Bill Text: MN SF2106 | 2013-2014 | 88th Legislature | Engrossed
Bill Title: All-payer claims data and database use modification
Sponsorship: Bipartisan Bill
Status: (Introduced - Dead) 2014-04-22 - HF substituted on General Orders HF2656 [SF2106 Detail]
Download: Minnesota-2013-SF2106-Engrossed.html
1.2relating to health; modifying the use of the all-payer claims data; convening a
1.3work group to make recommendations on expanded uses of the all-payer claims
1.4database;amending Minnesota Statutes 2012, section 62U.04, subdivision 4,
1.5by adding subdivisions.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 62U.04, subdivision 4, is amended to read:
1.8 Subd. 4. Encounter data. (a) Beginning July 1, 2009, and every six months
1.9thereafter, all health plan companies and third-party administrators shall submit encounter
1.10data to a private entity designated by the commissioner of health. The data shall be
1.11submitted in a form and manner specified by the commissioner subject to the following
1.12requirements:
1.13 (1) the data must be de-identified data as described under the Code of Federal
1.14Regulations, title 45, section 164.514;
1.15 (2) the data for each encounter must include an identifier for the patient's health care
1.16home if the patient has selected a health care home; and
1.17 (3) except for the identifier described in clause (2), the data must not include
1.18information that is not included in a health care claim or equivalent encounter information
1.19transaction that is required under section62J.536 .
1.20 (b) The commissioner or the commissioner's designee shall only use the data
1.21submitted under paragraph (a) to carry out its responsibilities in this section, including
1.22supplying the data to providers so they can verify their results of the peer grouping process
1.23consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
1.24and adopted by the commissioner and, if necessary, submit comments to the commissioner
1.25or initiate an appeal.
2.1 (c) Data on providers collected under this subdivision are private data on individuals
2.2or nonpublic data, as defined in section13.02 . Notwithstanding the definition of summary
2.3data in section13.02, subdivision 19 , summary data prepared under this subdivision
2.4may be derived from nonpublic data. The commissioner or the commissioner's designee
2.5shall establish procedures and safeguards to protect the integrity and confidentiality of
2.6any data that it maintains.
2.7 (d) The commissioner or the commissioner's designee shall not publish analyses or
2.8reports that identify, or could potentially identify, individual patients.
2.9(e) The commissioner shall compile summary information on the data submitted
2.10under this subdivision. The commissioner shall work with its vendors to assess the
2.11data submitted in terms of compliance with the data submission requirements and the
2.12completeness of the data submitted by comparing the data with summary information
2.13compiled by the commissioner and with established and emerging data quality standards
2.14to ensure data quality.
2.15 Sec. 2. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
2.16to read:
2.17 Subd. 10. Suspension. Notwithstanding subdivisions 3, 3a, 3b, 3c, and 3d, the
2.18commissioner shall suspend the development and implementation of the provider peer
2.19grouping system required under this section. This suspension shall continue until the
2.20legislature authorizes the commissioner to resume this activity.
2.21 Sec. 3. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
2.22to read:
2.23 Subd. 11. Restricted uses of the all-payer claims data. (a) Notwithstanding
2.24subdivision 4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or
2.25commissioner's designee shall only use the data submitted under subdivisions 4 and 5 for
2.26the following purposes:
2.27(1) to evaluate the performance of the health care home program as authorized under
2.28sections 256B.0751, subdivision 6, and 256B.0752, subdivision 2;
2.29(2) to study, in collaboration with the Reducing Avoidable Readmissions Effectively
2.30(RARE) campaign, hospital readmission trends and rates;
2.31(3) to analyze variations in health care costs, quality, utilization, and illness burden
2.32based on geographical areas or populations; and
2.33(4) to evaluate the state innovation model (SIM) testing grant received by the
2.34Departments of Health and Human Services, including the analysis of health care cost,
3.1quality, and utilization baseline and trend information for targeted populations and
3.2communities.
3.3(b) The commissioner may publish the results of the authorized uses identified
3.4in paragraph (a) so long as the data released publicly do not contain information or
3.5descriptions in which the identity of individual hospitals, clinics, or other providers may
3.6be discerned.
3.7(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
3.8using the data collected under subdivision 4 to complete the state-based risk adjustment
3.9system assessment due to the legislature on October 1, 2015.
3.10(d) The commissioner or the commissioner's designee may use the data submitted
3.11under subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until
3.12July 1, 2016.
