1.1                          A bill for an act 
  1.2             relating to data privacy; confidentiality and secrecy 
  1.3             of patient health information; prohibiting release of 
  1.4             health records from providers to the state 
  1.5             commissioner of health or the health data institute 
  1.6             without patient consent; amending Minnesota Statutes 
  1.7             2000, sections 62J.301, subdivision 4; 62J.321, 
  1.8             subdivisions 1 and 2; 62J.38; 62J.40; 62J.41, 
  1.9             subdivision 1; 62J.451, subdivisions 6, 6b, and 6c; 
  1.10            62J.452, subdivision 2; and 144.335, subdivision 3b. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  Minnesota Statutes 2000, section 62J.301, 
  1.13  subdivision 4, is amended to read: 
  1.14     Subd. 4.  [INFORMATION TO BE COLLECTED.] (a) The data 
  1.15  collected may include health outcomes data, patient functional 
  1.16  status, and health status consistent with section 144.335, 
  1.17  subdivision 3b.  The data collected may include information 
  1.18  necessary to measure and make adjustments for differences in the 
  1.19  severity of patient condition across different health care 
  1.20  providers, and may include data obtained directly from the 
  1.21  patient or from patient medical records, as provided in section 
  1.22  62J.321, subdivision 1. 
  1.23     (b) The commissioner may: 
  1.24     (1) collect the encounter level data required for the 
  1.25  research and data initiatives of sections 62J.301 to 62J.42, 
  1.26  using, to the greatest extent possible, standardized forms and 
  1.27  procedures; and 
  1.28     (2) process the data collected to ensure validity, 
  2.1   consistency, accuracy, and completeness, and as appropriate, 
  2.2   merge data collected from different sources. 
  2.3      (c) For purposes of estimating total health care spending 
  2.4   and forecasting rates of growth in health care spending, the 
  2.5   commissioner may collect from health care providers data on 
  2.6   patient revenues and health care spending during a time period 
  2.7   specified by the commissioner.  The commissioner may also 
  2.8   collect data on health care revenues and spending from group 
  2.9   purchasers of health care.  Health care providers and group 
  2.10  purchasers doing business in the state shall provide the data 
  2.11  requested by the commissioner at the times and in the form 
  2.12  specified by the commissioner.  Professional licensing boards 
  2.13  and state agencies responsible for licensing, registering, or 
  2.14  regulating providers and group purchasers shall cooperate fully 
  2.15  with the commissioner in achieving compliance with the reporting 
  2.16  requirements. 
  2.17     Sec. 2.  Minnesota Statutes 2000, section 62J.321, 
  2.18  subdivision 1, is amended to read: 
  2.19     Subdivision 1.  [DATA COLLECTION.] (a) The commissioner 
  2.20  shall collect data from health care providers, health plan 
  2.21  companies, and individuals in the most cost-effective manner, 
  2.22  which does not unduly burden them.  The commissioner may require 
  2.23  health care providers and health plan companies to collect and 
  2.24  provide patient health records and claim files, and cooperate in 
  2.25  other ways with the data collection process.  The commissioner 
  2.26  may also require health care providers and health plan companies 
  2.27  to provide mailing lists of patients.  Patient consent shall not 
  2.28  be is required for the release of patient identifying data and 
  2.29  roster data to the commissioner pursuant to sections 62J.301 to 
  2.30  62J.42 by any group purchaser, health plan company, health care 
  2.31  provider; or agent, contractor, or association acting on behalf 
  2.32  of a group purchaser or health care provider as provided in 
  2.33  section 144.335, subdivision 3b.  Any group purchaser, health 
  2.34  plan company, health care provider; or agent, contractor, or 
  2.35  association acting on behalf of a group purchaser or health care 
  2.36  provider, that releases data to the commissioner in good faith 
  3.1   pursuant to sections 62J.301 to 62J.42 shall be immune from 
  3.2   civil liability and criminal prosecution. 
