Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF2104 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to health; requiring data on fully denied claims to be submitted to the
3	3	1.3 all-payer claims database; establishing a fee schedule for expanded access to data
4	4	1.4 in the all-payer claims database; appropriating money; amending Minnesota Statutes
5	5	1.5 2024, section 62U.04, subdivisions 4, 13, by adding a subdivision.
6	6	1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
7	7	1.7 Section 1. Minnesota Statutes 2024, section 62U.04, subdivision 4, is amended to read:
8	8	1.8 Subd. 4.Encounter data.(a) All health plan companies, dental organizations, and
9	9	1.9third-party administrators shall submit encounter data on a monthly basis to a private entity
10	10	1.10designated by the commissioner of health. The data shall be submitted in a form and manner
11	11	1.11specified by the commissioner subject to the following requirements:
12	12	1.12 (1) the data must be de-identified data as described under the Code of Federal Regulations,
13	13	1.13title 45, section 164.514;
14	14	1.14 (2) the data for each encounter must include an identifier for the patient's health care
15	15	1.15home if the patient has selected a health care home, data on contractual value-based payments,
16	16	1.16and data deemed necessary by the commissioner to uniquely identify claims in the individual
17	17	1.17health insurance market;
18	18	1.18 (3) the data must include enrollee race and ethnicity, to the extent available, for claims
19	19	1.19incurred on or after January 1, 2023; and
20	20	1.20 (4) except for the data described in clauses (2) and (3), the data must not include
21	21	1.21information that is not included in a health care claim, dental care claim, or equivalent
22	22	1.22encounter information transaction that is required under section 62J.536.; and
23	23	1Section 1.
24	24	25-03201 as introduced02/18/25 REVISOR SGS/CH
25	25	SENATE
26	26	STATE OF MINNESOTA
27	27	S.F. No. 2104NINETY-FOURTH SESSION
28	28	(SENATE AUTHORS: WIKLUND, Port and Boldon)
29	29	OFFICIAL STATUSD-PGDATE
30	30	Introduction and first reading03/03/2025
31	31	Referred to Health and Human Services 2.1 (5) the data must include at least the following data fields for any fully denied claims:
32	32	2.2 (i) an indicator of which claim lines were denied;
33	33	2.3 (ii) the reason for denial of each denied claim line;
34	34	2.4 (iii) the claim line status in terms of adjudication; and
35	35	2.5 (iv) a claim identifier to link the original claim to subsequent actions on the claim.
36	36	2.6 (b) The commissioner or the commissioner's designee shall only use the data submitted
37	37	2.7under paragraph (a) to carry out the commissioner's responsibilities in this section, including
38	38	2.8supplying the data to providers so they can verify their results of the peer grouping process
39	39	2.9consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
40	40	2.10and adopted by the commissioner and, if necessary, submit comments to the commissioner
41	41	2.11or initiate an appeal.
42	42	2.12 (c) Data on providers collected under this subdivision are private data on individuals or
43	43	2.13nonpublic data, as defined in section 13.02. Notwithstanding the data classifications in this
44	44	2.14paragraph, data on providers collected under this subdivision may be released or published
45	45	2.15as authorized in subdivision 11. The commissioner or the commissioner's designee shall
46	46	2.16establish procedures and safeguards to protect the integrity and confidentiality of any data
47	47	2.17that it maintains.
48	48	2.18 (d) The commissioner or the commissioner's designee shall not publish analyses or
49	49	2.19reports that identify, or could potentially identify, individual patients.
50	50	2.20 (e) The commissioner shall compile summary information on the data submitted under
51	51	2.21this subdivision. The commissioner shall work with its vendors to assess the data submitted
52	52	2.22in terms of compliance with the data submission requirements and the completeness of the
53	53	2.23data submitted by comparing the data with summary information compiled by the
54	54	2.24commissioner and with established and emerging data quality standards to ensure data
55	55	2.25quality.
56	56	2.26 Sec. 2. Minnesota Statutes 2024, section 62U.04, subdivision 13, is amended to read:
57	57	2.27 Subd. 13.Expanded access to and use of the all-payer claims data.(a) The
58	58	2.28commissioner or the commissioner's designee shall make the data submitted under
59	59	2.29subdivisions 4, 5, 5a, and 5b, including data classified as private or nonpublic, available to
60	60	2.30individuals and organizations engaged in research on, or efforts to effect transformation in,
61	61	2.31health care outcomes, access, quality, disparities, or spending, provided the use of the data
62	62	2.32serves a public benefit. Data made available under this subdivision may not be used to:
63	63	2Sec. 2.
64	64	25-03201 as introduced02/18/25 REVISOR SGS/CH 3.1 (1) create an unfair market advantage for any participant in the health care market in
65	65	3.2Minnesota, including health plan companies, payers, and providers;
66	66	3.3 (2) reidentify or attempt to reidentify an individual in the data; or
67	67	3.4 (3) publicly report contract details between a health plan company and provider and
68	68	3.5derived from the data.