3.13 Sec. 4. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
3.14to read:
3.15 Subd. 12. ALL-PAYER CLAIMS DATABASE WORK GROUP. (a) The
3.16commissioner of health shall convene a work group to develop a framework for the
3.17expanded use of the all-payer claims database established under Minnesota Statutes,
3.18section 62U.04. The work group shall develop recommendations based on the following
3.19questions and other topics as identified by the work group:
3.20(1) what should the parameters be for allowable uses of the all-payer claims data
3.21collected under Minnesota Statutes, section 62U.04, beyond the uses authorized in
3.22Minnesota Statutes, section 62U.04, subdivision 11;
3.23(2) what type of advisory or governing body should guide the release of data from
3.24the all-payer claims database;
3.25(3) what type of funding or fee structure would be needed to support the expanded
3.26use of all-payer claims data;
3.27(4) what should the mechanisms be by which the data would be released or accessed,
3.28including the necessary information technology infrastructure to support the expanded use
3.29of the data under different assumptions related to the number of potential requests and
3.30manner of access;
3.31(5) what are the appropriate privacy and security protections needed for the
3.32expanded use of the all-payer claims database; and
3.33(6) what additional resources might be needed to support the expanded use of the
3.34all-payer claims database, including expected resources related to information technology
4.1infrastructure, review of proposals, maintenance of data use agreements, staffing an
4.2advisory body, or other new efforts.
4.3(b) The commissioner of health shall appoint the members to the work group
4.4as follows:
4.5(1) two members recommended by the Minnesota Medical Association;
4.6(2) two members recommended by the Minnesota Hospital Association;
4.7(3) two members recommended by the Minnesota Council of Health Plans;
4.8(4) one member who is a data practices expert from the Department of Administration;
4.9(5) three members who are academic researchers with expertise in claims database
4.10analysis;
4.11(6) two members representing two state agencies determined by the commissioner;
4.12(7) one member representing the Minnesota Health Care Safety Net Coalition; and
4.13(8) three members representing consumers.
4.14(c) The commissioner of health shall submit a report on the recommendations of
4.15the work group to the chairs and ranking minority members of the legislative committees
4.16and divisions with jurisdiction over health and human services, judiciary, and civil law
4.17by February 1, 2015. In considering the recommendations provided in the report, the
4.18legislature may consider whether the currently authorized uses of the all-payer claims data
4.19under section 62U.04 should continue to be authorized.
4.20EFFECTIVE DATE.This section is effective the day following final enactment.
1.3work group to make recommendations on expanded uses of the all-payer claims
1.4database;amending Minnesota Statutes 2012, section 62U.04, subdivision 4,
1.5by adding subdivisions.
1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.7 Section 1. Minnesota Statutes 2012, section 62U.04, subdivision 4, is amended to read:
1.8 Subd. 4. Encounter data. (a) Beginning July 1, 2009, and every six months
1.9thereafter, all health plan companies and third-party administrators shall submit encounter
1.10data to a private entity designated by the commissioner of health. The data shall be
1.11submitted in a form and manner specified by the commissioner subject to the following
1.12requirements:
1.13 (1) the data must be de-identified data as described under the Code of Federal
1.14Regulations, title 45, section 164.514;
1.15 (2) the data for each encounter must include an identifier for the patient's health care
1.16home if the patient has selected a health care home; and
1.17 (3) except for the identifier described in clause (2), the data must not include
1.18information that is not included in a health care claim or equivalent encounter information
1.19transaction that is required under section
1.20 (b) The commissioner or the commissioner's designee shall only use the data
1.21submitted under paragraph (a) to carry out its responsibilities in this section, including
1.22supplying the data to providers so they can verify their results of the peer grouping process
1.23consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
1.24and adopted by the commissioner and, if necessary, submit comments to the commissioner
1.25or initiate an appeal.
2.1 (c) Data on providers collected under this subdivision are private data on individuals
2.2or nonpublic data, as defined in section
2.3data in section
2.4may be derived from nonpublic data. The commissioner or the commissioner's designee
2.5shall establish procedures and safeguards to protect the integrity and confidentiality of
2.6any data that it maintains.
2.7 (d) The commissioner or the commissioner's designee shall not publish analyses or
2.8reports that identify, or could potentially identify, individual patients.
2.9(e) The commissioner shall compile summary information on the data submitted
2.10under this subdivision. The commissioner shall work with its vendors to assess the
2.11data submitted in terms of compliance with the data submission requirements and the
2.12completeness of the data submitted by comparing the data with summary information
2.13compiled by the commissioner and with established and emerging data quality standards
2.14to ensure data quality.
