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Office of the Revisor of Statutes

Key: (1) language to be deleted (2) new language

                            CHAPTER 140-S.F.No. 641 
                  An act relating to utilization review organizations; 
                  requiring a peer of the treating mental health or 
                  substance abuse provider to review a utilization 
                  review organization's determination not to certify a 
                  mental health or substance abuse service; amending 
                  Minnesota Statutes 1996, section 62M.09, subdivision 
                  3, and by adding a subdivision. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1996, section 62M.09, 
        subdivision 3, is amended to read: 
           Subd. 3.  [PHYSICIAN REVIEWER INVOLVEMENT.] A physician 
        must review all cases in which the utilization review 
        organization has concluded that a determination not to certify 
        for clinical reasons is appropriate.  The physician should be 
        reasonably available by telephone to discuss the determination 
        with the attending physician.  This subdivision does not apply 
        to outpatient mental health or substance abuse services governed 
        by subdivision 3a.  
           Sec. 2.  Minnesota Statutes 1996, section 62M.09, is 
        amended by adding a subdivision to read: 
           Subd. 3a.  [MENTAL HEALTH AND SUBSTANCE ABUSE REVIEWS.] A 
        peer of the treating mental health or substance abuse provider 
        or a physician must review requests for outpatient services in 
        which the utilization review organization has concluded that a 
        determination not to certify a mental health or substance abuse 
        service for clinical reasons is appropriate, provided that any 
        final determination not to certify treatment is made by a 
        psychiatrist certified by the American Board of Psychiatry and 
        Neurology, and appropriately licensed in the state in which the 
        psychiatrist resides. Notwithstanding the notification 
        requirements of section 62M.05, a utilization review 
        organization that has made an initial decision to certify in 
        accordance with the requirements of section 62M.05 may elect to 
        provide notification of a determination to continue coverage 
        through facsimile or mail. 
           Presented to the governor May 9, 1997 
           Signed by the governor May 12, 1997, 11:06 a.m.