  3.3      (b) When a group purchaser, health plan company, or health 
  3.4   care provider submits patient identifying data, as defined in 
  3.5   section 62J.451, to the commissioner pursuant to sections 
  3.6   62J.301 to 62J.42, and the data is submitted to the commissioner 
  3.7   in electronic form, or through other electronic means including, 
  3.8   but not limited to, the electronic data interchange system 
  3.9   defined in section 62J.451, the group purchaser, health plan 
  3.10  company, or health care provider shall submit the patient 
  3.11  identifying data in encrypted form, using an encryption method 
  3.12  specified by the commissioner.  Submission of encrypted data as 
  3.13  provided in this paragraph satisfies the requirements of section 
  3.14  144.335, subdivision 3b. 
  3.15     (c) The commissioner shall require all health care 
  3.16  providers, group purchasers, and state agencies to use a 
  3.17  standard patient identifier and a standard identifier for 
  3.18  providers and health plan companies when reporting data under 
  3.19  this chapter.  The commissioner must encrypt patient identifiers 
  3.20  to prevent identification of individual patients and to enable 
  3.21  release of otherwise private data to researchers, providers, and 
  3.22  group purchasers in a manner consistent with chapter 13 and 
  3.23  sections 62J.55 and 144.335.  This encryption must ensure that 
  3.24  any data released must be in a form that makes it impossible to 
  3.25  identify individual patients.  
  3.26     Sec. 3.  Minnesota Statutes 2000, section 62J.321, 
  3.27  subdivision 2, is amended to read: 
  3.28     Subd. 2.  [FAILURE TO PROVIDE DATA.] The intentional 
  3.29  failure to provide the data requested under this chapter and 
  3.30  which may be released consistent with section 144.335, 
  3.31  subdivision 3b, is grounds for disciplinary or regulatory action 
  3.32  against a regulated provider or group purchaser.  The 
  3.33  commissioner may assess a fine against a provider or group 
  3.34  purchaser who refuses to provide data required by the 
  3.35  commissioner.  If a provider or group purchaser refuses to 
  3.36  provide the data required, the commissioner may obtain a court 
  4.1   order requiring the provider or group purchaser to produce 
  4.2   documents and allowing the commissioner to inspect the records 
  4.3   of the provider or group purchaser for purposes of obtaining the 
  4.4   data required. 
  4.5      Sec. 4.  Minnesota Statutes 2000, section 62J.38, is 
  4.6   amended to read: 
  4.7      62J.38 [COST CONTAINMENT DATA FROM GROUP PURCHASERS.] 
  4.8      (a) The commissioner shall require group purchasers to 
  4.9   submit detailed data on total health care spending for each 
  4.10  calendar year.  Group purchasers shall submit data for the 1993 
  4.11  calendar year by April 1, 1994, and each April 1 thereafter 
  4.12  shall submit data for the preceding calendar year. 
  4.13     (b) The commissioner shall require each group purchaser to 
  4.14  submit data on revenue, expenses, and member months, as 
  4.15  applicable.  Revenue data must distinguish between premium 
  4.16  revenue and revenue from other sources and must also include 
  4.17  information on the amount of revenue in reserves and changes in 
  4.18  reserves.  Expenditure data, including raw data from 
  4.19  claims consistent with section 144.335, subdivision 3b, may be 
  4.20  provided separately for the following categories or for other 
  4.21  categories required by the commissioner:  physician services, 
  4.22  dental services, other professional services, inpatient hospital 
  4.23  services, outpatient hospital services, emergency, pharmacy 
  4.24  services and other nondurable medical goods, mental health, and 
  4.25  chemical dependency services, other expenditures, subscriber 
  4.26  liability, and administrative costs.  The commissioner may 
  4.27  require each group purchaser to submit any other data, including 
  4.28  data in unaggregated form consistent with section 144.335, 
  4.29  subdivision 3b, for the purposes of developing spending 
  4.30  estimates, setting spending limits, and monitoring actual 
  4.31  spending and costs. 
