language to be deleted (2) new language
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.