Minnesota Session Laws - 1990, Regular Session

  

                         Laws of Minnesota 1990 

                        CHAPTER 534-S.F.No. 1790 
           An act relating to health; creating a technology 
          assistance review panel; establishing a legislative 
          task force to study the regulation of health insurance 
          premium rates and health care costs; appropriating 
          money; proposing coding for new law in Minnesota 
          Statutes, chapter 256. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
     Section 1.  [256.9691] [TECHNOLOGY ASSISTANCE REVIEW 
PANEL.] 
    Subdivision 1.  [ESTABLISHMENT.] The commissioner of health 
shall establish a technology assistance review panel to resolve 
disputes over the provision of health care benefits for 
technology-assisted persons who receive benefits under a policy 
or plan of health, medical, hospitalization, or accident and 
sickness insurance regulated under chapter 62A, a subscriber 
contract of a nonprofit health service plan corporation 
regulated under chapter 62C, or a certificate of coverage of a 
health maintenance organization regulated under chapter 62D. 
    Subd. 2.  [DEFINITION.] For purposes of this section, 
"technology-assisted person" means a person who: 
    (1) has a chronic health condition; 
    (2) requires the routine use of a medical device to 
compensate for the loss of a life-sustaining body function; and 
    (3) requires ongoing care or monitoring by trained 
personnel on a daily basis. 
    Subd. 3.  [STEERING COMMITTEE.] The commissioner shall 
appoint a seven-member steering committee to appoint the review 
panel members, develop policies and procedures for the review 
process, including the replacement of review panel members, 
serve as a liaison between the regulatory agencies and the 
review panel, and provide the review panel with technical 
assistance.  The steering committee shall consist of 
representatives of the departments of health, human services, 
and commerce; a health maintenance organization regulated under 
chapter 62D; an insurer regulated under chapter 62A or a health 
service plan corporation regulated under chapter 62C; an 
advocacy organization representing persons who are technology 
assisted; and a tertiary care center that serves 
technology-assisted persons.  The steering committee shall not 
be reimbursed for any expenses as defined under section 15.0575, 
subdivision 3.  The steering committee shall dissolve no later 
than June 30, 1992. 
    Subd. 4.  [COMPOSITION OF REVIEW PANEL.] (a) The review 
panel shall be appointed by the members of the steering 
committee that do not represent state agencies and must include: 
    (1) a medical director from an insurer regulated under 
chapter 62A, a health service plan corporation regulated under 
chapter 62C, or a health maintenance organization regulated 
under chapter 62D; 
     (2) a contract benefits analyst from an insurer regulated 
under chapter 62A, a health service plan corporation regulated 
under chapter 62C, or a health maintenance organization 
regulated under chapter 62D; 
     (3) a consumer board member of an insurer regulated under 
chapter 62A, a health service plan corporation regulated under 
chapter 62C, or a health maintenance organization regulated 
under chapter 62D; 
     (4) a physician with expertise in providing care for 
technology-assisted persons in a nonhospital setting; 
     (5) a registered nurse with expertise in providing care for 
technology-assisted persons in a nonhospital setting; and 
    (6) a consumer of health care benefits regulated under 
chapter 62A, 62C, or 62D who is a technology-assisted person or 
the parent or guardian of a technology-assisted person. 
    (b) The term of service for review panel members is three 
years except that, for the initial appointment, the steering 
committee shall establish procedures to assure that the terms of 
the members are staggered.  Members are eligible to serve two 
consecutive terms. 
     Subd. 5.  [AUTHORITY.] The review panel may review cases 
involving disputes over the provision of contract benefits 
regarding discharge planning, home health care benefits 
eligibility and coverage, or changes in the level of home health 
care services for technology-assisted persons.  The review may 
be requested by a third-party payor, a health or social service 
professional, or a parent or guardian of a technology-assisted 
child or a technology-assisted adult.  For the case to be 
eligible for review by the panel, the parent or guardian of a 
technology-assisted child or technology-assisted adult must 
consent to the review.  The review panel may not review cases 
involving discharge to a long-term care facility or cases 
involving coverage by title 18 or 19 of the Social Security Act 
or other public funding sources.  The review panel may seek 
advice from experts outside the membership of the panel as 
necessary.  The internal grievance process within an insurer, 
health service plan corporation, or health maintenance 
organization, except binding arbitration, must be exhausted 
before requesting a review by the review panel.  The 
recommendations of the review panel are not binding.  If, 
following a review by the review panel, a complaint is filed 
with the appropriate state agency regarding the same subject 
matter, the findings of the review panel must be made available 
to the agency upon request and with the consent of the parent or 
guardian of a technology-assisted child or technology-assisted 
adult.  The information must be maintained by the agency as 
nonpublic information under chapter 13.  The steering committee 
may establish policies for reimbursement of expenses for review 
panel members consistent with the provisions of section 15.0575, 
subdivision 3. 
    Subd. 6.  [CONFIDENTIALITY.] All proceedings of the review 
organization are nonpublic under chapter 13.  All data, 
information, and findings acquired and developed by the review 
panel in the exercise of its duties or functions must be held in 
confidence, may not be disclosed to anyone except to the extent 
