SF 1421

as introduced - 90th Legislature (2017 - 2018) Posted on 03/08/2017 09:15am

A bill for an act
relating to health; requiring commissioner of human services to establish
demonstration projects for complex patient populations; establishing a fee schedule
for providers serving managed care enrollees; requiring a final report on new
payment methodologies; authorizing commissioner of health to award health
information technology grants; authorizing the establishment of health care
workforce pilot projects; modifying requirements governing measures to assess
health care quality and quality incentive payments to providers; appropriating
money; amending Minnesota Statutes 2016, sections 62J.496, subdivisions 1, 2,
by adding a subdivision; 62U.02, subdivisions 1, 2, 3, 4; 256B.0755, by adding a
subdivision; 256B.69, by adding a subdivision; Laws 2015, chapter 71, article 11,
section 63; proposing coding for new law in Minnesota Statutes, chapter 144.

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

ARTICLE 1

PAYMENT REFORM PILOT PROJECTS

Section 1.

Minnesota Statutes 2016, section 256B.0755, is amended by adding a subdivision
to read:

new text begin Subd. 8. new text end

new text begin Demonstration projects for complex patient populations. new text end

new text begin (a) The
commissioner of human services shall establish special demonstration projects for care
networks that serve patient populations that experience significantly poorer health, higher
risks of chronic disease, and poor quality and outcomes of care relative to the general
population due to social, cultural, and economic risk factors affecting population health and
the delivery of care. These factors include but are not limited to poverty, homelessness,
neighborhood or region of residence, mental health or substance use disorder, transportation
barriers, and racial or cultural barriers.
new text end

new text begin (b) To be eligible to be served by the pilot project, an individual must:
new text end

new text begin (1) be eligible for medical assistance under section 256B.055 or MinnesotaCare under
chapter 256L;
new text end

new text begin (2) reside in the service area of the care network;
new text end

new text begin (3) have a combination of multiple risk factors identified by the care network and
approved by the commissioner; and
new text end

new text begin (4) agree to participate in the pilot project. The commissioner may identify an individual
who is potentially eligible to be enrolled in the pilot project based on zip code or other
geographic designation, medical diagnosis, utilization history, or other factors that indicate
whether an individual would benefit from participation in the pilot project.
new text end

new text begin (c) Pilot projects may be established by care networks made up of multiple providers,
or individual providers with care coordination agreements with other providers, who can
provide integrated, coordinated services to patients. To participate in the demonstration
project, a care network:
new text end

new text begin (1) must have a patient caseload of which at least … percent of patients are enrolled in
medical assistance or MinnesotaCare, or are uninsured;
new text end

new text begin (2) serve a geographic area whose population experiences substantially poorer overall
health compared to the overall Minnesota population;
new text end

new text begin (3) have lower quality-of-care scores under some traditional quality measures due to the
economic, behavioral health, cultural and geographic factors of the patients served rather
than the clinical expertise of the providers in the care network; and
new text end

new text begin (4) serve a population whose utilization history indicates an opportunity to improve
health outcomes and reduce total cost of care through better patient engagement, coordination
of care, and the provision of specialized services to address nonclinical risk factors and
barriers to access.
new text end

new text begin (d) The commissioner shall waive or modify conditions and requirements for integrated
health partnerships under this section that may be a barrier to testing new care delivery
models that are tailored to high-risk, complex populations, as follows:
new text end

new text begin (1) quality of care and patient satisfaction standards must be risk-adjusted to reflect
economic, behavioral health, cultural, geographic, or other nonclinical risk factors of the
patients served;
new text end

new text begin (2) the commissioner shall pay a monthly care coordination fee for each enrollee that is
in addition to any other payments, gain-sharing, or health care home payments that would
otherwise be received;
new text end

new text begin (3) patient attribution to the care network shall be based on the patients who meet the
criteria identified in this section who have agreed to participate in the pilot project;
new text end

new text begin (4) requirements establishing a minimum number of persons to be eligible to participate
in the integrated health network do not apply; and
new text end

new text begin (5) the commissioner shall waive or modify other integrated health network requirements
that may discourage participation by rural, independent, community-based, and safety net
providers.
new text end

