITUTE 
 35.32  DATA.] (a) Data created, collected, received, maintained or 
 35.33  disseminated by the health data institute shall not be subject 
 35.34  to discovery or introduction into evidence in any civil or 
 35.35  criminal action.  Data created, collected, received, maintained 
 35.36  or disseminated by the health data institute that is otherwise 
 36.1   available from original sources is subject to discovery from 
 36.2   those sources and may be introduced into evidence in civil or 
 36.3   criminal actions in accordance with and subject to applicable 
 36.4   laws and rules of evidence and civil or criminal procedure, as 
 36.5   applicable. 
 36.6      (b) Information related to submission of data to the health 
 36.7   data institute by industry participants is not discoverable in 
 36.8   any civil or criminal action.  Discovery requests prohibited 
 36.9   under this paragraph include, but are not limited to, document 
 36.10  requests or interrogatories that ask for "all data provided to 
 36.11  the Minnesota health data institute." 
 36.12     Sec. 17.  Minnesota Statutes 1994, section 62J.54, is 
 36.13  amended to read: 
 36.14     62J.54 [IDENTIFICATION AND IMPLEMENTATION OF UNIQUE 
 36.15  IDENTIFIERS.] 
 36.16     Subdivision 1.  [UNIQUE IDENTIFICATION NUMBER FOR HEALTH 
 36.17  CARE PROVIDER ORGANIZATIONS.] (a) On and after January 1, 
 36.18  1996 1998, all group purchasers and health care providers in 
 36.19  Minnesota shall use a unique identification number to identify 
 36.20  health care provider organizations, except as provided in 
 36.21  paragraph (d). 
 36.22     (b) Following the recommendation of the workgroup for 
 36.23  electronic data interchange, the federal tax identification 
 36.24  number assigned to each health care provider organization by the 
 36.25  Internal Revenue Service of the Department of the Treasury shall 
 36.26  be used as the unique identification number for health care 
 36.27  provider organizations. 
 36.28     (c) The unique health care provider organization identifier 
 36.29  shall be used for purposes of submitting and receiving claims, 
 36.30  and in conjunction with other data collection and reporting 
 36.31  functions. 
 36.32     (d) The state and federal health care programs administered 
 36.33  by the department of human services shall use the unique 
 36.34  identification number assigned to health care providers for 
 36.35  implementation of the Medicaid Management Information System or 
 36.36  the uniform provider identification number (UPIN) assigned by 
 37.1   the Health Care Financing Administration. 
 37.2      Subd. 2.  [UNIQUE IDENTIFICATION NUMBER FOR INDIVIDUAL 
 37.3   HEALTH CARE PROVIDERS.] (a) On and after January 1, 1996 1998, 
 37.4   all group purchasers and health care providers in Minnesota 
 37.5   shall use a unique identification number to identify an 
 37.6   individual health care provider, except as provided in paragraph 
 37.7   (d). 
 37.8      (b) The uniform provider identification number (UPIN) 
 37.9   assigned by the Health Care Financing Administration shall be 
 37.10  used as the unique identification number for individual health 
 37.11  care providers.  Providers who do not currently have a UPIN 
 37.12  number shall request one from the health care financing 
 37.13  administration. 
 37.14     (c) The unique individual health care provider identifier 
 37.15  shall be used for purposes of submitting and receiving claims, 
 37.16  and in conjunction with other data collection and reporting 
 37.17  functions. 
 37.18     (d) The state and federal health care programs administered 
 37.19  by the department of human services shall use the unique 
 37.20  identification number assigned to health care providers for 
 37.21  implementation of the Medicaid Management Information System or 
 37.22  the uniform provider identification number (UPIN) assigned by 
 37.23  the health care financing administration. 
 37.24     Subd. 3.  [UNIQUE IDENTIFICATION NUMBER FOR GROUP 
 37.25  PURCHASERS.] (a) On and after January 1, 1996 1998, all group 
 37.26  purchasers and health care providers in Minnesota shall use a 
 37.27  unique identification number to identify group purchasers. 