69	69	3.6 (b) To implement paragraph (a), the commissioner shall:
70	70	3.7 (1) establish detailed requirements for data access; a process for data users to apply to
71	71	3.8access and use the data; legally enforceable data use agreements to which data users must
72	72	3.9consent; a clear and robust oversight process for data access and use, including a data
73	73	3.10management plan, that ensures compliance with state and federal data privacy laws;
74	74	3.11agreements for state agencies and the University of Minnesota to ensure proper and efficient
75	75	3.12use and security of data; and technical assistance for users of the data and for stakeholders;
76	76	3.13 (2) develop a fee assess fees according to the fee schedule in subdivision 14 to support
77	77	3.14the cost of expanded access to and use of the data, provided the fees charged under the
78	78	3.15schedule do not create a barrier to access or use for those most affected by disparities; and
79	79	3.16 (3) create a research advisory group to advise the commissioner on applications for data
80	80	3.17use under this subdivision, including an examination of the rigor of the research approach,
81	81	3.18the technical capabilities of the proposed user, and the ability of the proposed user to
82	82	3.19successfully safeguard the data.; and
83	83	3.20 (4) annually publish on the Department of Health website a list of projects authorized
84	84	3.21under this subdivision.
85	85	3.22 Sec. 3. Minnesota Statutes 2024, section 62U.04, is amended by adding a subdivision to
86	86	3.23read:
87	87	3.24 Subd. 14.Fees for expanded access to and use of the all-payer claims database.(a)
88	88	3.25For purposes of this section:
89	89	3.26 (1) "custom data set or report" means a de-identified data set or report for which a
90	90	3.27standard data set or limited-use data set is not appropriate, that only provides the minimum
91	91	3.28necessary data, and that is de-identified using the expert determination method as defined
92	92	3.29in Code of Federal Regulations, title 45, section 164.514(b)(1);
93	93	3.30 (2) "data file" means a data file derived from medical claims, pharmacy claims, dental
94	94	3.31claims, eligibility information, membership information, or provider information for a single
95	95	3.32year;
96	96	3Sec. 3.
97	97	25-03201 as introduced02/18/25 REVISOR SGS/CH 4.1 (3) "limited-use data set" means a data set that meets the requirements in Code of Federal
98	98	4.2Regulations, title 45, section 164.514(e), the data of which, disclosed under the principle
99	99	4.3of minimum necessity, may include protected health information from which certain direct
100	100	4.4identifiers of individuals have been removed; and
101	101	4.5 (4) "standard data set" means a static data release designed by the commissioner to serve
102	102	4.6a wide range of projects in which nearly all de-identified releasable data elements are
103	103	4.7disclosed in one release after applying the safe harbor de-identification method as defined
104	104	4.8in Code of Federal Regulations, title 45, section 164.514(b)(2), and from which protected
105	105	4.9health information and any combination of data elements that directly identify any person
106	106	4.10are excluded.
107	107	4.11 (b) The commissioner must assess fees on an individual or organization that requests to
108	108	4.12access or receive data for an activity specified in subdivision 13 for the cost of accessing
109	109	4.13or receiving the data. "Cost" under this paragraph may include but is not limited to the cost
110	110	4.14of producing and releasing data to the individual or organization under subdivision 13 and
111	111	4.15managing infrastructure and operations. The commissioner must assess fees according to
112	112	4.16the following schedule, based on the type of data requested and number of years for which
113	113	4.17access is requested:
114	114	4.18 (1) the fee for a standard data set is $3,500 per data file per year;
115	115	4.19 (2) the fee for a limited-use data set is $7,000 per data file per year; and
116	116	4.20 (3) the fee for a custom data set or report is $100 per hour of staff time expended, not
117	117	4.21to exceed 40 hours of staff time.
118	118	4.22 (c) The commissioner may grant a partial or full waiver of the fees in paragraph (b) if
119	119	4.23the individual or organization requesting access to the data meets at least one of the following
120	120	4.24criteria:
121	121	4.25 (1) the fee represents a financial hardship to the individual or organization;
122	122	4.26 (2) the organization is a self-insured data submitter under this section;
123	123	4.27 (3) the individual or organization is affiliated with an academic institution; or
124	124	4.28 (4) the individual or organization requests a high volume of data files.
125	125	4.29In determining whether to grant a waiver under this paragraph, the commissioner may
126	126	4.30consult with the research advisory group established under subdivision 13.
127	127	4Sec. 3.
128	128	25-03201 as introduced02/18/25 REVISOR SGS/CH 5.1 (d) An individual or organization that receives approval to access or receive data under
129	129	5.2subdivision 13 must pay all required fees in full before accessing or receiving the requested
130	130	5.3data.
131	131	5.4 (e) Fees paid by an individual or organization approved to access or receive data under
132	132	5.5subdivision 13 are nonrefundable. Fees collected under this subdivision must be deposited
133	133	5.6in an account in the special revenue fund. Money in that account does not cancel and is
134	134	5.7appropriated to the commissioner for purposes of offsetting the cost of providing expanded
135	135	5.8access to data under subdivision 13 and maintaining data submitted under subdivisions 4
136	136	5.9to 5b.
137	137	5.10 (f) The commissioner must publish the fee schedule in paragraph (b) on the Department
138	138	5.11of Health website.
139	139	5.12 Sec. 4. APPROPRIATION; COLLECTION OF DATA ON FULLY DENIED
140	140	5.13CLAIMS.
141	141	5.14 $....... in fiscal year 2026 and $....... in fiscal year 2027 are appropriated from the general
142	142	5.15fund to the commissioner of health for purposes of collecting data on fully denied claims
143	143	5.16according to Minnesota Statutes, section 62U.04, subdivision 4.
144	144	5Sec. 4.
145	145	25-03201 as introduced02/18/25 REVISOR SGS/CH