SF 1592

as introduced - 89th Legislature (2015 - 2016) Posted on 03/12/2015 09:00am

A bill for an act
relating to insurance; modifying requirements for utilization review of certain
mental health and substance abuse services; amending Minnesota Statutes 2014,
section 62M.09, subdivisions 3, 3a.

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

Section 1.

Minnesota Statutes 2014, section 62M.09, subdivision 3, is amended to read:

Subd. 3.

Physician reviewer involvement.

(a) A physician must review all cases
in which the utilization review organization has concluded that a determination not to
certify for clinical reasons is appropriate.

(b) The physician conducting the review must be licensed in this state. This
paragraph does not apply to reviews conducted in connection with policies issued by a
health plan company that is assessed less than three percent of the total amount assessed
by the Minnesota Comprehensive Health Association.

(c) The physician should be reasonably available by telephone to discuss the
determination with the attending health care professional.

(d) This subdivision does not apply to new text begin inpatient or new text end outpatient mental health or
substance abuse services governed by subdivision 3a.

Sec. 2.

Minnesota Statutes 2014, section 62M.09, subdivision 3a, is amended to read:

Subd. 3a.

Mental health and substance abuse reviews.

(a) A peer of the treating
mental health or substance abuse provider, a doctoral-level psychologist, or a physician
must review requests for outpatient services new text begin and inpatient services if these inpatient
services are to be covered by a health maintenance organization licensed under chapter
62D, new text end in which the utilization review organization has concluded that a determination not
to certify a mental health or substance abuse service for clinical reasons is appropriate,
provided that any final determination not to certify treatment is made by a psychiatrist
certified by the American Board of Psychiatry and Neurology and appropriately licensed
in this state or by a doctoral-level psychologist licensed in this state.

(b) Notwithstanding paragraph (a), a doctoral-level psychologist shall not review
any request or final determination not to certify a mental health or substance abuse service
or treatment if the treating provider is a psychiatrist. new text begin Notwithstanding paragraph (a), if
the utilization review organization is a health maintenance organization licensed under
chapter 62D, or is providing utilization review for a health maintenance organization,
a psychiatrist certified in child and adolescent psychiatry by the American Board of
Psychiatry and Neurology shall review any request or final determination not to certify
a mental health or substance abuse service or treatment if the treating provider is a
psychiatrist and the patient is under the age of 18.
new text end

(c) Notwithstanding the notification requirements of section 62M.05, a utilization
review organization that has made an initial decision to certify in accordance with the
requirements of section 62M.05 may elect to provide notification of a determination to
continue coverage through facsimile or mail.

(d) This subdivision does not apply to determinations made in connection with
policies issued by a health plan company that is assessed less than three percent of the
total amount assessed by the Minnesota Comprehensive Health Association.