2.15 Sec. 2. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
2.16to read:
2.17 Subd. 10. Suspension. Notwithstanding subdivisions 3, 3a, 3b, 3c, and 3d, the
2.18commissioner shall suspend the development and implementation of the provider peer
2.19grouping system required under this section. This suspension shall continue until the
2.20legislature authorizes the commissioner to resume this activity.
2.21 Sec. 3. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
2.22to read:
2.23 Subd. 11. Restricted uses of the all-payer claims data. (a) Notwithstanding
2.24subdivision 4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or
2.25commissioner's designee shall only use the data submitted under subdivisions 4 and 5 for
2.26the following purposes:
2.27(1) to evaluate the performance of the health care home program as authorized under
2.28sections 256B.0751, subdivision 6, and 256B.0752, subdivision 2;
2.29(2) to study, in collaboration with the Reducing Avoidable Readmissions Effectively
2.30(RARE) campaign, hospital readmission trends and rates;
2.31(3) to analyze variations in health care costs, quality, utilization, and illness burden
2.32based on geographical areas or populations; and
2.33(4) to evaluate the state innovation model (SIM) testing grant received by the
2.34Departments of Health and Human Services, including the analysis of health care cost,
3.1quality, and utilization baseline and trend information for targeted populations and
3.2communities.
3.3(b) The commissioner may publish the results of the authorized uses identified
3.4in paragraph (a) so long as the data released publicly do not contain information or
3.5descriptions in which the identity of individual hospitals, clinics, or other providers may
3.6be discerned.
3.7(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
3.8using the data collected under subdivision 4 to complete the state-based risk adjustment
3.9system assessment due to the legislature on October 1, 2015.
3.10(d) The commissioner or the commissioner's designee may use the data submitted
3.11under subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until
3.12July 1, 2016.
3.13 Sec. 4. Minnesota Statutes 2012, section 62U.04, is amended by adding a subdivision
3.14to read:
3.15 Subd. 12. ALL-PAYER CLAIMS DATABASE WORK GROUP. (a) The
3.16commissioner of health shall convene a work group to develop a framework for the
3.17expanded use of the all-payer claims database established under Minnesota Statutes,
3.18section 62U.04. The work group shall develop recommendations based on the following
3.19questions and other topics as identified by the work group:
3.20(1) what should the parameters be for allowable uses of the all-payer claims data
3.21collected under Minnesota Statutes, section 62U.04, beyond the uses authorized in
3.22Minnesota Statutes, section 62U.04, subdivision 11;
3.23(2) what type of advisory or governing body should guide the release of data from
3.24the all-payer claims database;
3.25(3) what type of funding or fee structure would be needed to support the expanded
3.26use of all-payer claims data;
3.27(4) what should the mechanisms be by which the data would be released or accessed,
3.28including the necessary information technology infrastructure to support the expanded use
3.29of the data under different assumptions related to the number of potential requests and
3.30manner of access;
3.31(5) what are the appropriate privacy and security protections needed for the
3.32expanded use of the all-payer claims database; and
3.33(6) what additional resources might be needed to support the expanded use of the
3.34all-payer claims database, including expected resources related to information technology
4.1infrastructure, review of proposals, maintenance of data use agreements, staffing an
4.2advisory body, or other new efforts.
4.3(b) The commissioner of health shall appoint the members to the work group
4.4as follows:
4.5(1) two members recommended by the Minnesota Medical Association;
4.6(2) two members recommended by the Minnesota Hospital Association;
4.7(3) two members recommended by the Minnesota Council of Health Plans;
4.8(4) one member who is a data practices expert from the Department of Administration;
4.9(5) three members who are academic researchers with expertise in claims database
4.10analysis;
4.11(6) two members representing two state agencies determined by the commissioner;
4.12(7) one member representing the Minnesota Health Care Safety Net Coalition; and
4.13(8) three members representing consumers.
4.14(c) The commissioner of health shall submit a report on the recommendations of
4.15the work group to the chairs and ranking minority members of the legislative committees
4.16and divisions with jurisdiction over health and human services, judiciary, and civil law
4.17by February 1, 2015. In considering the recommendations provided in the report, the
4.18legislature may consider whether the currently authorized uses of the all-payer claims data
4.19under section 62U.04 should continue to be authorized.
4.20EFFECTIVE DATE.This section is effective the day following final enactment.