 37.28     (b) The federal tax identification number assigned to each 
 37.29  group purchaser by the Internal Revenue Service of the 
 37.30  Department of the Treasury shall be used as the unique 
 37.31  identification number for group purchasers.  This paragraph 
 37.32  applies until the codes described in paragraph (c) are available 
 37.33  and feasible to use, as determined by the commissioner. 
 37.34     (c) A two-part code, consisting of 11 characters and 
 37.35  modeled after the National Association of Insurance 
 37.36  Commissioners company code shall be assigned to each group 
 38.1   purchaser and used as the unique identification number for group 
 38.2   purchasers.  The first six characters, or prefix, shall contain 
 38.3   the numeric code, or company code, assigned by the National 
 38.4   Association of Insurance Commissioners.  The last five 
 38.5   characters, or suffix, which is optional, shall contain further 
 38.6   codes that will enable group purchasers to further route 
 38.7   electronic transaction in their internal systems. 
 38.8      (d) The unique group purchaser identifier shall be used for 
 38.9   purposes of submitting and receiving claims, and in conjunction 
 38.10  with other data collection and reporting functions. 
 38.11     Subd. 4.  [UNIQUE PATIENT IDENTIFICATION NUMBER.] (a) On 
 38.12  and after January 1, 1996 1998, all group purchasers and health 
 38.13  care providers in Minnesota shall use a unique identification 
 38.14  number to identify each patient who receives health care 
 38.15  services in Minnesota, except as provided in paragraph (e). 
 38.16     (b) Except as provided in paragraph (d), following the 
 38.17  recommendation of the workgroup for electronic data interchange, 
 38.18  the social security number of the patient shall be used as the 
 38.19  unique patient identification number. 
 38.20     (c) The unique patient identification number shall be used 
 38.21  by group purchasers and health care providers for purposes of 
 38.22  submitting and receiving claims, and in conjunction with other 
 38.23  data collection and reporting functions. 
 38.24     (d) The commissioner shall develop an alternate numbering 
 38.25  system for patients who do not have or refuse to provide a 
 38.26  social security number.  This provision does not require that 
 38.27  patients provide their social security numbers and does not 
 38.28  require group purchasers or providers to demand that patients 
 38.29  provide their social security numbers.  Group purchasers and 
 38.30  health care providers shall establish procedures to notify 
 38.31  patients that they can elect not to have their social security 
 38.32  number used as the unique patient identification number. 
 38.33     (e) The state and federal health care programs administered 
 38.34  by the department of human services shall use the unique person 
 38.35  master index (PMI) identification number assigned to clients 
 38.36  participating in programs administered by the department of 
 39.1   human services. 
 39.2      Sec. 18.  Minnesota Statutes 1994, section 62J.55, is 
 39.3   amended to read: 
 39.4      62J.55 [PRIVACY OF UNIQUE IDENTIFIERS.] 
 39.5      (a) When the unique identifiers specified in section 62J.54 
 39.6   are used for data collection purposes, the identifiers must be 
 39.7   encrypted, as required in section 62J.30 62J.321, subdivision 6 
 39.8   1. Encryption must follow encryption standards set by the 
 39.9   National Bureau of Standards and approved by the American 
 39.10  National Standards Institute as ANSIX3. 92-1982/R 1987 to 
 39.11  protect the confidentiality of the data.  Social security 
 39.12  numbers must not be maintained in unencrypted form in the 
 39.13  database, and the data must never be released in a form that 
 39.14  would allow for the identification of individuals.  The 
 39.15  encryption algorithm and hardware used must not use clipper chip 
 39.16  technology.  
 39.17     (b) Providers and group purchasers shall treat medical 
 39.18  records, including the social security number if it is used as a 
 39.19  unique patient identifier, in accordance with section 144.335.  
 39.20  The social security number may be disclosed by providers and 
 39.21  group purchasers to the commissioner as necessary to allow 
 39.22  performance of those duties set forth in section 144.05.  
