Minnesota Session Laws - 1999, Regular Session

                             CHAPTER 51-H.F.No. 614 
                  An act relating to health; expanding the reserve 
                  corridor for community integrated service networks; 
                  modifying the definition of review organization; 
                  amending Minnesota Statutes 1998, sections 62N.28, 
                  subdivision 5; and 145.61, subdivision 5. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  Minnesota Statutes 1998, section 62N.28, 
        subdivision 5, is amended to read: 
           Subd. 5.  [NET WORTH CORRIDOR.] A community network shall 
        not maintain net worth that exceeds 2-1/2 three times the amount 
        required of the community network under subdivision 1.  
        Subdivision 4 is not relevant for purposes of this subdivision. 
           Sec. 2.  Minnesota Statutes 1998, section 145.61, 
        subdivision 5, is amended to read: 
           Subd. 5.  [REVIEW ORGANIZATION.] "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, a 
        clinic, a nursing home, one or more state or local associations 
        of professionals, an organization of professionals from a 
        particular area or medical institution, a health maintenance 
        organization as defined in chapter 62D, a community integrated 
        service network as defined in chapter 62N, a nonprofit health 
        service plan corporation as defined in chapter 62C, a preferred 
        provider organization, a professional standards review 
        organization established pursuant to United States Code, title 
        42, section 1320c-1 et seq., a medical review agent established 
        to meet the requirements of section 256B.04, subdivision 15, or 
        256D.03, subdivision 7, paragraph (b), the department of human 
        services, a health provider cooperative operating under sections 
        62R.17 to 62R.26, 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, 
        community integrated service networks, 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, community integrated service network, 
        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, health maintenance organizations, community 
        integrated service networks, self-insurers and their insureds, 
        subscribers, 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, health maintenance 
        organizations, community integrated service networks, or 
        self-insurers concerning a charge or fee for health care 
        services provided to an insured, subscriber, 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) 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; 
           (n) 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 
           (o) 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. 
           Presented to the governor April 12, 1999 
           Signed by the governor April 15, 1999, 10:45 a.m.