Minnesota Session Laws - 2012, Regular Session

CHAPTER 164--S.F.No. 1809

An act

relating to health; removing requirements for implementation of evidence-based strategies as part of hospital community benefit programs and health maintenance organizations collaboration plans; changing requirements for development of health care costs and quality outcome standards; providing for use and public release of certain health care data;

amending Minnesota Statutes 2010, sections 62U.04, subdivisions 1, 2, 4, 5; 256B.0754, subdivision 2; Minnesota Statutes 2011 Supplement, section 62U.04, subdivisions 3, 9; Laws 2011, First Special Session chapter 9, article 10, section 4, subdivision 2.

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

Section 1.

Laws 2011, First Special Session chapter 9, article 10, section 4, subdivision 2, is amended to read:

Subd. 2. Community and Family Health Promotion

Appropriations by Fund
General	45,577,000	46,030,000
State Government Special Revenue	1,033,000	1,033,000
Health Care Access	16,719,000	1,719,000
Federal TANF	11,713,000	11,713,000

TANF Appropriations. (1) $1,156,000 of the TANF funds is appropriated each year of the biennium to the commissioner for family planning grants under Minnesota Statutes, section 145.925.

(2) $3,579,000 of the TANF funds is appropriated each year of the biennium to the commissioner for home visiting and nutritional services listed under Minnesota Statutes, section 145.882, subdivision 7, clauses (6) and (7). Funds must be distributed to community health boards according to Minnesota Statutes, section 145A.131, subdivision 1.

(3) $2,000,000 of the TANF funds is appropriated each year of the biennium to the commissioner for decreasing racial and ethnic disparities in infant mortality rates under Minnesota Statutes, section 145.928, subdivision 7.

(4) $4,978,000 of the TANF funds is appropriated each year of the biennium to the commissioner for the family home visiting grant program according to Minnesota Statutes, section 145A.17. $4,000,000 of the funding must be distributed to community health boards according to Minnesota Statutes, section 145A.131, subdivision 1. $978,000 of the funding must be distributed to tribal governments based on Minnesota Statutes, section 145A.14, subdivision 2a.

(5) The commissioner may use up to 6.23 percent of the funds appropriated each fiscal year to conduct the ongoing evaluations required under Minnesota Statutes, section 145A.17, subdivision 7, and training and technical assistance as required under Minnesota Statutes, section 145A.17, subdivisions 4 and 5.

TANF Carryforward. Any unexpended balance of the TANF appropriation in the first year of the biennium does not cancel but is available for the second year.

Statewide Health Improvement Program. deleted text begin (a) deleted text end $15,000,000 in the biennium ending June 30, 2013, is appropriated from the health care access fund for the statewide health improvement program and is available until expended. Notwithstanding Minnesota Statutes, sections 144.396, and 145.928, the commissioner may use tobacco prevention grant funding and grant funding under Minnesota Statutes, section 145.928, to support the statewide health improvement program. The commissioner may focus the program geographically or on a specific goal of tobacco use reduction or on reducing obesity. deleted text begin By February 15, 2013, the commissioner shall report to the chairs of the health and human services committee on progress toward meeting the goals of the program as outlined in Minnesota Statutes, section deleted text end deleted text begin , and estimate the dollar value of the reduced health care costs for both public and private payers. deleted text end

deleted text begin (b) By February 15, 2012, the commissioner deleted text end deleted text begin shall develop a plan to implement deleted text end deleted text begin evidence-based strategies from the statewide deleted text end deleted text begin health improvement program as part of deleted text end deleted text begin hospital community benefit programs and deleted text end deleted text begin health maintenance organizations deleted text end deleted text begin collaboration plans. deleted text end deleted text begin The implementation plan shall include an advisory board to determine priority needs for health improvement in reducing obesity and tobacco use in Minnesota and to review and approve hospital community benefit activities reported under Minnesota Statutes, section 144.699, and health maintenance organizations collaboration plans in Minnesota Statutes, section . deleted text end deleted text begin The deleted text end deleted text begin commissioner shall consult with deleted text end deleted text begin hospital and deleted text end deleted text begin health maintenance organizations in deleted text end deleted text begin creating and implementing the plan. The deleted text end deleted text begin plan described in this paragraph shall be deleted text end deleted text begin implemented by July 1, 2012. deleted text end