 39.23     Sec. 19.  Minnesota Statutes 1994, section 62J.58, is 
 39.24  amended to read: 
 39.25     62J.58 [IMPLEMENTATION OF STANDARD TRANSACTION SETS.] 
 39.26     Subdivision 1.  [CLAIMS PAYMENT.] (a) By July 1, 1995 Six 
 39.27  months from the date the commissioner formally recommends the 
 39.28  use of guides to implement core transaction sets pursuant to 
 39.29  section 62J.56, subdivision 3, all category I industry 
 39.30  participants, except pharmacists, shall be able to submit or 
 39.31  accept, as appropriate, the ANSI ASC X12 835 health care claim 
 39.32  payment/advice transaction set (draft standard for trial use 
 39.33  version 3030) for electronic transfer of payment information.  
 39.34     (b) By July 1, 1996, and all category II industry 
 39.35  participants, except pharmacists, shall be able to submit or 
 39.36  accept, as appropriate, the ANSI ASC X12 835 health care claim 
 40.1   payment/advice transaction set (draft standard for trial use 
 40.2   version 3030) for electronic submission of payment information 
 40.3   to health care providers.  
 40.4      Subd. 2.  [CLAIMS SUBMISSION.] Beginning July 1, 1995 Six 
 40.5   months from the date the commissioner formally recommends the 
 40.6   use of guides to implement core transaction sets pursuant to 
 40.7   section 62J.56, subdivision 3, all category I and category II 
 40.8   industry participants, except pharmacists, shall be able to 
 40.9   accept or submit, as appropriate, the ANSI ASC X12 837 health 
 40.10  care claim transaction set (draft standard for trial use version 
 40.11  3030) for the electronic transfer of health care claim 
 40.12  information.  Category II industry participants, except 
 40.13  pharmacists, shall be able to accept or submit, as appropriate, 
 40.14  this transaction set, beginning July 1, 1996.  
 40.15     Subd. 3.  [ENROLLMENT INFORMATION.] Beginning January 1, 
 40.16  1996 Six months from the date the commissioner formally 
 40.17  recommends the use of guides to implement core transaction sets 
 40.18  pursuant to section 62J.56, subdivision 3, all category I and 
 40.19  category II industry participants, excluding pharmacists, shall 
 40.20  be able to accept or submit, as appropriate, the ANSI ASC X12 
 40.21  834 health care enrollment transaction set (draft standard for 
 40.22  trial use version 3030) for the electronic transfer of 
 40.23  enrollment and health benefit information.  Category II industry 
 40.24  participants, except pharmacists, shall be able to accept or 
 40.25  submit, as appropriate, this transaction set, beginning January 
 40.26  1, 1997.  
 40.27     Subd. 4.  [ELIGIBILITY INFORMATION.] By January 1, 1996 Six 
 40.28  months from the date the commissioner formally recommends the 
 40.29  use of guides to implement core transaction sets pursuant to 
 40.30  section 62J.56, subdivision 3, all category I and category II 
 40.31  industry participants, except pharmacists, shall be able to 
 40.32  accept or submit, as appropriate, the ANSI ASC X12 270/271 
 40.33  health care eligibility transaction set (draft standard for 
 40.34  trial use version 3030) for the electronic transfer of health 
 40.35  benefit eligibility information.  Category II industry 
 40.36  participants, except pharmacists, shall be able to accept or 
 41.1   submit, as appropriate, this transaction set, beginning January 
 41.2   1, 1997. 
 41.3      Subd. 5.  [APPLICABILITY.] This section does not require a 
 41.4   group purchaser, health care provider, or employer to use 
 41.5   electronic data interchange or to have the capability to do so.  
 41.6   This section applies only to the extent that a group purchaser, 
 41.7   health care provider, or employer chooses to use electronic data 
 41.8   interchange. 
