SF 2768

as introduced - 79th Legislature (1995 - 1996) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act
  1.2             relating to health; expanding participation in the 
  1.3             health provider cooperative demonstration; modifying 
  1.4             the definition of review organization; amending 
  1.5             Minnesota Statutes 1994, section 145.61, subdivision 
  1.6             5; Minnesota Statutes 1995 Supplement, section 62R.17. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  Minnesota Statutes 1995 Supplement, section 
  1.9   62R.17, is amended to read: 
  1.10     62R.17 [PROVIDER COOPERATIVE DEMONSTRATION.] 
  1.11     (a) A health provider cooperative incorporated and having 
  1.12  adopted bylaws before May 1, 1995, that has members who provide 
  1.13  services in Sibley, Nicollet, Blue Earth, Brown, Watonwan, 
  1.14  Martin, Faribault, Waseca, and LeSueur counties, may contract 
  1.15  with a qualified employer or self-insured employer plan to 
  1.16  provide health care services in accordance with sections 62R.17 
  1.17  to 62R.26.  
  1.18     (b) A health provider cooperative incorporated and having 
  1.19  adopted bylaws before July 1, 1995, that has members who provide 
  1.20  services in Big Stone, Chippewa, Cottonwood, Jackson, Kandiyohi, 
  1.21  Lac Qui Parle, Lincoln, Lyon, McLeod, Meeker, Murray, Nobles, 
  1.22  Pipestone, Redwood, Renville, Rock, Swift, and Yellow Medicine 
  1.23  counties, may contract with a qualified employer or self-insured 
  1.24  employer plan to provide health care services in accordance with 
  1.25  sections 62R.17 to 62R.26. 
  1.26     (c) The health provider cooperative, the qualified 
  2.1   employer, or the self-insured employer plan shall not, solely on 
  2.2   account of that contract, be subject to any provision of 
  2.3   Minnesota Statutes relating to health carriers except as 
  2.4   provided in section 62R.21.  The grant of contracting power 
  2.5   under this section shall not be interpreted to permit or 
  2.6   prohibit any other lawful arrangement between a health care 
  2.7   provider and a self-insured employee welfare benefit plan or its 
  2.8   sponsor. 
  2.9      Sec. 2.  Minnesota Statutes 1994, section 145.61, 
  2.10  subdivision 5, is amended to read: 
  2.11     Subd. 5.  "Review organization" means a nonprofit 
  2.12  organization acting according to clause (k) or a committee whose 
  2.13  membership is limited to professionals, administrative staff, 
  2.14  and consumer directors, except where otherwise provided for by 
  2.15  state or federal law, and which is established by one or more of 
  2.16  the following:  a hospital, a clinic, a nursing home, one or 
  2.17  more state or local associations of professionals, an 
  2.18  organization of professionals from a particular area or medical 
  2.19  institution, a health maintenance organization as defined in 
  2.20  chapter 62D, a nonprofit health service plan corporation as 
  2.21  defined in chapter 62C, a preferred provider organization, a 
  2.22  professional standards review organization established pursuant 
  2.23  to United States Code, title 42, section 1320c-1 et seq., a 
  2.24  medical review agent established to meet the requirements of 
  2.25  section 256B.04, subdivision 15, or 256D.03, subdivision 7, 
  2.26  paragraph (b), the department of human services, a health 
  2.27  provider cooperative operating under sections 62R.17 to 62R.26, 
  2.28  or a corporation organized under chapter 317A that owns, 
  2.29  operates, or is established by one or more of the above 
  2.30  referenced entities, to gather and review information relating 
  2.31  to the care and treatment of patients for the purposes of: 
  2.32     (a) evaluating and improving the quality of health care 
  2.33  rendered in the area or medical institution or by the entity or 
  2.34  organization that established the review organization; 
  2.35     (b) reducing morbidity or mortality; 
  2.36     (c) obtaining and disseminating statistics and information 
  3.1   relative to the treatment and prevention of diseases, illness 
  3.2   and injuries; 
  3.3      (d) developing and publishing guidelines showing the norms 
  3.4   of health care in the area or medical institution or in the 
  3.5   entity or organization that established the review organization; 
  3.6      (e) developing and publishing guidelines designed to keep 
  3.7   within reasonable bounds the cost of health care; 
  3.8      (f) reviewing the quality or cost of health care services 
  3.9   provided to enrollees of health maintenance organizations, 
  3.10  health service plans, preferred provider organizations, and 
  3.11  insurance companies; 
  3.12     (g) acting as a professional standards review organization 
  3.13  pursuant to United States Code, title 42, section 1320c-1 et 
  3.14  seq.; 
  3.15     (h) determining whether a professional shall be granted 
  3.16  staff privileges in a medical institution, membership in a state 
  3.17  or local association of professionals, or participating status 
  3.18  in a nonprofit health service plan corporation, health 
  3.19  maintenance organization, preferred provider organization, or 
  3.20  insurance company, or whether a professional's staff privileges, 
  3.21  membership, or participation status should be limited, suspended 
  3.22  or revoked; 
  3.23     (i) reviewing, ruling on, or advising on controversies, 
  3.24  disputes or questions between: 
  3.25     (1) health insurance carriers, nonprofit health service 
  3.26  plan corporations, health maintenance organizations, 
  3.27  self-insurers and their insureds, subscribers, enrollees, or 
  3.28  other covered persons; 
  3.29     (2) professional licensing boards and health providers 
  3.30  licensed by them; 
  3.31     (3) professionals and their patients concerning diagnosis, 
  3.32  treatment or care, or the charges or fees therefor; 
  3.33     (4) professionals and health insurance carriers, nonprofit 
  3.34  health service plan corporations, health maintenance 
  3.35  organizations, or self-insurers concerning a charge or fee for 
  3.36  health care services provided to an insured, subscriber, 
  4.1   enrollee, or other covered person; 
  4.2      (5) professionals or their patients and the federal, state, 
  4.3   or local government, or agencies thereof; 
  4.4      (j) providing underwriting assistance in connection with 
  4.5   professional liability insurance coverage applied for or 
  4.6   obtained by dentists, or providing assistance to underwriters in 
  4.7   evaluating claims against dentists; 
  4.8      (k) acting as a medical review agent under section 256B.04, 
  4.9   subdivision 15, or 256D.03, subdivision 7, paragraph (b); 
  4.10     (l) providing recommendations on the medical necessity of a 
  4.11  health service, or the relevant prevailing community standard 
  4.12  for a health service; 
  4.13     (m) reviewing a provider's professional practice as 
  4.14  requested by the data analysis unit under section 62J.32; 
  4.15     (n) providing quality assurance as required by United 
  4.16  States Code, title 42, sections 1396r(b)(1)(b) and 
  4.17  1395i-3(b)(1)(b) of the Social Security Act; 
  4.18     (o) providing information to group purchasers of health 
  4.19  care services when that information was originally generated 
  4.20  within the review organization for a purpose specified by this 
  4.21  subdivision; or 
  4.22     (p) providing information to other, affiliated or 
  4.23  nonaffiliated review organizations, when that information was 
  4.24  originally generated within the review organization for a 
  4.25  purpose specified by this subdivision, and as long as that 
  4.26  information will further the purposes of a review organization 
  4.27  as specified by this subdivision.