HF 1208

as introduced - 89th Legislature (2015 - 2016) Posted on 03/10/2015 05:38pm

A bill for an act
relating to health; requiring health care quality measures and payment methods
to identify and adjust for health disparities related to race, ethnicity, language,
and sociodemographic risk factors; establishing a health equity data plan;
appropriating money; amending Minnesota Statutes 2014, sections 62U.02,
subdivisions 1, 2, 3, 4; 256B.072.

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

Section 1.

Minnesota Statutes 2014, 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 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;

(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;

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

(5) incorporate measures for primary care, including preventive services, coronary
artery and heart disease, diabetes, asthma, depression, and other measures as determined
by the commissioner new text begin ; and
new text end

new text begin (6) effective January 1, 2016, be stratified by race, ethnicity, preferred language, and
country of origin. On or after January 1, 2017, the commissioner may require measures to
be stratified by other sociodemographic factors that are correlated with health disparities
and have an impact on performance on quality and cost indicators after completion of
voluntary pilot projects. 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 new text end .

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

Sec. 2.

Minnesota Statutes 2014, 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 reduce incentives to health care providers to avoid high-risk patients
or populations new text begin , including those with risk factors related to race, ethnicity, language, and
sociodemographic factors new text end .

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

Sec. 3.

Minnesota Statutes 2014, section 62U.02, subdivision 3, is amended to read:

Subd. 3.

Quality transparency.

new text begin (a) new text end 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.

new text begin (b) Effective January 1, 2017, the risk adjustment system established under
this subdivision shall adjust for patient characteristics identified under subdivision 1,
paragraph (a), clause (6), 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 an actual-to-expected comparison that reflects the characteristics
of the patient population served by the clinic or hospital.
new text end

new text begin (c) new text end 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 publicly reported, communitywide quality
reporting activities currently under way in Minnesota. Nothing in this subdivision is
intended to replace or duplicate current privately supported activities related to quality
measurement and reporting in Minnesota.

Sec. 4.

Minnesota Statutes 2014, section 62U.02, subdivision 4, is amended to read:

Subd. 4.

Contracting.

The commissioner may contract with a private entity or
consortium of private entities to complete the tasks in subdivisions 1 to 3. The private
entity or consortium must be nonprofit and have governance that includes representatives
from the following stakeholder groups: health care providers, health plan companies,
consumers new text begin , including consumers representing groups who experience health disparities new text end ,
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.

Sec. 5.

Minnesota Statutes 2014, section 256B.072, is amended to read:

256B.072 PERFORMANCE REPORTING AND QUALITY IMPROVEMENT
SYSTEM.

(a) The commissioner of human services shall establish a performance reporting
system for health care providers who provide health care services to public program
recipients covered under chapters 256B, 256D, and 256L, reporting separately for
managed care and fee-for-service recipients.

(b) The measures used for the performance reporting system for medical groups
shall include measures of care for asthma, diabetes, hypertension, and coronary artery
disease and measures of preventive care services. The measures used for the performance
reporting system for inpatient hospitals shall include measures of care for acute myocardial
infarction, heart failure, and pneumonia, and measures of care and prevention of surgical
infections. In the case of a medical group, the measures used shall be consistent with
measures published by nonprofit Minnesota or national organizations that produce and
disseminate health care quality measures or evidence-based health care guidelines. In
the case of inpatient hospital measures, the commissioner shall appoint the Minnesota
Hospital Association and Stratis Health to advise on the development of the performance
measures to be used for hospital reporting. To enable a consistent measurement process
across the community, the commissioner may use measures of care provided for patients in
addition to those identified in paragraph (a). The commissioner shall ensure collaboration
with other health care reporting organizations so that the measures described in this
section are consistent with those reported by those organizations and used by other
purchasers in Minnesota.

(c) The commissioner may require providers to submit information in a required
format to a health care reporting organization or to cooperate with the information collection
procedures of that organization. The commissioner may collaborate with a reporting
organization to collect information reported and to prevent duplication of reporting.

(d) By October 1, 2007, and annually thereafter, the commissioner shall report
through a public Web site the results by medical groups and hospitals, where possible,
of the measures under this section, and shall compare the results by medical groups and
hospitals for patients enrolled in public programs to patients enrolled in private health
plans. To achieve this reporting, the commissioner may collaborate with a health care
reporting organization that operates a Web site suitable for this purpose.

new text begin (e) Effective January 1, 2016, performance measures must be stratified by race,
ethnicity, preferred language, and country of origin consistent with section 62U.02,
subdivision 1, paragraph (a), clause (6). On or after January 1, 2017, performance
measures must be stratified by other sociodemographic factors incorporated into the
statewide quality reporting and measurement system by the commissioner of health
under section 62U.02, subdivision 1, paragraph (a), clause (6). By January 1, 2017,
performance measures must be risk adjusted based on these factors pursuant to section
62U.02, subdivision 3, paragraph (b).
new text end

Sec. 6. new text begin HEALTH DISPARITIES PAYMENT ENHANCEMENT.
new text end

new text begin 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. The commissioner shall submit a
report and recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health care policy and finances by December 15, 2015,
including the proposed methodology for providing a health disparities payment adjustment.
new text end

Sec. 7. new text begin APPROPRIATIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Commissioner of health. new text end

new text begin $....... is appropriated for the biennium
ending June 30, 2017, from the general fund to the commissioner of health for the
following:
new text end

new text begin (1) the development of the quality incentive payment system specified in Minnesota
Statutes, section 62U.02, subdivision 1, paragraph (a), clause (6);
new text end

new text begin (2) the development of the risk adjustment system specified in Minnesota Statutes,
section 62U.02, subdivision 3, paragraph (b); and
new text end

new text begin (3) community engagement with those communities impacted by health disparities.
new text end

new text begin Subd. 2. new text end

new text begin Commissioner of human services. new text end

new text begin $....... is appropriated for the biennium
ending June 30, 2017, from the general fund to the commissioner of human services for
the modification of provider performance measures under Minnesota Statutes, section
256B.072, paragraph (e), to implement stratification and risk adjustment methods.
new text end