  4.32     (c) The commissioner may collect information on: 
  4.33     (1) premiums, benefit levels, managed care procedures, and 
  4.34  other features of health plan companies; 
  4.35     (2) prices, provider experience, and other information for 
  4.36  services less commonly covered by insurance or for which 
  5.1   patients commonly face significant out-of-pocket expenses; and 
  5.2      (3) information on health care services not provided 
  5.3   through health plan companies, including information on prices, 
  5.4   costs, expenditures, and utilization. 
  5.5      (d) All group purchasers shall provide the required data 
  5.6   using a uniform format and uniform definitions, as prescribed by 
  5.7   the commissioner. 
  5.8      Sec. 5.  Minnesota Statutes 2000, section 62J.40, is 
  5.9   amended to read: 
  5.10     62J.40 [COST CONTAINMENT DATA FROM STATE AGENCIES AND OTHER 
  5.11  GOVERNMENTAL UNITS.] 
  5.12     (a) All state departments or agencies that administer one 
  5.13  or more health care programs shall provide to the commissioner 
  5.14  of health any additional data on the health care programs they 
  5.15  administer that is requested by the commissioner of health, 
  5.16  including data in unaggregated form consistent with section 
  5.17  144.335, subdivision 3b, for purposes of developing estimates of 
  5.18  spending, setting spending limits, and monitoring actual 
  5.19  spending.  The data must be provided at the times and in the 
  5.20  form specified by the commissioner of health. 
  5.21     (b) For purposes of estimating total health care spending 
  5.22  as provided in section 62J.301, subdivision 4, clause (c), all 
  5.23  local governmental units shall provide expenditure data to the 
  5.24  commissioner.  The commissioner shall consult with 
  5.25  representatives of the affected local government units in 
  5.26  establishing definitions, reporting formats, and reporting time 
  5.27  frames.  As much as possible, the data shall be collected in a 
  5.28  manner that ensures that the data collected is consistent with 
  5.29  data collected from the private sector and minimizes the 
  5.30  reporting burden to local government. 
  5.31     Sec. 6.  Minnesota Statutes 2000, section 62J.41, 
  5.32  subdivision 1, is amended to read: 
  5.33     Subdivision 1.  [COST CONTAINMENT DATA TO BE COLLECTED FROM 
  5.34  PROVIDERS.] The commissioner shall require health care providers 
  5.35  to collect and provide both patient specific 
  5.36  information consistent with section 144.335, subdivision 3b, and 
  6.1   descriptive and financial aggregate data on: 
  6.2      (1) the total number of patients served; 
  6.3      (2) the total number of patients served by state of 
  6.4   residence and Minnesota county; 
  6.5      (3) the site or sites where the health care provider 
  6.6   provides services; 
  6.7      (4) the number of individuals employed, by type of 
  6.8   employee, by the health care provider; 
  6.9      (5) the services and their costs for which no payment was 
  6.10  received; 
  6.11     (6) total revenue by type of payer or by groups of payers, 
  6.12  including but not limited to, revenue from Medicare, medical 
  6.13  assistance, MinnesotaCare, nonprofit health service plan 
  6.14  corporations, commercial insurers, health maintenance 
  6.15  organizations, and individual patients; 
  6.16     (7) revenue from research activities; 
  6.17     (8) revenue from educational activities; 
  6.18     (9) revenue from out-of-pocket payments by patients; 
  6.19     (10) revenue from donations; and 
  6.20     (11) any other data required by the commissioner, including 
  6.21  data in unaggregated form, for the purposes of developing 
  6.22  spending estimates, setting spending limits, monitoring actual 
  6.23  spending, and monitoring costs.  
  6.24  The commissioner may, by rule, modify the data submission 
  6.25  categories listed above if the commissioner determines that this 
  6.26  will reduce the reporting burden on providers without having a 
  6.27  significant negative effect on necessary data collection efforts.