deleted text begin (c) The commissioners of Minnesota deleted text end deleted text begin management and budget, human services, deleted text end deleted text begin and health shall include in each forecast deleted text end deleted text begin beginning February of 2013 a report that deleted text end deleted text begin identifies an estimated dollar value of the deleted text end deleted text begin health care savings in the state health care deleted text end deleted text begin programs that are directly attributable to the deleted text end deleted text begin strategies funded from the statewide health deleted text end deleted text begin improvement program. The report shall deleted text end deleted text begin include a description of methodologies and deleted text end deleted text begin assumptions used to calculate the estimate. deleted text end

Funding Usage. Up to 75 percent of the fiscal year 2012 appropriation for local public health grants may be used to fund calendar year 2011 allocations for this program and up to 75 percent of the fiscal year 2013 appropriation may be used for calendar year 2012 allocations. The fiscal year 2014 base shall be increased by $5,193,000.

Base Level Adjustment. The general fund base is increased by $5,188,000 in fiscal year 2014 and decreased by $5,000 in 2015.

Sec. 2.

Minnesota Statutes 2010, section 62U.04, subdivision 1, is amended to read:

Subdivision 1.

Development of tools to improve costs and quality outcomes.

The commissioner of health shall develop a plan to create transparent prices, encourage greater provider innovation and collaboration across points on the health continuum in cost-effective, high-quality care delivery, reduce the administrative burden on providers and health plans associated with submitting and processing claims, and provide comparative information to consumers on variation in health care cost and quality across providers. deleted text begin The development must be complete by January 1, 2010. deleted text end

Sec. 3.

Minnesota Statutes 2010, section 62U.04, subdivision 2, is amended to read:

Subd. 2.

Calculation of health care costs and quality.

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

(1) provider attribution of costs and quality;

(2) appropriate adjustment for outlier or catastrophic cases;

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

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

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

(6) appropriate adjustment for variation in payment rates;

(7) the appropriate provider level for analysis;

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

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

Sec. 4.

Minnesota Statutes 2011 Supplement, section 62U.04, subdivision 3, is amended to read:

Subd. 3.

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

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

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

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

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

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

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

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

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

new text begin Subd. 3a. new text end

new text begin Provider peer grouping; dissemination of data to providers. new text end

deleted text begin (b) By no later than October 15, 2010, deleted text end new text begin (a) new text end The commissioner shall disseminate information to providers on their total cost of care, total resource use, total quality of care, and the total care results of the grouping developed under deleted text begin this deleted text end subdivision new text begin 3 new text end in comparison to an appropriate peer group. new text begin Data used for this analysis must be the most recent data available. new text end 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 new text begin in order to verify, consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner the accuracy and representativeness of any analyses or reports new text end and submit comments new text begin to the commissioner or initiate an appeal under subdivision 3b new text end . deleted text begin Providers may deleted text end new text begin Upon request, providers shall new text end be given any data for which they are the subject of the data. The provider shall have deleted text begin 30 deleted text end new text begin 60 new text end days to review the data for accuracy and initiate an appeal as specified in deleted text begin paragraph (d) deleted text end new text begin subdivision 3b new text end .

deleted text begin (c) By no later than January 1, 2011, deleted text end new text begin (b) new text end 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 deleted text begin this deleted text end subdivision new text begin 3 new text end in comparison to an appropriate peer group. new text begin Data used for this analysis must be the most recent data available. new text end 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 new text begin in order to verify, consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner the accuracy and representativeness of any analyses or reports new text end and submit comments new text begin to the commissioner or initiate an appeal under subdivision 3b new text end . deleted text begin Providers may deleted text end new text begin Upon request, providers shall new text end be given any data for which they are the subject of the data. The provider shall have deleted text begin 30 deleted text end new text begin 60 new text end days to review the data for accuracy and initiate an appeal as specified in deleted text begin paragraph (d) deleted text end new text begin subdivision 3b new text end .