 41.9      Sec. 20.  Minnesota Statutes 1994, section 62Q.03, 
 41.10  subdivision 1, is amended to read: 
 41.11     Subdivision 1.  [PURPOSE.] Risk adjustment is a vital 
 41.12  element of the state's strategy for achieving a more equitable, 
 41.13  efficient system of health care delivery and financing for all 
 41.14  state residents.  The purpose of risk adjustment is to reduce 
 41.15  the effects of risk selection on health insurance premiums by 
 41.16  making monetary transfers from health plan companies that insure 
 41.17  lower risk populations to health plan companies that insure 
 41.18  higher risk populations.  Risk adjustment is needed to:  achieve 
 41.19  a more equitable, efficient system of health care financing; 
 41.20  remove current disincentives in the health care system to insure 
 41.21  and serve provide adequate access for high risk and special 
 41.22  needs populations; promote fair competition among health plan 
 41.23  companies on the basis of their ability to efficiently and 
 41.24  effectively provide services rather than on the health risk 
 41.25  status of those in a given insurance pool; and help 
 41.26  assure maintain the viability of all health plan companies, 
 41.27  including community integrated service networks by protecting 
 41.28  them from the financial effects of enrolling a disproportionate 
 41.29  number of high risk individuals.  It is the commitment of the 
 41.30  state to develop and implement a risk adjustment system by July 
 41.31  1, 1997, and to continue to improve and refine risk adjustment 
 41.32  over time.  The process for designing and implementing risk 
 41.33  adjustment shall be open, explicit, utilize resources and 
 41.34  expertise from both the private and public sectors, and include 
 41.35  at least the representation described in subdivision 4.  The 
 41.36  process shall take into account the formative nature of risk 
 42.1   adjustment as an emerging science, and shall develop and 
 42.2   implement risk adjustment to allow continual modifications, 
 42.3   expansions, and refinements over time.  The process shall have 
 42.4   at least two stages, as described in subdivisions 2 and 3.  The 
 42.5   risk adjustment system shall:  
 42.6      (1) possess a reasonable level of accuracy and 
 42.7   administrative feasibility, be adaptable to changes as methods 
 42.8   improve, incorporate safeguards against fraud and manipulation, 
 42.9   and shall neither reward inefficiency nor penalize for 
 42.10  verifiable improvements in health status; 
 42.11     (2) require participation by all health plan companies 
 42.12  providing coverage in the individual, small group, and Medicare 
 42.13  supplement markets; 
 42.14     (3) address unequal distribution of risk between health 
 42.15  plan companies, but shall not address the financing of public 
 42.16  programs or subsidies for low-income people; and 
 42.17     (4) be developed and implemented by the risk adjustment 
 42.18  association with joint oversight by the commissioners of health 
 42.19  and commerce. 
 42.20     Sec. 21.  Minnesota Statutes 1994, section 62Q.03, is 
 42.21  amended by adding a subdivision to read: 
 42.22     Subd. 5a.  [PUBLIC PROGRAMS.] The risk adjustment systems 
 42.23  must be developed for state-run public programs, including 
 42.24  medical assistance, general assistance medical care, and 
 42.25  MinnesotaCare.  The commissioners of health and human services 
 42.26  shall convene a work group to discuss and recommend any special 
 42.27  features of the public program risk adjustment system.  The 
 42.28  system must be developed in accordance with the general risk 
 42.29  adjustment methodologies described in this section, and may 
 42.30  include additional demographic factors in addition to age and 
 42.31  sex, different targeted conditions, or different payment amounts 
 42.32  for conditions.  The risk adjustment system for public programs 
 42.33  must attempt to reflect the special needs related to poverty, 
 42.34  cultural or language barriers, and other needs of some segments 
 42.35  of the public program population.  The commissioner of health 
 42.36  shall work with the risk adjustment association to ensure 
 43.1   coordination between the risk adjustment systems for the public 
 43.2   and private sectors.  The commissioners of health and human 
 43.3   services shall have the authority to collect data from health 
 43.4   plan companies as needed for the purposes of developing a risk 
 43.5   adjustment mechanism for public programs.  The date for final 
 43.6   implementation and the final methods for risk adjustment in 
 43.7   public programs shall be determined by the commissioner of human 
 43.8   services, and shall be in compliance with state and federal 
 43.9   requirements for the Medicaid program. 
