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SF 3689

as introduced - 92nd Legislature (2021 - 2022) Posted on 03/04/2022 08:26am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

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A bill for an act
relating to health; modifying data collected under the all-payer claims database
and uses of this data; requiring the commissioner of health to study and report on
systems used by health plan companies and third-party administrators to pay health
care providers; amending Minnesota Statutes 2020, sections 62U.04, subdivision
11, by adding a subdivision; 62U.10, subdivision 7; Minnesota Statutes 2021
Supplement, section 62U.04, subdivisions 4, 5.

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

Section 1.

Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 4, is amended
to read:


Subd. 4.

Encounter data.

(a) All health plan companies and third-party administrators
shall submit encounter data on a monthly basis 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 homenew text begin , data on contractual value-based payments,new text end
anddeleted text begin , for claims incurred on or after January 1, 2019,deleted text end data deemed necessary by the
commissioner to uniquely identify claims in the individual health insurance market; 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) to carry out the commissioner's 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.

(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.

(e) The commissioner shall compile summary information on the data submitted under
this subdivision. The commissioner shall work with its vendors to assess the data submitted
in terms of compliance with the data submission requirements and the completeness of the
data submitted by comparing the data with summary information compiled by the
commissioner and with established and emerging data quality standards to ensure data
quality.

Sec. 2.

Minnesota Statutes 2021 Supplement, section 62U.04, subdivision 5, is amended
to read:


Subd. 5.

Pricing data.

(a) All health plan companies and third-party administrators shall
submit, on a monthly basis, 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. new text begin Data on contracted prices submitted under this
paragraph must include data on supplemental contractual value-based payments paid to
health care providers.
new text end 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 to carry out the commissioner's 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.

(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. 3.

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, contractual value-based payments. new text end

new text begin (a) On October 1
of each year, all health plan companies and third-party administrators shall submit to a
private entity designated by the commissioner of health all non-claims-based, contractual
value-based payments made to health care providers. The data shall be submitted in a form
and manner specified by the commissioner. Non-claims-based, contractual value-based
payments include but are not limited to capitation payments, risk-based payments, health
care home payments, payments made to develop capacity to improve care to patients with
chronic conditions, payments made to support the adoption of health information technology,
and payments made for services provided by patient educators, patient navigators, or care
managers. Non-claims-based, contractual value-based payments submitted under this
subdivision must be attributed to a health care provider in the same manner in which
claims-based data is attributed to a health care provider and must be combined with data
collected under subdivisions 4 and 5 in analyses of health care spending.
new text end

new text begin (b) 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. 4.

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; deleted text begin and
deleted text end

(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, 2015deleted text begin .deleted text end new text begin ; and
new text end

new text begin (6) for a onetime study of health care payment systems used by health plan companies
to pay health care providers and for development of recommendations for changes to health
care payment systems to reward value over volume of services, promote health, support
primary care and preventive services, and ensure the availability of an adequate health care
workforce.
new text end

(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.

(d) The commissioner or the commissioner's designee may 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 purpose described in paragraph (a), clause (3), until
July 1, 2023.

(e) 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. 5.

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


Subd. 7.

Outcomes reporting; savings determination.

(a) Beginning November 1,
2016, and each November 1 thereafter, 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. 6. 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) "Capitation" means a health care payment system that pays practitioners and hospitals
a set amount for each enrollee assigned to the practitioner or hospital per period of time,
whether or not the enrollee seeks care from the practitioner or hospital.
new text end

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

new text begin (d) "Direct primary care" means a health care payment model in which consumers pay
their primary care practitioner or practice directly in the form of a flat monthly or annual
fee for a defined set of primary care services.
new text end

new text begin (e) "Enrollee" means an individual covered by a health plan company or health insurance
or health coverage plan and includes an insured policyholder, subscriber, contract holder,
member, covered person, or certificate holder.
new text end

new text begin (f) "Fee-for-service payment" means a method of health care payment in which
practitioners and hospitals are paid for each specific health care service provided.
new text end

new text begin (g) "Practitioner" means an individual who is a physician, advanced practice registered
nurse, or physician assistant and is currently practicing in Minnesota.
new text end

new text begin (h) "Primary care practitioner" means an individual who is a physician, advanced practice
registered nurse, or physician assistant; is currently practicing in Minnesota; is a direct entry
point for patients; and provides a full spectrum of primary care services.
new text end

new text begin (i) "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 (j) "Value-based payment" means a health care payment model in which practitioners
and hospitals are reimbursed based on patient health outcomes such as helping patients
improve their health, reduce the effects and incidence of chronic disease, and live healthier
lives in an evidence-based way.
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 the information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
on the current health care payment systems used by health plan companies and shall
recommend ways to modify these systems. The commissioner shall prepare this report using
data submitted under Minnesota Statutes, section 62U.04; input from stakeholders; and
surveys of health plan companies, and shall submit a report to the legislature by December
15, 2022.
new text end

new text begin (b) In this report, the commissioner shall examine the types of services currently paid
for, the use of value-based payments, and whether current payment systems are structured
to support a patient-centered, primary care-based, interprofessional team approach to care
that promotes better patient outcomes. The report must include:
new text end

new text begin (1) how payments are currently made to practitioners, including:
new text end

new text begin (i) the percentage of total claims and the percentage of claims for primary care services
that are paid solely on a fee-for-service basis;
new text end

new text begin (ii) the percentage of total claims and the percentage of claims for primary care services
that include a value-based payment and the types of value-based payments used; and
new text end

new text begin (iii) the percentage of total claims and the percentage of primary care claims that are
paid on a total capitation basis or a partial capitation basis, such as direct primary care;
new text end

new text begin (2) the percentage of total payments made for services that are for primary care services
and the percentage of total payments made for services that are for non-primary care services;
and
new text end

new text begin (3) recommendations on changes needed to expedite implementation of a health care
payment system that rewards value over volume of services provided, that promotes the
health of all Minnesotans, that supports the provision of primary care services and preventive
services, and that ensures availability of an adequate health care workforce needed to
implement a reformed payment system.
new text end