  6.28     Sec. 7.  Minnesota Statutes 2000, section 62J.451, 
  6.29  subdivision 6, is amended to read: 
  6.30     Subd. 6.  [PERFORMANCE MEASUREMENT INFORMATION.] (a) The 
  6.31  health data institute shall develop and implement a performance 
  6.32  measurement plan to analyze and disseminate health care data to 
  6.33  address the needs of consumers, group purchasers, providers, and 
  6.34  the state for performance measurement at various levels of the 
  6.35  health care system in the state.  The plan shall include a 
  6.36  mechanism to: 
  7.1      (1) provide comparative information to consumers, 
  7.2   purchasers, and policymakers for use in performance assessment 
  7.3   of health care system components, including health plan 
  7.4   companies and provider organizations; 
  7.5      (2) complement and enhance, but not replace, existing 
  7.6   internal performance improvement efforts of health care 
  7.7   providers and plans; and 
  7.8      (3) reduce unnecessary administrative costs in the health 
  7.9   care system by eliminating duplication in the collection of data 
  7.10  for both evaluation and improvement efforts. 
  7.11     (b) Performance measurement at the provider organization 
  7.12  level may be conducted on a condition-specific basis.  Criteria 
  7.13  for selecting conditions for measurement may include: 
  7.14     (1) relevance to consumers and purchasers; 
  7.15     (2) prevalence of conditions; 
  7.16     (3) costs related to diagnosis and treatment; 
  7.17     (4) demonstrated efficacy of treatments; 
  7.18     (5) evidence of variability in management; 
  7.19     (6) existence of risk adjustment methodologies to control 
  7.20  for patient and other risk factors contributing to variation in 
  7.21  cost and quality; 
  7.22     (7) existence of practice guidelines related to the 
  7.23  condition; and 
  7.24     (8) relevance of the condition to public health goals. 
  7.25     (c) Performance measurement on a condition-specific basis 
  7.26  may consider multiple dimensions of performance, including, but 
  7.27  not limited to: 
  7.28     (1) accessibility; 
  7.29     (2) appropriateness; 
  7.30     (3) effectiveness, including clinical outcomes, patient 
  7.31  satisfaction, and functional status; and 
  7.32     (4) efficiency. 
  7.33     (d) Collection of data for condition-specific performance 
  7.34  measurement may be conducted at the patient level consistent 
  7.35  with section 144.335, subdivision 3b.  Encounter-level data 
  7.36  collected for this purpose may include unique identifiers for 
  8.1   patients, providers, payers, and employers in order to link 
  8.2   episodes of care across care settings and over time.  The health 
  8.3   data institute must encrypt patient identifiers to prevent 
  8.4   identification of individual patients and to enable release of 
  8.5   otherwise private data to researchers, providers, and group 
  8.6   purchasers in a manner consistent with chapter 13 and sections 
  8.7   62J.452 and 144.335. 
  8.8      Sec. 8.  Minnesota Statutes 2000, section 62J.451, 
  8.9   subdivision 6b, is amended to read: 
  8.10     Subd. 6b.  [CONSUMER SURVEYS.] (a) The health data 
  8.11  institute shall develop and implement a mechanism for collecting 
  8.12  comparative data on consumer perceptions of the health care 
  8.13  system, including consumer satisfaction, through adoption of a 
  8.14  standard consumer survey.  This survey shall include enrollees 
  8.15  in community integrated service networks, health maintenance 
  8.16  organizations, preferred provider organizations, indemnity 
  8.17  insurance plans, public programs, and other health plan 
  8.18  companies.  The health data institute shall determine a 
  8.19  mechanism for the inclusion of the uninsured.  This consumer 
  8.20  survey may be conducted every two years.  A focused survey may 
  8.21  be conducted on the off years.  Health plan companies and group 
  8.22  purchasers shall provide to the health data institute roster 
  8.23  data as defined in subdivision 2, including the names, 
  8.24  addresses, and telephone numbers of enrollees and former 
  8.25  enrollees and other data necessary for the completion of this 
  8.26  survey consistent with section 144.335, subdivision 3b.  This 
  8.27  roster data provided by the health plan companies and group 
  8.28  purchasers is classified as provided under section 62J.452.  The 
  8.29  health data institute may analyze and prepare findings from the 
  8.30  raw, unaggregated data, and the findings from this survey may be 
  8.31  included in the health plan company performance reports 
  8.32  specified in subdivision 6a, and in other reports developed and 
  8.33  disseminated by the health data institute and the commissioner.  