 43.10     Sec. 22.  Minnesota Statutes 1994, section 62Q.03, 
 43.11  subdivision 6, is amended to read: 
 43.12     Subd. 6.  [CREATION OF RISK ADJUSTMENT ASSOCIATION.] The 
 43.13  Minnesota risk adjustment association is created on July 1, 
 43.14  1994, and may operate as a nonprofit unincorporated 
 43.15  association.  The risk adjustment association is subject to the 
 43.16  open meeting law. 
 43.17     Sec. 23.  Minnesota Statutes 1994, section 62Q.03, 
 43.18  subdivision 7, is amended to read: 
 43.19     Subd. 7.  [PURPOSE OF ASSOCIATION.] The association is 
 43.20  established to carry out the purposes of subdivision 1, as 
 43.21  further elaborated on by the implementation report described in 
 43.22  subdivision 5 and by legislation enacted in 1995 or subsequently 
 43.23  established to develop and implement a private sector risk 
 43.24  adjustment system.  
 43.25     Subject to state oversight set forth in subdivision 10, the 
 43.26  association shall:  
 43.27     (1) develop and implement comprehensive risk adjustment 
 43.28  systems for individual, small group, and Medicare supplement 
 43.29  markets consistent with the provisions of this chapter; 
 43.30     (2) submit a plan for the development of the risk 
 43.31  adjustment system and identify appropriate implementation dates 
 43.32  consistent with the rating and underwriting restrictions of each 
 43.33  market to the commissioners of health and commerce by November 
 43.34  5, 1995; 
 43.35     (3) develop a combination of a demographic risk adjustment 
 43.36  system and payments for targeted conditions; 
 44.1      (4) test an ambulatory care groups (ACGs), diagnostic cost 
 44.2   groups (DCGs) system, and recommend whether such a methodology 
 44.3   should be adopted; 
 44.4      (5) fund the development and testing of the risk adjustment 
 44.5   system; 
 44.6      (6) recommend market conduct guidelines; and 
 44.7      (7) develop a plan for assessing members for the costs of 
 44.8   administering the risk adjustment system. 
 44.9      Sec. 24.  Minnesota Statutes 1994, section 62Q.03, 
 44.10  subdivision 8, is amended to read: 
 44.11     Subd. 8.  [GOVERNANCE.] (a) The association shall be 
 44.12  governed by an interim 19-member board as follows:  one provider 
 44.13  member appointed by the Minnesota Hospital Association; one 
 44.14  provider member appointed by the Minnesota Medical Association; 
 44.15  one provider member appointed by the governor; three members 
 44.16  appointed by the Minnesota Council of HMOs to include an HMO 
 44.17  with at least 50 percent of total membership enrolled through a 
 44.18  public program; three members appointed by Blue Cross and Blue 
 44.19  Shield of Minnesota, to include a member from a Blue Cross and 
 44.20  Blue Shield of Minnesota affiliated health plan with fewer than 
 44.21  50,000 enrollees and located outside the Minneapolis-St. Paul 
 44.22  metropolitan area; two members appointed by the Insurance 
 44.23  Federation of Minnesota; one member appointed by the Minnesota 
 44.24  Association of Counties; and three public members appointed by 
 44.25  the governor, to include at least one representative of a public 
 44.26  program.  The commissioners of health, commerce, human services, 
 44.27  and employee relations shall be nonvoting ex officio members. 
 44.28     (b) The board may elect officers and establish committees 
 44.29  as necessary. 
 44.30     (c) A majority of the members of the board constitutes a 
 44.31  quorum for the transaction of business. 
 44.32     (d) Approval by a majority of the board members present is 
 44.33  required for any action of the board. 
 44.34     (e) Interim board members shall be appointed by July 1, 
 44.35  1994, and shall serve until a new board is elected according to 
 44.36  the plan of operation developed by the association. 
 45.1      (f) A member may designate a representative to act as a 
 45.2   member of the interim board in the member's absence. 
