SF 2262 makes a number of changes to section 62U.04 and the peer provider grouping system.  It also removes the current timeline requirements for developing a peer grouping system.

Section 1 (62U.04, subdivision 1) strikes the January 1, 2010, date in which the Commissioner of Health is required to develop a plan to create transparency, encourage innovation, reduce administrative burdens, and provide comparative information to consumers.

Section 2 (62U.04, subdivision 2) requires that when developing a uniform method of calculating providers’ relative cost of care the commissioner shall address appropriate risk adjustment that reflects the differences in demographics and health status across provider populations using generally accepted risk adjustment methodologies and case mix adjustments and requires the commissioner to consider other factors that the advisory committee established under section 3 deems important.

Section 3 (62U.04 subdivision 3) modifies this subdivision relating to provider peer grouping by turning the paragraphs into new subdivisions. The substantive changes are as follows:

Subdivision 3 strikes the reference to “combined measures” in terms of the development of the peer grouping system.  It also requires the commissioner to establish an advisory committee to assist the commissioner in developing and administering the peer grouping system.

Subdivision 3a requires that the data used by the commissioner to determine a provider’s total cost of care grouping must be the most recent data available.  Clarifies that before publishing any analyses or reports that identify providers, the commissioner must provide a provider the opportunity to review the underlying data in order to verify the accuracy and representativeness of any analyses or reports and submit comments to the commissioner or initiate an appeal.  Clarifies that upon request the provider shall be given any data for which they are the subject of the data and extends the time in which a provider has to review the data from 30 days to 60 days. 

Subdivision 3b modifies the required appeals process by requiring the process to also resolve disputes involving errors in the application of standards or methodology established by the commissioner in consultation with the advisory committee.  The commissioner shall cooperate with the provider during the data review period by giving the provider information necessary for the preparation of an appeal.

Subdivision 3c clarifies that the commissioner may publicly release summary data related to the peer grouping system as long as the data do not contain information or descriptions from which the identity of individual hospitals, clinics, or other providers may be discerned and establishes criteria that must be met before the commissioner may publically release analyses or results related to the peer grouping system that indentify hospitals, clinics, or other providers.  This subdivision also requires the commissioner to convene a work group for the purpose of identifying and agreeing upon the specific data elements and other supporting documentation or information that is necessary and reasonable for physician clinics and hospitals to receive to allow for verification of the accuracy and representativeness of the peer grouping results.

Subdivision 3d makes conforming changes.  This subdivision also strikes the requirement that the commissioner report to the legislature if there is a delay in the dissemination of the data or the publication of information.

Section 4 (62U.04, subdivision 4) specifies that the commissioner shall only use the encounter data submitted by health plan companies and third-party administrators to carry out the responsibilities in this section, including supplying the data to providers so the providers can verify the results of the peer grouping process and to further quality of care and patient safety improvement initiatives and research in a manner consistent with appropriate data safeguards.

Section 5 (64U.04, subdivision 5) specifies that the commissioner may provide the pricing data submitted by health plan  companies and third-party administrators to providers in order for the providers to verify their results of the peer grouping process.

Section 6 (62U.04, subdivision 6) changes the word “shall” to “may” in terms of the Commissioner of Management and Budget and health plan companies using the information and methods developed under this section to strengthen incentives for members to use high-quality, low-cost providers; offer plans that differentiate providers on their costs and quality performance; and develop products that encourage consumers to use high-quality, low-cost providers.

Section 7 (256B.0754, subdivision 2) changes the word “shall” to “may” in terms of the Commissioner of Human Services using the peer grouping information and other methods developed under section 62U.04 to establish a payment system for the public health care programs that rewards high-quality, low-cost providers, creates incentives for enrollees to receive care from high-quality, low-cost providers; and fosters collaboration among providers to reduce cost shifting from one part of the health continuum to another.

Section 8 establishes an effective date of July 1, 2012, and states that this date applies to all information provided or released to the public or to providers pursuant to section 62U.04 on or after that date.

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