new text begin (e) The commissioner, in consultation with the commissioner of health, may authorize
care networks to test workforce models that will improve health outcomes or reduce health
care costs. The commissioner may waive enrollment, credentialing, or reimbursement
conditions or requirements for new or emerging categories of health care professionals and
may establish or modify payment methods to encourage the use of new or emerging
categories of health care professionals to improve health outcomes or reduce costs.
new text end

new text begin (f) An existing integrated health partnership operating under this section is eligible to
participate in the pilot project while continuing as an integrated health partnership, and
qualifies for the exceptions in paragraph (e). All pilot projects authorized under this
subdivision are eligible to receive the information and data that are available to integrated
health networks.
new text end

new text begin (g) The commissioners of health and human services, in consultation with care networks
and organizations with expertise in serving the patients identified in this subdivision, shall
test new methods of measuring provider performance and providing payment incentives to
improve health outcomes and reduce administrative burdens for providers and state agencies.
The new payment incentives, performance measures must:
new text end

new text begin (1) pay providers adequately for patient engagement, health improvement, and care
coordination services for high-risk, complex populations;
new text end

new text begin (2) ensure that providers use the additional payments made available under this
subdivision to reduce the total costs of health care for patients by reducing unnecessary
utilization of hospital services, emergency rooms, and high-cost specialty services and
prescription drugs; and
new text end

new text begin (3) establish payment methods and set payment amounts based in part on patient
complexity related to poverty, homelessness, mental health or substance abuse, rural isolation,
transportation barriers, and language or cultural barriers. Total payment may reflect payments
for new types of cost-effective services or health professionals, higher rates for existing
cost-effective covered services and health professionals, and special add-on payment amounts
that increase existing payment rates based on the nonclinical factors contributing to the
complexity of the patients served.
new text end

new text begin (h) A health care provider participating in a pilot project under this subdivision remains
eligible to receive any other payments authorized by federal or state law, rule, or policy,
unless the provider and commissioner have mutually agreed to an alternative payment
method intended to replace an existing payment method. This includes but is not limited to
base payment rates, add-on payments, critical access payments, disproportionate share
payments, or other special rates. The commissioner shall also require any managed care
organization under contract with the commissioner to deliver services to medical assistance
and MinnesotaCare enrollees to continue to make payments to a provider participating in
a pilot project under this section for services provided to medical assistance and
MinnesotaCare enrollees.
new text end

ARTICLE 2

ADEQUACY OF MANAGED CARE PAYMENTS

Section 1.

Minnesota Statutes 2016, section 256B.69, is amended by adding a subdivision
to read:

new text begin Subd. 36. new text end

new text begin Payment rates. new text end

new text begin The commissioner shall develop a minimum provider payment
fee schedule for managed care plans and county-based purchasing plans for use in
reimbursing health care providers for services delivered to medical assistance and
MinnesotaCare enrollees. A managed care or county-based purchasing plan must pay health
care providers at least the minimum amount specified in the fee schedule. The minimum
amount specified shall be 110 percent of the base payment amount that applies to services
provided to persons not enrolled in a managed care or county-based purchasing plan. The
base payment amount must include all applicable payment increases, add-on or supplemental
payments, disproportionate share payments, critical access payments, care coordination
payments, and gain-sharing payments, and payment amounts determined under any applicable
prospective or alternative payment method. Managed care and county-based purchasing
plans must submit documentation of compliance with this requirement to the commissioner,
in the form and manner specified by the commissioner. For purposes of this subdivision,
"health care provider" means a vendor of medical care as defined in section 256B.02,
subdivision 7.
new text end

Sec. 2.

Laws 2015, chapter 71, article 11, section 63, is amended to read:

Sec. 63. HEALTH DISPARITIES PAYMENT ENHANCEMENT.

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

(b) The commissioner shall submit a report on the analysis and provide options for new
payment methodologies that incorporate health disparities to the chairs and ranking minority
members of the legislative committees with jurisdiction over health care policy and finance
by February 1, 2016. The scope of the report and the development work described in
paragraph (a) is limited to data currently available to the Department of Human Services;
analyses of the data for reliability and completeness; analyses of how these data relate to
health disparities, outcomes, and expenditures; and options for incorporating these data or
measures into a payment methodology.

new text begin (c) The commissioner shall submit a final report, implementation plan, and
implementation budget to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care policy and finance by December 1, 2017.
new text end

ARTICLE 3

REFORMS TO PROVIDER PAYMENTS AND QUALITY STANDARDS

Section 1.