new text begin Subd. 3b. new text end

new text begin Provider peer grouping; appeals process. new text end

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

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

(2) provide new text begin any new text end evidence deleted text begin and deleted text end new text begin , calculations, or new text end documentation to support the reason deleted text begin that data was not accurate deleted text end new text begin for the appeal new text end ; and

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

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

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

new text begin Subd. 3c. new text end

new text begin Provider peer grouping; publication of information for the public. new text end

deleted text begin (e) Beginning January 1, 2011, the commissioner shall, no less than annually, publish information on providers' total cost, total resource use, total quality, and the results of the total care portion of the peer grouping process. The results that are published must be on a risk-adjusted basis. deleted text end new text begin (a) The commissioner may publicly release summary data related to the peer grouping system as long as the data do not contain information or descriptions from which the identity of individual hospitals, clinics, or other providers may be discerned. new text end

deleted 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, and condition-specific quality, and the results of the condition-specific portion of the peer grouping process. The results that are published must be on a risk-adjusted basis. deleted text end new text begin (b) The commissioner may publicly release analyses or results related to the peer grouping system that identify hospitals, clinics, or other providers only if the following criteria are met: new text end

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

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

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

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

deleted text begin (g) deleted text end new text begin (c) After publishing the first public report, the commissioner shall, no less frequently than annually, publish information on providers' total cost, total resource use, total quality, and the results of the total care portion of the peer grouping process, as well as information on providers' condition-specific cost, condition-specific resource use, and condition-specific quality, and the results of the condition-specific portion of the peer grouping process. The results that are published must be on a risk-adjusted basis, including case mix adjustments. new text end

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

new text begin Subd. 3d. new text end

new text begin Provider peer grouping; standards for dissemination and publication. new text end

new text begin (a) new text end Prior to disseminating data to providers under deleted text begin paragraph (b) or (c) deleted text end new text begin subdivision 3a new text end or publishing information under deleted text begin paragraph (e) or (f) deleted text end new text begin subdivision 3c new text end , the commissioner new text begin , in consultation with the advisory committee, new text end shall ensure the scientific new text begin and statistical new text end validity and reliability of the results according to the standards described in paragraph deleted text begin (h) deleted text end new text begin (b) new text end . If additional time is needed to establish the scientific validity new text begin , statistical significance, new text end and reliability of the results, the commissioner may delay the dissemination of data to providers under deleted text begin paragraph (b) or (c) deleted text end new text begin subdivision 3a new text end , or the publication of information under deleted text begin paragraph (e) or (f) deleted text end new text begin subdivision 3c new text end . deleted text begin If the delay is more than 60 days, the commissioner shall report in writing to the chairs and ranking minority members of the legislative committees with jurisdiction over health care policy and finance the following information: deleted text end

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

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

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

deleted text begin If there is a delay under this paragraph, deleted text end The commissioner must disseminate the information to providers under deleted text begin paragraph (b) or (c) deleted text end new text begin subdivision 3a new text end at least deleted text begin 90 deleted text end new text begin 120 new text end days before publishing results under deleted text begin paragraph (e) or (f) deleted text end new text begin subdivision 3c new text end .

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

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

(2) establishment of deleted text begin an deleted text end explicit minimum reliability deleted text begin threshold deleted text end new text begin thresholds for both quality and costs new text end developed in collaboration with the subjects of the data and the users of the data, at a level not below nationally accepted standards where such standards exist.

In achieving these thresholds, the commissioner shall not aggregate clinics that are not part of the same system or practice group. The commissioner shall consult with and solicit feedback from new text begin the advisory committee and new text end representatives of physician clinics and hospitals during the peer grouping data analysis process to obtain input on the methodological options prior to final analysis and on the design, development, and testing of provider reports.

Sec. 5.

Minnesota Statutes 2010, section 62U.04, subdivision 4, is amended to read:

Subd. 4.

Encounter data.