  8.34  The raw, unaggregated data is classified as provided under 
  8.35  section 62J.452, and may be made available by the health data 
  8.36  institute to the extent permitted under section 62J.452.  The 
  9.1   health data institute shall provide raw, unaggregated data to 
  9.2   the commissioner.  The survey may include information on the 
  9.3   following subjects: 
  9.4      (1) enrollees' overall satisfaction with their health care 
  9.5   plan; 
  9.6      (2) consumers' perception of access to emergency, urgent, 
  9.7   routine, and preventive care, including locations, hours, 
  9.8   waiting times, and access to care when needed; 
  9.9      (3) premiums and costs; 
  9.10     (4) technical competence of providers; 
  9.11     (5) communication, courtesy, respect, reassurance, and 
  9.12  support; 
  9.13     (6) choice and continuity of providers; 
  9.14     (7) continuity of care; 
  9.15     (8) outcomes of care; 
  9.16     (9) services offered by the plan, including range of 
  9.17  services, coverage for preventive and routine services, and 
  9.18  coverage for illness and hospitalization; 
  9.19     (10) availability of information; and 
  9.20     (11) paperwork. 
  9.21     (b) The health data institute shall appoint a consumer 
  9.22  advisory group which shall consist of 13 individuals, 
  9.23  representing enrollees from public and private health plan 
  9.24  companies and programs and two uninsured consumers, to advise 
  9.25  the health data institute on issues of concern to consumers.  
  9.26  The advisory group must have at least one member from each 
  9.27  regional coordinating board region of the state.  The advisory 
  9.28  group expires June 30, 1996. 
  9.29     Sec. 9.  Minnesota Statutes 2000, section 62J.451, 
  9.30  subdivision 6c, is amended to read: 
  9.31     Subd. 6c.  [PROVIDER ORGANIZATION PERFORMANCE MEASUREMENT.] 
  9.32  (a) As part of the performance measurement plan specified in 
  9.33  subdivision 6, the health data institute shall develop a 
  9.34  mechanism to assess the performance of hospitals and other 
  9.35  provider organizations, and to disseminate this information to 
  9.36  consumers, purchasers, policymakers, and other interested 
 10.1   parties, consistent with the data policies specified in section 
 10.2   62J.452.  Data to be collected may include structural 
 10.3   characteristics including staff-mix and nurse-patient ratios.  
 10.4   In selecting additional data for collection, the health data 
 10.5   institute may consider: 
 10.6      (1) feasibility and statistical validity of the indicator; 
 10.7      (2) purchaser and public demand for the indicator; 
 10.8      (3) estimated expense of collecting and reporting the 
 10.9   indicator; and 
 10.10     (4) usefulness of the indicator for internal improvement 
 10.11  purposes. 
 10.12     (b) The health data institute may conduct consumer surveys 
 10.13  that focus on health care provider organizations.  Health care 
 10.14  provider organizations may provide roster data, as defined in 
 10.15  subdivision 2, including names, addresses, and telephone numbers 
 10.16  of their patients, to the health data institute for purposes of 
 10.17  conducting the surveys.  Roster data provided by health care 
 10.18  provider organizations under this paragraph are private data on 
 10.19  individuals as defined in section 13.02, subdivision 12.  
 10.20  Providing data under this paragraph does not constitute 
 10.21  constitutes a release of health records for purposes of section 
 10.22  144.335, subdivision 3a 3b. 
 10.23     Sec. 10.  Minnesota Statutes 2000, section 62J.452, 
 10.24  subdivision 2, is amended to read: 
 10.25     Subd. 2.  [DATA CLASSIFICATIONS.] (a) Data collected, 
 10.26  obtained, received, or created by the health data institute 
 10.27  shall be private or nonpublic, as applicable, unless given a 
 10.28  different classification in this subdivision.  Data classified 
 10.29  as private or nonpublic under this subdivision may be released 
 10.30  or disclosed only as permitted under this subdivision and under 
 10.31  the other subdivisions referenced in this subdivision.  For 
 10.32  purposes of this section, data that identify individual patients 
 10.33  or industry participants are private data on individuals or 
 10.34  nonpublic data, as appropriate.  Data not on individuals are 
 10.35  nonpublic data.  Notwithstanding sections 13.03, subdivisions 6 
 10.36  to 8; 13.10, subdivisions 1 to 4; and 138.17, data received by 
 11.1   the health data institute shall retain the classification 
 11.2   designated under this chapter and shall not be disclosed other 
 11.3   than pursuant to this chapter.  Nothing in this subdivision 
 11.4   prevents patients from gaining access to their health record 
 11.5   information pursuant to section 144.335. 
