language to be deleted (2) new language
CHAPTER 497-H.F.No. 1496 An act relating to health; modifying the definition of review organization; allowing review organizations to provide information to purchasers and other review organizations; providing confidentiality protection and protection from discovery process for the transfer of the information; clarifying the scope of confidentiality of review organization records; exempting medical societies from reporting obligations when performing peer review functions; amending Minnesota Statutes 1992, sections 145.61, subdivision 5, and by adding a subdivision; 145.64, subdivision 1; and 147.111, subdivision 3. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. Minnesota Statutes 1992, section 145.61, is amended by adding a subdivision to read: Subd. 4c. [PREFERRED PROVIDER ORGANIZATION.] "Preferred provider organization" means an organization that contracts with insurance carriers or other entities to arrange a network of health care providers whose services are offered to the insureds or other covered persons. Sec. 2. Minnesota Statutes 1992, 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 one or more of the following: a hospital,
bya clinic, bya nursing home, byone or more state or local associations of professionals, byan organization of professionals from a particular area or medical institution, bya health maintenance organization as defined in chapter 62D, bya nonprofit health service plan corporation as defined in chapter 62C, a preferred provider organization, bya professional standards review organization established pursuant to United States Code, title 42, section 1320c-1 et seq., or bya medical review agent established to meet the requirements of section 256B.04, subdivision 15, or 256D.03, subdivision 7, paragraph (b), or bythe department of human services, or a corporation organized under chapter 317A that owns, operates, or is established by one or more of the above referenced entities, 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 or by the entity or organization that established the review organization; (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 or in the entity or organization that established the review organization; (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, preferred provider organizations, 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, membership in a state or local association of professionals, or participating status in a nonprofit health service plan corporation, health maintenance organization, preferred provider organization, or insurance company, or whether a professional's staff privileges, membership, 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, orhealth maintenance organizations, self-insurers and their insureds, subscribers, orenrollees, or other covered persons; (2) professional licensing boards and health providers licensed by them; (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, orhealth maintenance organizations, or self-insurers concerning a charge or fee for health care services provided to an insured, subscriber, orenrollee, or other covered person; (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); (l) providing recommendations on the medical necessity of a health service, or the relevant prevailing community standard for a health service; (m) reviewing a provider's professional practice as requested by the health care analysis unit under section 62J.32; or(n) 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; (o) providing information to group purchasers of health care services when that information was originally generated within the review organization for a purpose specified by this subdivision; or (p) providing information to other, affiliated or nonaffiliated review organizations, when that information was originally generated within the review organization for a purpose specified by this subdivision, and as long as that information will further the purposes of a review organization as specified by this subdivision. Sec. 3. Minnesota Statutes 1992, section 145.64, subdivision 1, is amended to read: Subdivision 1. [DATA AND INFORMATION.] All data and information acquired by a review organization, in the exercise of its duties and functions, or by an individual or other entity acting at the direction of a review organization, 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 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. Sec. 4. Minnesota Statutes 1992, section 147.111, subdivision 3, is amended to read: Subd. 3. [MEDICAL SOCIETIES.] A state or local medical society shall report to the board any termination, revocation, or suspension of membership or any other disciplinary action taken against a physician. If the society has received a complaint which might be grounds for discipline under sections 147.01 to 147.22 against a member physician on which it has not taken any disciplinary action, the society shall report the complaint and the reason why it has not taken action on it or shall direct the complainant to the board of medical practice. This subdivision does not apply to a medical society when it performs peer review functions as an agent of an outside entity, organization, or system. Sec. 5. [EFFECTIVE DATE.] This act is effective the day following final enactment. Presented to the governor April 20, 1994 Signed by the governor April 21, 1994, 12:04 p.m.