Legislative Session number- 81

Bill Name: SF1522

E Modifying certain review and complaint procedures for health plan companies;
requiring and providing for an expedited initial review determination under
utilization review procedures under certain conditions; specifying a time limit
for certification notice to attending physicians after expedited appeals;
providing for written reconsideration or hearing of initial determinations not
reversed in the first level of appeal; modifying the health plan company
complaint procedure; including accountable provider networks under the procedure
and exempting the Minnesota comprehensive health association (MCHA), government
programs and certain health plans from the process; specifying the procedures
for filing a complaint and decision notice requirements of health plans;
changing the appeals process to a written reconsideration or hearing process and
the alternative dispute resolution process to arbitration; modifying certain
reporting and notice requirements of health plans; providing for a stay of the
procedures upon complainant filing of a suit against the health plan; repealing
the health maintenance organization (HMO) enrollee complaint system, certain
provisions providing for the handling of medically urgent complaints by health
plan companies and requiring the commissioners of health and commerce to make
dispute resolution processes available to encourage early settlement of disputes
and certain rules (ra, ja)