Minnesota Session Laws - 1992, Regular Session

  

                         Laws of Minnesota 1992 

                        CHAPTER 400-S.F.No. 1900 
           An act relating to health; allowing nursing homes to 
          establish review organizations; including quality 
          assurance under medical assistance and Medicare as an 
          activity of a review organization; amending Minnesota 
          Statutes 1991 Supplement, section 145.61, subdivisions 
          4a and 5.  
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
    Section 1.  Minnesota Statutes 1991 Supplement, section 
145.61, subdivision 4a, is amended to read: 
    Subd. 4a.  "Administrative staff" means the staff of a 
hospital, clinic, nursing home, nonprofit health service plan 
corporation, or health maintenance organization. 
    Sec. 2.  Minnesota Statutes 1991 Supplement, 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, 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 a nursing home, 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; or 
     (m) providing quality assurance as required by United 
States Code, title 42, sections 1396r(b)(1)(b) and 
1395i-3(b)(1)(b) of the Social Security Act. 
    Presented to the governor April 2, 1992 
    Signed by the governor April 3, 1992, 2:50 p.m.