(a) Beginning July 1, 2009, and every six months thereafter, all health plan companies and third-party administrators shall submit encounter data to a private entity designated by the commissioner of health. The data shall be submitted in a form and manner specified by the commissioner subject to the following requirements:

(1) the data must be de-identified data as described under the Code of Federal Regulations, title 45, section 164.514;

(2) the data for each encounter must include an identifier for the patient's health care home if the patient has selected a health care home; and

(3) except for the identifier described in clause (2), the data must not include information that is not included in a health care claim or equivalent encounter information transaction that is required under section 62J.536.

(b) The commissioner or the commissioner's designee shall only use the data submitted under paragraph (a) deleted text begin for the deleted text end deleted text begin purpose of carrying out its responsibilities in this section, and must maintain the data that it receives according to the provisions of this section. deleted text end new text begin to carry out its responsibilities in this section, including supplying the data to providers so they can verify their results of the peer grouping process consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner and, if necessary, submit comments to the commissioner or initiate an appeal. new text end

(c) Data on providers collected under this subdivision are private data on individuals or nonpublic data, as defined in section 13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this subdivision may be derived from nonpublic data. The commissioner or the commissioner's designee shall establish procedures and safeguards to protect the integrity and confidentiality of any data that it maintains.

(d) The commissioner or the commissioner's designee shall not publish analyses or reports that identify, or could potentially identify, individual patients.

Sec. 6.

Minnesota Statutes 2010, section 62U.04, subdivision 5, is amended to read:

Subd. 5.

Pricing data.

(a) Beginning July 1, 2009, and annually on January 1 thereafter, all health plan companies and third-party administrators shall submit data on their contracted prices with health care providers to a private entity designated by the commissioner of health for the purposes of performing the analyses required under this subdivision. The data shall be submitted in the form and manner specified by the commissioner of health.

(b) The commissioner or the commissioner's designee shall only use the data submitted under this subdivision deleted text begin for the purpose of carrying out its responsibilities under this section deleted text end new text begin to carry out its responsibilities under this section, including supplying the data to providers so they can verify their results of the peer grouping process consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d), and adopted by the commissioner and, if necessary, submit comments to the commissioner or initiate an appeal new text end .

(c) Data collected under this subdivision are nonpublic data as defined in section 13.02. Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary data prepared under this section may be derived from nonpublic data. The commissioner shall establish procedures and safeguards to protect the integrity and confidentiality of any data that it maintains.

Sec. 7.

Minnesota Statutes 2011 Supplement, section 62U.04, subdivision 9, is amended to read:

Subd. 9.

Uses of information.

deleted text begin (a) deleted text end For product renewals or for new products that are offered deleted text begin , after 12 months have elapsed from publication by the commissioner of the information in subdivision 3, paragraph (e) deleted text end :

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

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

(3) deleted text begin all deleted text end health plan companies deleted text begin shall deleted text end new text begin may new text end use the information and methods developed under deleted text begin subdivision 3 deleted text end new text begin subdivisions 3 to 3d new text end 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 deleted text begin must deleted text end new text begin may new text end offer at least one health plan that uses the information developed under deleted text begin subdivision 3 deleted text end new text begin subdivisions 3 to 3d new text end to establish financial incentives for consumers to choose higher-quality, lower-cost providers through enrollee cost-sharing or selective provider networks.

deleted text begin (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. deleted text end

Sec. 8.

Minnesota Statutes 2010, section 256B.0754, subdivision 2, is amended to read:

Subd. 2.

Payment reform.

By no later than 12 months after the commissioner of health publishes the information in section deleted text begin 62U.04, subdivision 3, paragraph (e) deleted text end new text begin 62U.04, subdivision 3c, paragraph (b) new text end , the commissioner of human services deleted text begin shall deleted text end new text begin may new text end 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. 9.

new text begin EFFECTIVE DATE. new text end

new text begin Sections 2 to 8 are effective July 1, 2012, and apply to all information provided or released to the public or to health care providers, pursuant to Minnesota Statutes, section 62U.04, on or after that date. Section 4 shall be implemented by the commissioner of health within available resources. new text end

Presented to the governor April 3, 2012

Signed by the governor April 5, 2012, 03:18 p.m.