Minnesota Session Laws - 1994, Regular Session

                            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, 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, a preferred provider organization, 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, 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, or health maintenance organizations, 
        self-insurers and their insureds, subscribers, or enrollees, 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, or health maintenance 
        organizations, or self-insurers concerning a charge or fee for 
        health care services provided to an insured, subscriber, or 
        enrollee, 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.