Minnesota Statutes 2016, section 62U.02, subdivision 1, is amended to read:

Subdivision 1.

Development.

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

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

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

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

deleted text begin (4) deleted text end new text begin (3) new text end place a priority on measures of health care outcomes new text begin and health improvement new text end ,
rather than process measures, wherever possible; and

deleted text begin (5) deleted text end new text begin (4) new text end incorporate measures for primary care, including new text begin health risk assessments and
new text end preventive new text begin and health improvement new text end services, coronary artery and heart disease, diabetes,
asthma, depression, and other measures as determined by the commissioner.

(b) Effective July 1, 2016, the commissioner shall stratify quality measures by race,
ethnicity, preferred language, and country of origin beginning with five measures, and
stratifying additional measures to the extent resources are available. On or after January 1,
2018, the commissioner deleted text begin may require measures to be stratified by deleted text end new text begin shall stratify all measures
by a population health risk index factor that accounts for a combination of factors outside
the control of health care providers that affect patient health and provider performance on
quality measures. Population health risk factors to be considered in developing the index
shall include poverty, neighborhood or region of residence, homelessness, co-occurring
mental health and substance use disorders, and new text end other sociodemographic factors that according
to reliable data are correlated with health disparities and have an impact on performance
on quality or cost indicators. New methods of stratifying data under this paragraph must be
tested and evaluated through pilot projects prior to adding them to the statewide system. In
determining whether to add additional sociodemographic factors and developing the
methodology to be used, the commissioner shall consider the reporting burden on providers
and determine whether there are alternative sources of data that could be used. The
commissioner shall ensure that categories and data collection methods are developed in
consultation with those communities impacted by health disparities using culturally
appropriate community engagement principles and methods. deleted text begin The commissioner shall
implement this paragraph in coordination with the contracting entity retained under
subdivision 4, in order to build upon the data stratification methodology that has been
developed and tested by the entity. deleted text end Nothing in this paragraph expands or changes the
commissioner's authority to collect, analyze, or report health care data. Any data collected
to implement this paragraph must be data that is available or is authorized to be collected
under other laws. Nothing in this paragraph grants authority to the commissioner to collect
or analyze patient-level or patient-specific data of the patient characteristics identified under
this paragraph.

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

Sec. 2.

Minnesota Statutes 2016, section 62U.02, subdivision 2, is amended to read:

Subd. 2.

Quality incentive payments.

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

(b) To the extent possible, the payment system must adjust for variations in patient
population in order to new text begin factor out nonclinical factors that affect quality measures scores and
to new text end reduce incentives to health care providers to avoid high-risk patients or populations,
including those with risk factors related to race, ethnicity, language, country of origin, and
sociodemographic factors new text begin , including those population health risk factors specified in
subdivision 1, paragraph (b) new text end .

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

Sec. 3.

Minnesota Statutes 2016, section 62U.02, subdivision 3, is amended to read:

Subd. 3.

Quality transparency.

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

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

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

Sec. 4.

Minnesota Statutes 2016, section 62U.02, subdivision 4, is amended to read:

Subd. 4.

Contracting.

The commissioner may contract with deleted text begin a private entity or consortium
of deleted text end new text begin one or more new text end private entities to complete the tasks in subdivisions 1 to 3. deleted text begin The deleted text end new text begin A new text end private
entity or consortium must deleted text begin be nonprofit and deleted text end have governance that includes representatives
from the following stakeholder groups: health care providers, including providers serving
high concentrations of patients and communities impacted by health disparities; health plan
companies; consumers, including consumers representing groups who experience health
disparities; employers or other health care purchasers; and state government. No one
stakeholder group shall have a majority of the votes on any issue or hold extraordinary
powers not granted to any other governance stakeholder.

ARTICLE 4

HEALTH INFORMATION TECHNOLOGY GRANTS

Section 1.

Minnesota Statutes 2016, section 62J.496, subdivision 1, is amended to read:

Subdivision 1.

Account establishment.