 45.3      Sec. 25.  Minnesota Statutes 1994, section 62Q.03, is 
 45.4   amended by adding a subdivision to read: 
 45.5      Subd. 8a.  [PLAN OF OPERATION.] The board shall submit a 
 45.6   proposed plan of operation by August 15, 1995, to the 
 45.7   commissioners of health and commerce for review.  The 
 45.8   commissioners of health and commerce shall have the authority to 
 45.9   approve or reject the plan of operation. 
 45.10     Amendments to the plan of operation may be made by the 
 45.11  commissioners or by the directors of the association, subject to 
 45.12  the approval of the commissioners. 
 45.13     Sec. 26.  Minnesota Statutes 1994, section 62Q.03, 
 45.14  subdivision 9, is amended to read: 
 45.15     Subd. 9.  [DATA COLLECTION AND DATA PRIVACY.] The board of 
 45.16  the association shall consider antitrust implications and 
 45.17  establish procedures to assure that pricing and other 
 45.18  competitive information is appropriately shared among 
 45.19  competitors in the health care market or members of the board.  
 45.20  Any information shared shall be distributed only for the 
 45.21  purposes of administering or developing any of the tasks 
 45.22  identified in subdivisions 2 and 4.  In developing these 
 45.23  procedures, the board of the association may consider the 
 45.24  identification of a state agency or other appropriate third 
 45.25  party to receive information of a confidential or competitive 
 45.26  nature.  The association members shall not have access to 
 45.27  unaggregated data on individuals or health plan companies.  The 
 45.28  association shall develop, as a part of the plan of operation, 
 45.29  procedures for ensuring that data is collected by an appropriate 
 45.30  entity.  The commissioners of health and commerce shall have the 
 45.31  authority to audit and examine data collected by the association 
 45.32  for the purposes of the development and implementation of the 
 45.33  risk adjustment system.  Data on individuals collected for the 
 45.34  purposes of risk adjustment development, testing, and operation 
 45.35  are designated as private data.  Data not on individuals which 
 45.36  is obtained by the commissioner for the purposes of development, 
 46.1   testing, and operation of risk adjustment, are designated as 
 46.2   nonpublic data.  Nothing in this section is intended to prohibit 
 46.3   the preparation of summary data under section 13.05, subdivision 
 46.4   7.  The association, state agencies, and any contractors having 
 46.5   access to this data shall maintain it in accordance with this 
 46.6   classification. 
 46.7      Sec. 27.  Minnesota Statutes 1994, section 62Q.03, 
 46.8   subdivision 10, is amended to read: 
 46.9      Subd. 10.  [SUPERVISION STATE OVERSIGHT OF RISK ADJUSTMENT 
 46.10  ACTIVITIES.] The association's activities shall be supervised by 
 46.11  the commissioners of health and commerce.  The commissioners 
 46.12  shall provide specific oversight functions during the 
 46.13  development and implementation phases as follows: 
 46.14     (1) the commissioners shall approve or reject the 
 46.15  association's plan for testing risk adjustment methods, the 
 46.16  methods to be used, and any changes to those methods; 
 46.17     (2) the commissioners must have the right to attend and 
 46.18  participate in all meetings of the association and its work 
 46.19  groups or committees; 
 46.20     (3) the commissioners shall approve any consultants or 
 46.21  administrators used by the association; 
 46.22     (4) the commissioners shall approve or reject the 
 46.23  association's plan of operation; and 
 46.24     (5) the commissioners shall approve or reject the plan for 
 46.25  the risk adjustment system described in subdivision 7, clause 
 46.26  (2). 
 46.27     If the commissioners reject any of the plans identified in 
 46.28  clauses (1), (4), and (5) of this subdivision, the directors 
 46.29  shall submit for review an appropriate revised plan within 30 
 46.30  days. 
