HF 463

2nd Engrossment - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; providing for review of ambulance 
  1.3             services and first responders; amending Minnesota 
  1.4             Statutes 1998, section 145.61, subdivision 5; 
  1.5             proposing coding for new law in Minnesota Statutes, 
  1.6             chapter 144E. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  [144E.32] [REVIEW ORGANIZATION.] 
  1.9      Subdivision 1.  [APPLICABLE LAW.] The provisions of 
  1.10  sections 145.61 to 145.67 apply to an ambulance service or first 
  1.11  responder review organization. 
  1.12     Subd. 2.  [REVIEW ORGANIZATION DEFINED.] A review 
  1.13  organization, as defined under section 145.61, includes a 
  1.14  committee of an ambulance service provider, a physician medical 
  1.15  director, a medical advisor, or ambulance supervisory personnel 
  1.16  who gather, create, and review information relating to the care 
  1.17  and treatment of patients in providing emergency medical care, 
  1.18  including employee performance reviews, quality assurance data, 
  1.19  and other ambulance service or first responder performance data 
  1.20  for ambulance services licensed under section 144E.10 or 144E.12 
  1.21  or first responders registered under section 144E.27, for the 
  1.22  purposes specified under section 145.61, subdivision 5. 
  1.23     Sec. 2.  Minnesota Statutes 1998, section 145.61, 
  1.24  subdivision 5, is amended to read: 
  1.25     Subd. 5.  [REVIEW ORGANIZATION.] "Review organization" 
  1.26  means a nonprofit organization acting according to clause (k), a 
  2.1   committee as defined under section 144E.32, subdivision 2, or a 
  2.2   committee whose membership is limited to professionals, 
  2.3   administrative staff, and consumer directors, except where 
  2.4   otherwise provided for by state or federal law, and which is 
  2.5   established by one or more of the following:  a hospital, a 
  2.6   clinic, a nursing home, an ambulance service or first responder 
  2.7   service regulated under chapter 144E, one or more state or local 
  2.8   associations of professionals, an organization of professionals 
  2.9   from a particular area or medical institution, a health 
  2.10  maintenance organization as defined in chapter 62D, a nonprofit 
  2.11  health service plan corporation as defined in chapter 62C, a 
  2.12  preferred provider organization, a professional standards review 
  2.13  organization established pursuant to United States Code, title 
  2.14  42, section 1320c-1 et seq., a medical review agent established 
  2.15  to meet the requirements of section 256B.04, subdivision 15, or 
  2.16  256D.03, subdivision 7, paragraph (b), the department of human 
  2.17  services, a health provider cooperative operating under sections 
  2.18  62R.17 to 62R.26, or a corporation organized under chapter 317A 
  2.19  that owns, operates, or is established by one or more of the 
  2.20  above referenced entities, to gather and review information 
  2.21  relating to the care and treatment of patients for the purposes 
  2.22  of: 
  2.23     (a) evaluating and improving the quality of health care 
  2.24  rendered in the area or medical institution or by the entity or 
  2.25  organization that established the review organization; 
  2.26     (b) reducing morbidity or mortality; 
  2.27     (c) obtaining and disseminating statistics and information 
  2.28  relative to the treatment and prevention of diseases, illness 
  2.29  and injuries; 
  2.30     (d) developing and publishing guidelines showing the norms 
  2.31  of health care in the area or medical institution or in the 
  2.32  entity or organization that established the review organization; 
  2.33     (e) developing and publishing guidelines designed to keep 
  2.34  within reasonable bounds the cost of health care; 
  2.35     (f) reviewing the quality or cost of health care services 
  2.36  provided to enrollees of health maintenance organizations, 
  3.1   health service plans, preferred provider organizations, and 
  3.2   insurance companies; 
  3.3      (g) acting as a professional standards review organization 
  3.4   pursuant to United States Code, title 42, section 1320c-1 et 
  3.5   seq.; 
  3.6      (h) determining whether a professional shall be granted 
  3.7   staff privileges in a medical institution, membership in a state 
  3.8   or local association of professionals, or participating status 
  3.9   in a nonprofit health service plan corporation, health 
  3.10  maintenance organization, preferred provider organization, or 
  3.11  insurance company, or whether a professional's staff privileges, 
  3.12  membership, or participation status should be limited, suspended 
  3.13  or revoked; 
  3.14     (i) reviewing, ruling on, or advising on controversies, 
  3.15  disputes or questions between: 
  3.16     (1) health insurance carriers, nonprofit health service 
  3.17  plan corporations, health maintenance organizations, 
  3.18  self-insurers and their insureds, subscribers, enrollees, or 
  3.19  other covered persons; 
  3.20     (2) professional licensing boards and health providers 
  3.21  licensed by them; 
  3.22     (3) professionals and their patients concerning diagnosis, 
  3.23  treatment or care, or the charges or fees therefor; 
  3.24     (4) professionals and health insurance carriers, nonprofit 
  3.25  health service plan corporations, health maintenance 
  3.26  organizations, or self-insurers concerning a charge or fee for 
  3.27  health care services provided to an insured, subscriber, 
  3.28  enrollee, or other covered person; 
  3.29     (5) professionals or their patients and the federal, state, 
  3.30  or local government, or agencies thereof; 
  3.31     (j) providing underwriting assistance in connection with 
  3.32  professional liability insurance coverage applied for or 
  3.33  obtained by dentists, or providing assistance to underwriters in 
  3.34  evaluating claims against dentists; 
  3.35     (k) acting as a medical review agent under section 256B.04, 
  3.36  subdivision 15, or 256D.03, subdivision 7, paragraph (b); 
  4.1      (l) providing recommendations on the medical necessity of a 
  4.2   health service, or the relevant prevailing community standard 
  4.3   for a health service; 
  4.4      (m) providing quality assurance as required by United 
  4.5   States Code, title 42, sections 1396r(b)(1)(b) and 
  4.6   1395i-3(b)(1)(b) of the Social Security Act; 
  4.7      (n) providing information to group purchasers of health 
  4.8   care services when that information was originally generated 
  4.9   within the review organization for a purpose specified by this 
  4.10  subdivision; or 
  4.11     (o) providing information to other, affiliated or 
  4.12  nonaffiliated review organizations, when that information was 
  4.13  originally generated within the review organization for a 
  4.14  purpose specified by this subdivision, and as long as that 
  4.15  information will further the purposes of a review organization 
  4.16  as specified by this subdivision.