Minnesota Session Laws - 1999, Regular Session

                             CHAPTER 84-H.F.No. 463 
                  An act relating to health; providing for review of 
                  ambulance services and first responders; amending 
                  Minnesota Statutes 1998, section 145.61, subdivision 
                  5; proposing coding for new law in Minnesota Statutes, 
                  chapter 144E. 
        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
           Section 1.  [144E.32] [REVIEW ORGANIZATION.] 
           Subdivision 1.  [APPLICABLE LAW.] The provisions of 
        sections 145.61 to 145.67 apply to an ambulance service or first 
        responder review organization. 
           Subd. 2.  [REVIEW ORGANIZATION DEFINED.] A review 
        organization, as defined under section 145.61, includes a 
        committee of an ambulance service provider, a physician medical 
        director, a medical advisor, or ambulance supervisory personnel 
        who gather, create, and review information relating to the care 
        and treatment of patients in providing emergency medical care, 
        including employee performance reviews, quality assurance data, 
        and other ambulance service or first responder performance data 
        for ambulance services licensed under section 144E.10 or 144E.12 
        or first responders registered under section 144E.27, for the 
        purposes specified under section 145.61, subdivision 5. 
           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), a 
        committee as defined under section 144E.32, subdivision 2, 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, an ambulance service or first responder 
        service regulated under chapter 144E, 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 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, 
        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, health maintenance organizations, 
        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, 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 19, 1999 
           Signed by the governor April 22, 1999, 9:28 a.m.