 46.31     Sec. 28.  Minnesota Statutes 1994, section 214.16, 
 46.32  subdivision 2, is amended to read: 
 46.33     Subd. 2.  [BOARD COOPERATION REQUIRED.] The board shall 
 46.34  assist the commissioner of health and the data analysis unit in 
 46.35  data collection activities required under Laws 1992, chapter 
 46.36  549, article 7, and shall assist the commissioner of revenue in 
 47.1   activities related to collection of the health care provider tax 
 47.2   required under Laws 1992, chapter 549, article 9.  Upon the 
 47.3   request of the commissioner, the data analysis unit, or the 
 47.4   commissioner of revenue, the board shall make available names 
 47.5   and addresses of current licensees and provide other information 
 47.6   or assistance as needed. 
 47.7      Sec. 29.  Minnesota Statutes 1994, section 214.16, 
 47.8   subdivision 3, is amended to read: 
 47.9      Subd. 3.  [GROUNDS FOR DISCIPLINARY ACTION.] The board 
 47.10  shall take disciplinary action, which may include license 
 47.11  revocation, against a regulated person for: 
 47.12     (1) intentional failure to provide the commissioner of 
 47.13  health or the data analysis unit established under section 
 47.14  62J.30 with the data required under chapter 62J; 
 47.15     (2) intentional failure to provide the commissioner of 
 47.16  revenue with data on gross revenue and other information 
 47.17  required for the commissioner to implement sections 295.50 to 
 47.18  295.58; and 
 47.19     (3) intentional failure to pay the health care provider tax 
 47.20  required under section 295.52. 
 47.21     Sec. 30.  Minnesota Statutes 1994, section 295.57, is 
 47.22  amended to read: 
 47.23     295.57 [COLLECTION AND ENFORCEMENT; REFUNDS; RULEMAKING; 
 47.24  APPLICATION OF OTHER CHAPTERS; ACCESS TO RECORDS.] 
 47.25     Subdivision 1.  [APPLICATION OF OTHER CHAPTERS.] Unless 
 47.26  specifically provided otherwise by sections 295.50 to 295.58, 
 47.27  the enforcement, interest, and penalty provisions under chapter 
 47.28  294, appeal provisions in sections 289A.43 and 289A.65, criminal 
 47.29  penalties in section 289A.63, and refunds provisions in section 
 47.30  289A.50, and collection and rulemaking provisions under chapter 
 47.31  270, apply to a liability for the taxes imposed under sections 
 47.32  295.50 to 295.58. 
 47.33     Subd. 2.  [ACCESS TO RECORDS.] For purposes of 
 47.34  administering the taxes imposed by sections 295.50 to 295.59, 
 47.35  the commissioner may access patients' records that contain 
 47.36  billing or other financial information without prior consent 
 48.1   from the patients.  The data collected is classified as private 
 48.2   or nonpublic data. 
 48.3      Sec. 31.  [RULES.] 
 48.4      Notwithstanding Minnesota Statutes, section 14.05, 
 48.5   subdivision 1, Minnesota Rules, chapters 4650, 4651, and 4652, 
 48.6   shall continue in effect under the authority granted in 
 48.7   Minnesota Statutes, section 62J.321, subdivision 6. 
 48.8      Sec. 32.  [INSTRUCTION TO REVISOR.] 
 48.9      (a) The revisor of statutes is instructed to change the 
 48.10  term "data institute" or "institute", where applicable, to 
 48.11  "health data institute" in the 1996 edition of Minnesota 
 48.12  Statutes and Minnesota Rules.  
 48.13     (b) The revisor of statutes is instructed to change any 
 48.14  statutory reference to the information clearinghouse from 
 48.15  Minnesota Statutes, section 62J.33 or 62J.33, subdivision 2, to 
 48.16  62J.2930, in the 1996 edition of Minnesota Statutes and 
 48.17  Minnesota Rules. 
 48.18     Sec. 33.  [REPEALER.] 
 48.19     Minnesota Statutes 1994, sections 62J.30; 62J.31; 62J.32; 
 48.20  62J.33; 62J.34; 62J.35; 62J.41, subdivisions 3 and 4; 62J.44; 
 48.21  and 62J.45, are repealed.