SF 967

as introduced - 81st Legislature (1999 - 2000) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; modifying the Minnesota 
  1.3             Utilization Review Act; modifying definition of 
  1.4             practice of medicine; amending Minnesota Statutes 
  1.5             1998, sections 62M.09, subdivisions 3, 6, and by 
  1.6             adding a subdivision; 62M.10, subdivision 7; and 
  1.7             147.081, subdivision 3. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 1998, section 62M.09, 
  1.10  subdivision 3, is amended to read: 
  1.11     Subd. 3.  [PHYSICIAN REVIEWER INVOLVEMENT.] A physician 
  1.12  must review all cases in which the utilization review 
  1.13  organization has concluded that a determination not to certify 
  1.14  for clinical reasons is appropriate.  The physician conducting 
  1.15  the review must be licensed in the state and must be currently 
  1.16  practicing in the same specialty as the physician who is 
  1.17  ordering care.  The physician should be reasonably available by 
  1.18  telephone to discuss the determination with the attending 
  1.19  physician.  This subdivision does not apply to outpatient mental 
  1.20  health or substance abuse services governed by subdivision 3a.  
  1.21     Sec. 2.  Minnesota Statutes 1998, section 62M.09, 
  1.22  subdivision 6, is amended to read: 
  1.23     Subd. 6.  [PHYSICIAN CONSULTANTS.] A utilization review 
  1.24  organization must use physician consultants in the appeal 
  1.25  process described in section 62M.06, subdivision 3.  The 
  1.26  physician consultants should include, as needed and available, 
  2.1   specialists who are must be board-certified, or board-eligible 
  2.2   and working towards certification, in a specialty board approved 
  2.3   by the American Board of Medical Specialists or the American 
  2.4   Board of Osteopathy. 
  2.5      Sec. 3.  Minnesota Statutes 1998, section 62M.09, is 
  2.6   amended by adding a subdivision to read: 
  2.7      Subd. 9.  [ANNUAL REPORT.] A utilization review 
  2.8   organization shall file an annual report with the commissioner 
  2.9   of commerce that includes: 
  2.10     (1) the number and rate of denied claims for each procedure 
  2.11  or service; and 
  2.12     (2) the number and rate of denials overturned on appeal. 
  2.13     Sec. 4.  Minnesota Statutes 1998, section 62M.10, 
  2.14  subdivision 7, is amended to read: 
  2.15     Subd. 7.  [AVAILABILITY OF CRITERIA.] Upon request, a 
  2.16  utilization review organization shall provide to an enrollee or 
  2.17  to, an attending physician or provider, and the commissioner of 
  2.18  commerce the criteria used for a specific procedure to determine 
  2.19  the medical necessity, appropriateness, and efficacy of that a 
  2.20  procedure or service and identify the database, professional 
  2.21  treatment guideline, or other basis for the criteria. 
  2.22     Sec. 5.  Minnesota Statutes 1998, section 147.081, 
  2.23  subdivision 3, is amended to read: 
  2.24     Subd. 3.  [PRACTICE OF MEDICINE DEFINED.] For purposes of 
  2.25  this chapter, a person not exempted under section 147.09 is 
  2.26  "practicing medicine" or engaged in the "practice of medicine" 
  2.27  if the person does any of the following:  
  2.28     (1) advertises, holds out to the public, or represents in 
  2.29  any manner that the person is authorized to practice medicine in 
  2.30  this state; 
  2.31     (2) offers or undertakes to prescribe, give, or administer 
  2.32  any drug or medicine for the use of another; 
  2.33     (3) offers or undertakes to prevent or to diagnose, 
  2.34  correct, or treat in any manner or by any means, methods, 
  2.35  devices, or instrumentalities, any disease, illness, pain, 
  2.36  wound, fracture, infirmity, deformity or defect of any person; 
  3.1      (4) offers or undertakes to perform any surgical operation 
  3.2   including any invasive or noninvasive procedures involving the 
  3.3   use of a laser or laser assisted device, upon any person; 
  3.4      (5) offers to undertake to use hypnosis for the treatment 
  3.5   or relief of any wound, fracture, or bodily injury, infirmity, 
  3.6   or disease; or 
  3.7      (6) uses in the conduct of any occupation or profession 
  3.8   pertaining to the diagnosis of human disease or conditions, the 
  3.9   designation "doctor of medicine," "medical doctor," "doctor of 
  3.10  osteopathy," "osteopath," "osteopathic physician," "physician," 
  3.11  "surgeon," "M.D.," "D.O.," or any combination of these 
  3.12  designations; or 
  3.13     (7) makes a determination of medical necessity for a 
  3.14  covered service based on clinical information under section 
  3.15  62M.09, subdivision 3.