language to be deleted (2) new language
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.