HF 523

as introduced - 89th Legislature (2015 - 2016) Posted on 05/08/2015 11:23am

A bill for an act
relating to health; providing additional accrediting organization for ambulatory
health care; amending Minnesota Statutes 2014, section 62Q.37, subdivision 2.

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

Section 1.

Minnesota Statutes 2014, section 62Q.37, subdivision 2, is amended to read:

Subd. 2.

Definitions.

For purposes of this section, the following terms have the
meanings given them.

(a) "Commissioner" means the commissioner of health for purposes of regulating
health maintenance organizations and community integrated service networks, the
commissioner of commerce for purposes of regulating nonprofit health service plan
corporations, or the commissioner of human services for the purpose of contracting with
managed care organizations serving persons enrolled in programs under chapter 256B,
256D, or 256L.

(b) "Health plan company" means (i) a nonprofit health service plan corporation
operating under chapter 62C; (ii) a health maintenance organization operating under
chapter 62D; (iii) a community integrated service network operating under chapter 62N;
or (iv) a managed care organization operating under chapter 256B, 256D, or 256L.

(c) "Nationally recognized independent organization" means (i) an organization
that sets specific national standards governing health care quality assurance processes,
utilization review, provider credentialing, marketing, and other topics covered by
this chapter and other chapters and audits and provides accreditation to those health
plan companies that meet those standards. The American Accreditation Health Care
Commission (URAC), the National Committee for Quality Assurance (NCQA), deleted text begin and deleted text end
the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) new text begin , and the
Accreditation Association for Ambulatory Health Care (AAAHC) new text end are, at a minimum,
defined as nationally recognized independent organizations; and (ii) the Centers for
Medicare and Medicaid Services for purposes of reviews or audits conducted of health
plan companies under Part C of Title XVIII of the Social Security Act or under section
1876 of the Social Security Act.

(d) "Performance standard" means those standards relating to quality management
and improvement, access and availability of service, utilization review, provider selection,
provider credentialing, marketing, member rights and responsibilities, complaints, appeals,
grievance systems, enrollee information and materials, enrollment and disenrollment,
subcontractual relationships and delegation, confidentiality, continuity and coordination of
care, assurance of adequate capacity and services, coverage and authorization of services,
practice guidelines, health information systems, and financial solvency.