Minnesota Session Laws - 1991, Regular Session

  

                         Laws of Minnesota 1991 

                        CHAPTER 137-H.F.No. 1066 
           An act relating to health; modifying the definition of 
          and requirements related to review organizations; 
          amending Minnesota Statutes 1990, sections 145.61, 
          subdivisions 4a, 5, and by adding a subdivision; 
          145.63, subdivision 1; and 145.64. 
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1990, section 145.61, 
subdivision 4a, is amended to read: 
    Subd. 4a.  "Administrative staff" means the staff of a 
hospital or, clinic, nonprofit health service plan corporation, 
or health maintenance organization. 
    Sec. 2.  Minnesota Statutes 1990, section 145.61, is 
amended by adding a subdivision to read: 
    Subd. 4b.  "Consumer director" means a director of a health 
service plan corporation or health maintenance organization who 
is not a licensed or registered health care professional. 
    Sec. 3.  Minnesota Statutes 1990, section 145.61, 
subdivision 5, is amended to read: 
    Subd. 5.  "Review organization" means a nonprofit 
organization acting according to clause (k) or a committee whose 
membership is limited to professionals and, administrative 
staff, and consumer directors, except where otherwise provided 
for by state or federal law, and which is established by a 
hospital, by a clinic, by one or more state or local 
associations of professionals, by an organization of 
professionals from a particular area or medical institution, by 
a health maintenance organization as defined in chapter 62D, by 
a nonprofit health service plan corporation as defined in 
chapter 62C, by a professional standards review organization 
established pursuant to United States Code, title 42, section 
1320c-1 et seq., or by a medical review agent established to 
meet the requirements of section 256B.04, subdivision 15, or 
256D.03, subdivision 7, paragraph (b), or by the department of 
human services, to gather and review information relating to the 
care and treatment of patients for the purposes of: 
    (a) evaluating and improving the quality of health care 
rendered in the area or medical institution; 
    (b) reducing morbidity or mortality; 
    (c) obtaining and disseminating statistics and information 
relative to the treatment and prevention of diseases, illness 
and injuries; 
    (d) developing and publishing guidelines showing the norms 
of health care in the area or medical institution; 
    (e) developing and publishing guidelines designed to keep 
within reasonable bounds the cost of health care; 
    (f) reviewing the quality or cost of health care services 
provided to enrollees of health maintenance organizations, 
health service plans, and insurance companies; 
    (g) acting as a professional standards review organization 
pursuant to United States Code, title 42, section 1320c-1 et 
seq.; 
    (h) determining whether a professional shall be granted 
staff privileges in a medical institution, or participating 
status in a nonprofit health service plan corporation, health 
maintenance organization, or insurance company, or whether a 
professional's staff privileges or participation status should 
be limited, suspended or revoked; 
    (i) reviewing, ruling on, or advising on controversies, 
disputes or questions between: 
    (1) health insurance carriers, nonprofit health service 
plan corporations, or health maintenance organizations and their 
insureds, subscribers, or enrollees; 
    (2) professional licensing boards acting under their powers 
including disciplinary, license revocation or suspension 
procedures and health providers licensed by them when the matter 
is referred to a review committee by the professional licensing 
board; 
    (3) professionals and their patients concerning diagnosis, 
treatment or care, or the charges or fees therefor; 
    (4) professionals and health insurance carriers, nonprofit 
health service plan corporations, or health maintenance 
organizations concerning a charge or fee for health care 
services provided to an insured, subscriber, or enrollee; 
    (5) professionals or their patients and the federal, state, 
or local government, or agencies thereof; 
    (j) providing underwriting assistance in connection with 
professional liability insurance coverage applied for or 
obtained by dentists, or providing assistance to underwriters in 
evaluating claims against dentists; 
    (k) acting as a medical review agent under section 256B.04, 
subdivision 15, or 256D.03, subdivision 7, paragraph (b); or 
    (l) providing recommendations on the medical necessity of a 
health service, or the relevant prevailing community standard 
for a health service. 
    Sec. 4.  Minnesota Statutes 1990, section 145.63, 
subdivision 1, is amended to read: 
    Subdivision 1.  [MEMBERS, DIRECTORS, AND OFFICERS.] No 
review organization and no person who is a member or employee, 
director, or officer of, who acts in an advisory capacity to, or 
who furnishes counsel or services to, a review organization 
shall be liable for damages or other relief in any action 
brought by a person or persons whose activities have been or are 
being scrutinized or reviewed by a review organization, by 
reason of the performance by the person of any duty, function, 
or activity of such review organization, unless the performance 
of such duty, function or activity was motivated by malice 
toward the person affected thereby.  No review organization and 
no person shall be liable for damages or other relief in any 
action by reason of the performance of the review organization 
or person of any duty, function, or activity as a review 
organization or a member of a review committee or by reason of 
any recommendation or action of the review committee when the 
person acts in the reasonable belief that the action or 
recommendation is warranted by facts known to the person or the 
review organization after reasonable efforts to ascertain the 
facts upon which the review organization's action or 
recommendation is made, except that any corporation designated 
as a review organization under the Code of Federal Regulations, 
title 42, section 466 (1983) shall be subject to actions for 
damages or other relief by reason of any failure of a person, 
whose care or treatment is required to be scrutinized or 
reviewed by the review organization, to receive medical care or 
treatment as a result of a determination by the review 
organization that medical care was unnecessary or inappropriate. 
     The protections from liability provided in this subdivision 
shall also apply to the governing body of the review 
organization and shall not be waived as a result of referral of 
a matter from the review organization to the governing body or 
consideration by the governing body of decisions, 
recommendations, or documentation of the review organization. 
    Sec. 5.  Minnesota Statutes 1990, section 145.64, is 
amended to read: 
    145.64 [CONFIDENTIALITY OF RECORDS OF REVIEW ORGANIZATION.] 
    Subdivision 1.  [DATA AND INFORMATION.] All data and 
information acquired by a review organization, in the exercise 
of its duties and functions, shall be held in confidence, shall 
not be disclosed to anyone except to the extent necessary to 
carry out one or more of the purposes of the review 
organization, and shall not be subject to subpoena or 
discovery.  No person described in section 145.63 shall disclose 
what transpired at a meeting of a review organization except to 
the extent necessary to carry out one or more of the purposes of 
a review organization.  The proceedings and records of a review 
organization shall not be subject to discovery or introduction 
into evidence in any civil action against a professional arising 
out of the matter or matters which are the subject of 
consideration by the review organization.  Information, 
documents or records otherwise available from original sources 
shall not be immune from discovery or use in any civil action 
merely because they were presented during proceedings of a 
review organization, nor shall any person who testified before a 
review organization or who is a member of it be prevented from 
testifying as to matters within the person's knowledge, but a 
witness cannot be asked about the witness' testimony before a 
review organization or opinions formed by the witness as a 
result of its hearings.  The provisions of this section shall 
not apply to a review organization of the type described in 
section 145.61, subdivision 5, clause (h).  
    The confidentiality protection and protection from 
discovery or introduction into evidence provided in this 
subdivision shall also apply to the governing body of the review 
organization and shall not be waived as a result of referral of 
a matter from the review organization to the governing body or 
consideration by the governing body of decisions, 
recommendations, or documentation of the review organization.  
    Subd. 2.  [PROVIDER DATA.] The restrictions in subdivision 
1 shall not apply to professionals requesting or seeking through 
discovery, data, information, or records relating to their 
medical staff privileges or participation status. 
    Presented to the governor May 17, 1991 
    Signed by the governor May 21, 1991, 1:33 p.m.