(a) An account is established to:

(1) finance the purchase of certified electronic health records or qualified electronic
health records as defined in section 62J.495, subdivision 1a;

(2) enhance the utilization of electronic health record technology, which may include
costs associated with upgrading the technology to meet the criteria necessary to be a certified
electronic health record or a qualified electronic health record;

(3) train personnel in the use of electronic health record technology; deleted text begin and
deleted text end

(4) improve the secure electronic exchange of health information new text begin ; and
new text end

new text begin (5) improve the use of health information technology and data analytics to support new
health care delivery models and payment models designed to improve health outcomes and
reduce the total cost of care new text end .

(b) Amounts deposited in the account, including any grant funds obtained through federal
or other sources, loan repayments, and interest earned on the amounts shall be used only
for awarding loans or loan guarantees, as a source of reserve and security for leveraged
loans, for activities authorized in section 62J.495, deleted text begin subdivision deleted text end new text begin subdivisions new text end 4 new text begin and 5 new text end , or for
the administration of the account.

(c) The commissioner may accept contributions to the account from private sector entities
subject to the following provisions:

(1) the contributing entity may not specify the recipient or recipients of any loan issued
under this subdivision;

(2) the commissioner shall make public the identity of any private contributor to the
loan new text begin and grant new text end fund, as well as the amount of the contribution provided;

(3) the commissioner may issue letters of commendation or make other awards that have
no financial value to any such entity; and

(4) a contributing entity may not specify that the recipient or recipients of any loan use
specific products or services, nor may the contributing entity imply that a contribution is
an endorsement of any specific product or service.

(d) The commissioner may use the loan funds to reimburse private sector entities for
any contribution made to the loan new text begin and grant new text end fund. Reimbursement to private entities may
not exceed the principle amount contributed to the loan new text begin and grant new text end fund.

(e) The commissioner may use funds deposited in the account to guarantee, or purchase
insurance for, a local obligation if the guarantee or purchase would improve credit market
access or reduce the interest rate applicable to the obligation involved.

(f) The commissioner may use funds deposited in the account as a source of revenue or
security for the payment of principal and interest on revenue or general obligation bonds
issued by the state if the proceeds of the sale of the bonds will be deposited into the loan
new text begin and grant new text end fund.

(g) The commissioner shall not award new loans or loan guarantees after July 1, 2016.

Sec. 2.

Minnesota Statutes 2016, section 62J.496, subdivision 2, is amended to read:

Subd. 2.

Eligibility.

(a) "Eligible borrower" new text begin or "eligible grantee" new text end means one of the
following:

(1) federally qualified health centers;

(2) community clinics, as defined under section 145.9268;

(3) nonprofit or local unit of government hospitals licensed under sections 144.50 to
144.56;

(4) individual or small group physician practices that are focused primarily on primary
care;

(5) nursing facilities licensed under sections 144A.01 to 144A.27;

(6) local public health departments as defined in chapter 145A; deleted text begin and
deleted text end

new text begin (7) community-based mental health, substance use disorder, or dental providers who are
not part of a large health system, large health care corporation, or large group practice; and
new text end

deleted text begin (7) deleted text end new text begin (8) new text end other providers of health or health care services approved by the commissioner
for which interoperable electronic health record capability would improve quality of care,
patient safety, or community health.

(b) The commissioner shall administer the loan new text begin and grant new text end fund to prioritize support and
assistance to:

(1) critical access hospitals;

(2) federally qualified health centers;

(3) new text begin community-based new text end entities that serve new text begin a high proportion of new text end uninsured, underinsured,
and medically underserved individuals, regardless of whether such area is urban or rural;

(4) individual or small group practices that are primarily focused on primary care new text begin and
serve a high proportion of patients who are low income and uninsured, underinsured, or
enrolled in medical assistance or MinnesotaCare new text end ;

(5) nursing facilities certified to participate in the medical assistance program; and

(6) providers enrolled in the elderly waiver program of customized living or 24-hour
customized living of the medical assistance program, if at least half of their annual operating
revenue is paid under the medical assistance program.