necessary to carry out one or more of the purposes of the review 
panel or as described in subdivision 5, and are not subject to 
subpoena or discovery.  Members of the review panel may not 
disclose what transpired at a meeting of the review panel except 
to the extent necessary to carry out one or more of the purposes 
of the review panel.  The proceedings and record of the review 
panel are not subject to discovery or introduction into evidence 
in any civil action against a health care professional or 
insurer, health service plan corporation, or health maintenance 
organization, arising out of the matter or matters that are the 
subject of consideration by the review panel. 
    Subd. 7.  [LIMITATION ON LIABILITY FOR MEMBERS OF STEERING 
COMMITTEE AND REVIEW PANEL.] A person who is a member of, or who 
acts in an advisory capacity to or who gives counsel or services 
to, the steering committee or review panel is not liable for 
damages or other relief in any action brought by a person or 
persons whose case has been reviewed by the panel, by reason of 
the performance of any duty, function, or activity of the review 
panel, unless the performance of the duty, function, or activity 
was motivated by malice toward the person affected.  A member is 
not liable for damages or other relief in any action by reason 
of the performance of the member of any duty, function, or 
activity as a member of the steering committee or review panel 
or by reason of any recommendation or action of the review 
committee when the member acts in the reasonable belief that the 
action or recommendation is warranted by the facts known to the 
member or review panel after reasonable efforts to ascertain the 
facts. 
    Sec. 2.  [LEGISLATIVE TASK FORCE ON HEALTH AND INSURANCE 
COSTS.] 
    Subdivision 1. [LEGISLATIVE TASK FORCE ESTABLISHED.] The 
legislative task force on health and insurance costs and cost 
containment practices consists of five members of the house of 
representatives appointed by the speaker of the house and five 
members of the senate appointed by the subcommittee on 
committees of the senate rules and administration committee.  At 
least two of the house members and at least two of the senate 
members must be from the minority caucus. 
    Subd. 2.  [CHAIR.] The members of the task force shall 
elect one member to serve as chair of the task force. 
    Subd. 3.  [STAFF.] The task force shall use legislative 
staff to carry out its duties. 
    Subd. 4.  [DUTIES OF THE LEGISLATIVE TASK FORCE.] (a) The 
legislative task force shall collect and analyze information on 
health insurance and health maintenance organization premiums, 
including information on increases in premiums, reasons for the 
increases, standards and methods the insurance industry and 
health maintenance organizations use to establish premiums, 
geographic differences in rates, and insurance industry 
practices related to cost containment.  The task force shall 
evaluate current methods of regulating health insurance and 
health maintenance organization premiums under Minnesota law to 
determine whether these methods provide adequate protection 
against unreasonable increases in premium rates.  The task force 
shall study industry cost containment practices, including 
utilization review issues, to evaluate their impact on the 
insurance and health coverage subscribers receive. 
    (b) The legislative task force shall study recent increases 
in health costs and their effects upon the ability of state 
residents to obtain health care.  The task force shall examine 
reasons for increases in health care costs and the feasibility 
of imposing limits on costs at the state level. 
    (c) In evaluating health insurance premiums, health care 
costs, and utilization review activities, the legislature shall 
seek testimony and comments from consumer groups and groups 
representing the insurance and health care industries and health 
maintenance organizations. 
    (d) The task force shall examine the feasibility of 
developing state mechanisms to regulate health insurance and 
health maintenance organization premiums and health care costs.  
The task force shall study the issue of state regulation of 
utilization review activities to ensure appropriate consumer 
access and coverage for necessary health care. 
    (e) The task force shall develop methods to regulate and 
slow the rate of increases in health care costs and premiums for 
health insurance and health maintenance organizations, while 
ensuring continued access to appropriate health insurance 
coverage. 
    (f) The legislative task force shall study the denial of 
health care benefits to Minnesota consumers.  The task force 
shall review denial rates and appeals processes available to 
consumers.  The task force shall examine systems, processes, and 
standards of criteria used for medical necessity determinations 
by insurers.  The task force shall seek input from consumers, 
health care providers, and representatives of insurance and 
health maintenance organizations. 
    (g) The legislative task force shall study provider charges 
to determine why the charges increase at rates in excess of the 
general rate of inflation. 
    (h) The legislative task force shall study the procedures 
used by medical care providers for billing recipients of medical 
care when payment is to be made by a third-party payor. 
    Subd. 5.  [REPORT.] The task force shall submit a report on 
its findings and recommendations to the legislature by January 
1, 1991. 
     Sec. 3.  [APPROPRIATION.] 
    $34,000 is appropriated from the general fund to the 
commissioner of health for the fiscal year ending June 30, 1991, 
for the purpose of operating the technology assistance review 
panel under section 1.  The commissioner may contract with an 
organization or entity to provide administrative support 
services for the review panel. 
    Sec.  4.  [EFFECTIVE DATE.] 
    Sections 1, 2, and 3 are effective the day after final 
enactment. 
    Presented to the governor April 24, 1990 
    Signed by the governor April 26, 1990, 10:22 p.m.