SF 2815

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 03/24/2010 01:43pm

A bill for an act
relating to health; modifying the provider peer grouping timelines and system;
amending Minnesota Statutes 2008, sections 62U.04, subdivisions 3, 9;
256B.0754, subdivision 2; repealing Minnesota Statutes 2009 Supplement,
section 256B.032.

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

Section 1.

Minnesota Statutes 2008, section 62U.04, subdivision 3, is amended to read:

Subd. 3.

Provider peer grouping.

(a) The commissioner shall develop a peer
grouping system for providers based on a combined measure that incorporates both
provider risk-adjusted cost of care and quality of care, and for specific conditions as
determined by the commissioner. In developing this system, the commissioner shall
consult and coordinate with health care providers, health plan companies, state agencies,
and organizations that work to improve health care quality in Minnesota. For purposes of
the final establishment of the peer grouping system, the commissioner shall not contract
with any private entity, organization, or consortium of entities that has or will have a direct
financial interest in the outcome of the system.

(b) deleted text begin Beginning June 1 deleted text end new text begin By no later than October 15 new text end , 2010, the commissioner shall
disseminate information to providers on their new text begin total new text end cost of care, new text begin total new text end resource use, new text begin total
new text end quality of care, and the new text begin total care new text end results of the grouping developed under this subdivision
in comparison to an appropriate peer group. Any analyses or reports that identify
providers may only be published after the provider has been provided the opportunity by
the commissioner to review the underlying data and submit comments. new text begin Providers may be
given any data for which they are the subject of the data. new text end The provider shall have deleted text begin 21 deleted text end new text begin 30
new text end days to review the data for accuracy new text begin and initiate an appeal as specified in paragraph (d) new text end .

(c) new text begin By no later than January 1, 2011, the commissioner shall disseminate information
to providers on their condition-specific cost of care, condition-specific resource use,
condition-specific quality of care, and the condition-specific results of the grouping
developed under this subdivision in comparison to an appropriate peer group. Any
analyses or reports that identify providers may only be published after the provider has
been provided the opportunity by the commissioner to review the underlying data and
submit comments. Providers may be given any data for which they are the subject of the
data. The provider shall have 30 days to review the data for accuracy and initiate an
appeal as specified in paragraph (d).
new text end

new text begin (d) new text end The commissioner shall establish an appeals process to resolve disputes from
providers regarding the accuracy of the data used to develop analyses or reports. new text begin When
a provider appeals the accuracy of the data used to calculate the peer grouping system
results, the provider shall:
new text end

new text begin (1) clearly indicate the reason they believe the data used to calculate the peer group
system results are not accurate;
new text end

new text begin (2) provide evidence and documentation to support the reason that data was not
accurate; and
new text end

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

new text begin If a provider does not meet the requirements of this paragraph, a provider's appeal shall be
considered withdrawn. The commissioner shall not publish results for a specific provider
under paragraph (e) or (f) while that provider has an unresolved appeal.
new text end

deleted text begin (d) deleted text end new text begin (e) new text end Beginning deleted text begin September 1, 2010 deleted text end new text begin January 1, 2011 new text end , the commissioner shall, no
less than annually, publish information on providers' new text begin total new text end cost, new text begin total resource use, new text end new text begin total
new text end quality, and the results of the new text begin total care portion of the new text end peer grouping process. The results
that are published must be on a risk-adjusted basis.

new text begin (f) Beginning March 30, 2011, the commissioner shall no less than annually
publish information on providers' condition-specific cost, condition-specific resource use,
condition-specific quality, and the results of the condition-specific portion of the peer
grouping process. The results that are published must be on a risk-adjusted basis.
new text end

new text begin (g) If additional time is needed to establish the scientific validity of the results, the
commissioner may delay the dissemination of data to providers under paragraph (b) or (c),
or the publication of information under paragraph (e) or (f). If the delay is more than 60
days, the commissioner shall report in writing to the Legislative Commission on Health
Care Access the following information:
new text end

new text begin (1) the reason for the delay;
new text end

new text begin (2) the actions being taken to resolve the delay and establish the scientific validity
of the results; and
new text end

new text begin (3) the new dates by which the results shall be disseminated.
new text end

new text begin If there is a delay under this paragraph, the commissioner must disseminate the
information to providers under paragraph (b) or (c) at least 90 days before publishing
results under paragraph (e) or (f).
new text end

Sec. 2.

Minnesota Statutes 2008, section 62U.04, subdivision 9, is amended to read:

Subd. 9.

Uses of information.

(a) By deleted text begin January 1, 2011 deleted text end new text begin no later than 12 months after
the commissioner publishes the information in section 62U.04, subdivision 3, paragraph
(e) new text end :

(1) the commissioner of management and budget shall use the information and
methods developed under subdivision 3 to strengthen incentives for members of the state
employee group insurance program to use high-quality, low-cost providers;

(2) all political subdivisions, as defined in section 13.02, subdivision 11, that offer
health benefits to their employees must offer plans that differentiate providers on their
cost and quality performance and create incentives for members to use better-performing
providers;

(3) all health plan companies shall use the information and methods developed
under subdivision 3 to develop products that encourage consumers to use high-quality,
low-cost providers; and

(4) health plan companies that issue health plans in the individual market or the
small employer market must offer at least one health plan that uses the information
developed under subdivision 3 to establish financial incentives for consumers to choose
higher-quality, lower-cost providers through enrollee cost-sharing or selective provider
networks.

(b) By January 1, 2011, the commissioner of health shall report to the governor
and the legislature on recommendations to encourage health plan companies to promote
widespread adoption of products that encourage the use of high-quality, low-cost providers.
The commissioner's recommendations may include tax incentives, public reporting of
health plan performance, regulatory incentives or changes, and other strategies.

Sec. 3.

Minnesota Statutes 2008, section 256B.0754, subdivision 2, is amended to read:

Subd. 2.

Payment reform.

By deleted text begin January 1, 2011 deleted text end new text begin no later than 12 months after the
commissioner of health publishes the information in section 62U.04, subdivision 3,
paragraph (e) new text end , the commissioner of human services shall use the information and methods
developed under section 62U.04 to establish a payment system that:

(1) rewards high-quality, low-cost providers;

(2) creates enrollee incentives to receive care from high-quality, low-cost providers;
and

(3) fosters collaboration among providers to reduce cost shifting from one part of
the health continuum to another.

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2009 Supplement, section 256B.032, new text end new text begin is repealed.
new text end