(c) An eligible applicant must submit a loan application to the commissioner of health
on forms prescribed by the commissioner. The application must include, at a minimum:

(1) the amount of the loan requested and a description of the purpose or project for which
the loan proceeds will be used;

(2) a quote from a vendor;

(3) a description of the health care entities and other groups participating in the project;

(4) evidence of financial stability and a demonstrated ability to repay the loan; and

(5) a description of how the system to be financed interoperates or plans in the future
to interoperate with other health care entities and provider groups located in the same
geographical area;

(6) a plan on how the certified electronic health record technology will be maintained
and supported over time; and

(7) any other requirements for applications included or developed pursuant to section
3014 of the HITECH Act.

Sec. 3.

Minnesota Statutes 2016, section 62J.496, is amended by adding a subdivision to
read:

new text begin Subd. 5. new text end

new text begin Technology grants. new text end

new text begin In addition to administering the loan program under this
section, the commissioner shall award grants to eligible grantees according to the priorities
in subdivision 2, paragraph (b). Grants must be awarded from money appropriated to the
commissioner for purposes of this section or from money obtained from other sources as
authorized under subdivision 1. Grant funds must be used for the purposes specified in
subdivision 1.
new text end

ARTICLE 5

HEALTH CARE WORKFORCE PILOT PROJECTS

Section 1.

new text begin [144.1915] HEALTH CARE WORKFORCE PILOT PROJECTS.
new text end

new text begin Subdivision 1. new text end

new text begin Pilot projects. new text end

new text begin The commissioner of health shall establish workforce
pilot projects to test new workforce models to:
new text end

new text begin (1) improve population health and patient health outcomes;
new text end

new text begin (2) reduce health care costs;
new text end

new text begin (3) improve patient and consumer engagement and satisfaction;
new text end

new text begin (4) increase employment opportunities for individuals from racial, ethnic, cultural, and
geographic communities that experience low incomes, high unemployment rates, and poor
health outcomes;
new text end

new text begin (5) improve access to health care for underserved individuals and communities; or
new text end

new text begin (6) reduce health disparities.
new text end

new text begin Subd. 2. new text end

new text begin Temporary waivers of regulations and restrictions. new text end

new text begin For purposes of testing
workforce models, the commissioner is authorized to temporarily waive, modify, or substitute
alternatives for existing education or training requirements, practice restrictions, or other
state laws governing health care providers that are in statute or have been established by
the commissioner or health-related licensing boards. The commissioner may waive, modify,
or substitute alternatives for a requirement, restriction, or law only if the commissioner
determines that the requirement, restriction, or law impedes workforce innovation and is
not necessary to protect public health and safety under the safeguards established for the
pilot projects.
new text end

new text begin Subd. 3. new text end

new text begin Consultation. new text end

new text begin The commissioner shall consult with any applicable health-related
licensing board or regulating entity before establishing pilot projects under this section.
new text end

new text begin Subd. 4. new text end

new text begin Research and evaluation. new text end

new text begin (a) The commissioner, in cooperation with the
University of Minnesota and Minnesota State Colleges and Universities, shall evaluate
workforce pilot projects established under this section and report to the legislative committees
with jurisdiction over higher education and health and human services on:
new text end

new text begin (1) findings and conclusions of the pilot projects; and
new text end

new text begin (2) proposed changes to any state law, based on the outcomes of the pilot projects.
new text end

new text begin (b) The report must be submitted by January 31, 2018.
new text end

new text begin Subd. 5. new text end

new text begin Reimbursement. new text end

new text begin The commissioner shall consult with the commissioner of
human services regarding the establishment of pilot projects under this section and may
request that the commissioner of human services temporarily waive or modify payment
rates or provider requirements for purposes of the pilot projects. Notwithstanding any law
to the contrary, the commissioner of human services is authorized to waive or modify
requirements for individuals or organizations participating in the pilot projects.
new text end

new text begin Subd. 6. new text end

new text begin Education and training. new text end

new text begin The commissioner shall award grants to the University
of Minnesota and Minnesota State Colleges and Universities to:
new text end

new text begin (1) provide research, training, and technical assistance to the commissioner and sponsors
of pilot projects developed under this section;
new text end

new text begin (2) provide training, clinical experiences, and consultation to individuals who will
participate in pilot projects as providers of health care services;
new text end

new text begin (3) develop and test technology and data to support workforce innovations; or
new text end

new text begin (4) evaluate pilot projects as requested by the commissioner.
new text end