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HF 3696

1st Engrossment - 92nd Legislature (2021 - 2022) Posted on 03/24/2022 03:47pm

KEY: stricken = removed, old language.
underscored = added, new language.
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A bill for an act
relating to health; requiring disclosure of certain payments made to health care
providers; changing a provision for all-payer claims data; requiring a report on
transparency of health care payments; amending Minnesota Statutes 2020, sections
62U.04, subdivision 11, by adding a subdivision; 62U.10, subdivision 7.

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

Section 1.

Minnesota Statutes 2020, section 62U.04, is amended by adding a subdivision
to read:


new text begin Subd. 5b. new text end

new text begin Non-claims-based payments. new text end

new text begin (a) Beginning in 2024, all health plan companies
and third-party administrators shall submit to a private entity designated by the commissioner
of health all non-claims-based payments made to health care providers. The data shall be
submitted in a form, manner, and frequency specified by the commissioner. Non-claims-based
payments are payments to health care providers designed to pay for value of health care
services over volume of health care services and include alternative payment models or
incentives, payments for infrastructure expenditures or investments, and payments for
workforce expenditures or investments. Non-claims-based payments submitted under this
subdivision must, to the extent possible, be attributed to a health care provider in the same
manner in which claims-based data are attributed to a health care provider and, where
appropriate, must be combined with data collected under subdivisions 4 and 5 in analyses
of health care spending.
new text end

new text begin (b) 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 subdivision may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data maintained by the commissioner.
new text end

new text begin (c) The commissioner shall consult with health plan companies, hospitals, and health
care providers in developing the data reported under this subdivision and standardized
reporting forms.
new text end

Sec. 2.

Minnesota Statutes 2020, section 62U.04, subdivision 11, is amended to read:


Subd. 11.

Restricted uses of the all-payer claims data.

(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 deleted text begin anddeleted text end new text begin ,new text end 5new text begin , and 5bnew text end for the
following purposes:

(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;

(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;

(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;

(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and

(5) to compile one or more public use files of summary data or tables that must:

(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;

(ii) not identify individual patients, payers, or providers;

(iii) be updated by the commissioner, at least annually, with the most current data
available;

(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and

(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.

(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.

(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.

deleted text begin (d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
deleted text end

deleted text begin (e)deleted text end new text begin (d)new text end The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).

Sec. 3.

Minnesota Statutes 2020, section 62U.10, subdivision 7, is amended to read:


Subd. 7.

Outcomes reporting; savings determination.

(a) deleted text begin Beginning November 1,
2016, and
deleted text end Each November 1 deleted text begin thereafterdeleted text end , the commissioner of health shall determine the
actual total private and public health care and long-term care spending for Minnesota
residents related to each health indicator projected in subdivision 6 for the most recent
calendar year available. The commissioner shall determine the difference between the
projected and actual spending for each health indicator and for each year, and determine
the savings attributable to changes in these health indicators. The assumptions and research
methods used to calculate actual spending must be determined to be appropriate by an
independent actuarial consultant. If the actual spending is less than the projected spending,
the commissioner, in consultation with the commissioners of human services and management
and budget, shall use the proportion of spending for state-administered health care programs
to total private and public health care spending for each health indicator for the calendar
year two years before the current calendar year to determine the percentage of the calculated
aggregate savings amount accruing to state-administered health care programs.

(b) The commissioner may use the data submitted under section 62U.04, subdivisions
4 deleted text begin anddeleted text end new text begin ,new text end 5, new text begin and 5b, new text end to complete the activities required under this section, but may only report
publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.

Sec. 4. new text begin REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The terms defined in this subdivision apply to this section.
new text end

new text begin (b) "Commissioner" means the commissioner of health.
new text end

new text begin (c) "Non-claims-based payments" means payments to health care providers designed to
support and reward value of health care services over volume of health care services and
includes alternative payment models or incentives, payments for infrastructure expenditures
or investments, and payments for workforce expenditures or investments.
new text end

new text begin (d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02,
subdivision 9.
new text end

new text begin (e) "Primary care services" means integrated, accessible health care services provided
by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of
family and community. Primary care services include but are not limited to preventive
services, office visits, administration of vaccines, annual physicals, pre-operative physicals,
assessments, care coordination, development of treatment plans, management of chronic
conditions, and diagnostic tests.
new text end

new text begin Subd. 2. new text end

new text begin Report. new text end

new text begin (a) To provide the legislature with information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
by February 15, 2023, on the volume and distribution of health care spending across payment
models used by health plan companies and third-party administrators, with a particular focus
on value-based care models and primary care spending.
new text end

new text begin (b) The report must include specific health plan and third-party administrator estimates
of health care spending for claims-based payments and non-claims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in state health care
programs, Medicare Advantage, and commercial health insurance. The report must also
include recommendations on changes needed to gather better data from health plan companies
and third-party administrators on the use of value-based payments that pay for value of
health care services provided over volume of services provided, promote the health of all
Minnesotans, reduce health disparities, and support the provision of primary care services
and preventive services.
new text end

new text begin (c) In preparing the report, the commissioner shall:
new text end

new text begin (1) describe the form, manner, and timeline for submission of data by health plan
companies and third-party administrators to produce estimates as specified in paragraph
(b);
new text end

new text begin (2) collect summary data that permits the computation of:
new text end

new text begin (i) the percentage of total payments that are non-claims-based payments; and
new text end

new text begin (ii) the percentage of payments in item (i) that are for primary care services;
new text end

new text begin (3) where data was not directly derived, specify the methods used to estimate data
elements;
new text end

new text begin (4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses
of the magnitude of primary care payments using data collected by the commissioner under
Minnesota Statutes, section 62U.04; and
new text end

new text begin (5) conduct interviews with health plan companies and third-party administrators to
better understand the types of non-claims-based payments and models in use, the purposes
or goals of each, the criteria for health care providers to qualify for these payments, and the
timing and structure of health plan companies or third-party administrators making these
payments to health care provider organizations.
new text end

new text begin (d) Health plan companies and third-party administrators must comply with data requests
from the commissioner under this section within 60 days after receiving the request.
new text end

new text begin (e) Data collected under this section are nonpublic data. Notwithstanding the definition
of summary data in Minnesota Statutes, 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 maintained
by the commissioner.
new text end