 11.6      (b) When industry participants, as defined in section 
 11.7   62J.451, are required by statute to provide, either directly or 
 11.8   through a contractor, as defined in section 62J.451, subdivision 
 11.9   2, paragraph (c), patient identifying data to the commissioner 
 11.10  pursuant to this chapter or to the health data institute 
 11.11  pursuant to section 62J.451, the industry participant or its 
 11.12  contractor shall be able to must not provide the data with or 
 11.13  without patient consent, and may not be held liable for doing so 
 11.14  as required by section 144.335, subdivision 3b. 
 11.15     (c) When an industry participant submits patient 
 11.16  identifying data to the health data institute, and the data is 
 11.17  submitted to the health data institute in electronic form, or 
 11.18  through other electronic means including, but not limited to, 
 11.19  the electronic data interchange system defined in section 
 11.20  62J.451, the industry participant shall submit the patient 
 11.21  identifying data in encrypted form, using an encryption method 
 11.22  supplied or specified by the health data institute.  Submission 
 11.23  of encrypted data as provided in this paragraph satisfies the 
 11.24  requirements of section 144.335, subdivision 3b. 
 11.25     (d) Patient identifying data may be disclosed only as 
 11.26  permitted under subdivision 3. 
 11.27     (e) Industry participant identifying data which is not 
 11.28  patient identifying data may be disclosed only by being made 
 11.29  public in an analysis as permitted under subdivisions 4 and 5 or 
 11.30  through access to an approved researcher, industry participant, 
 11.31  or contractor as permitted under subdivision 6 or 7. 
 11.32     (f) Data that is not patient identifying data and not 
 11.33  industry participant identifying data is public data. 
 11.34     (g) Data that describes the finances, governance, internal 
 11.35  operations, policies, or operating procedures of the health data 
 11.36  institute, and that does not identify patients or industry 
 12.1   participants or identifies them only in connection with their 
 12.2   involvement with the health data institute, is public data. 
 12.3      Sec. 11.  Minnesota Statutes 2000, section 144.335, 
 12.4   subdivision 3b, is amended to read: 
 12.5      Subd. 3b.  [RELEASE OF RECORDS TO COMMISSIONER OF HEALTH OR 
 12.6   HEALTH DATA INSTITUTE.] Subdivision 3a does not apply applies to 
 12.7   the release of health records to the commissioner of health or 
 12.8   the health data institute under chapter 62J, provided that the 
 12.9   commissioner encrypts the patient identifier upon receipt of the 
 12.10  data. whenever patient-identifying data or roster data is 
 12.11  released to such entities in any form, whether or not encrypted, 
 12.12  coded with unique identification numbers, or otherwise 
 12.13  shielded.  For purposes of this subdivision, the following 
 12.14  definitions apply: 
 12.15     (a) "patient-identifying data" means data that identifies a 
 12.16  patient directly or that identifies characteristics that 
 12.17  reasonably could uniquely identify a specific patient 
 12.18  circumstantially; and 
 12.19     (b) "roster data" means, with regard to an enrollee of a 
 12.20  health plan company or group purchaser, an enrollee's name, 
 12.21  address, telephone number, date of birth, gender, and enrollment 
 12.22  status under a group purchaser's health plan.  "Roster data" 
 12.23  means, with regard to a patient of a provider, the patient's 
 12.24  name, address, telephone number, date of birth, gender, and date 
 12.25  or dates treated, including, if applicable, the date of 
 12.26  admission and the date of discharge.