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148.106 Peer review of services and fees.

Subdivision 1. Definitions. As used in this section, the term:

(a) "Accepted standards" for peer review of a licensed chiropractor means those standards of care, skill, and treatment which are recognized by a reasonably prudent similar health care provider as being acceptable under similar conditions and circumstances.

(b) "Appropriate chiropractic treatment" means a determination made of treatment and other services performed, which by virtue of a substantiated and properly diagnosed condition, appears to be of a type consistent with that diagnosis as reviewed by the peer review committee.

(c) "Unconscionable fees" means charges submitted for services performed that are unnecessary or unreasonable charges in the judgment of the peer review committee. In determining the unconscionability of costs, the committee may consider, among other appropriate factors, charges by health care providers other than chiropractors for the same or similar services.

(d) "Bill for treatment" means all services provided to a consumer, regardless of the monetary consideration paid to the health care provider.

(e) "Patient" means an individual who receives chiropractic treatment from a chiropractor.

(f) "Peer review" means an evaluation, based on accepted standards, by a peer review committee of the appropriateness, quality, utilization, and cost of health care and health services provided to a patient.

(g) "Peer review committee" means a committee of seven individuals, five of whom are chiropractors licensed under this chapter, two of whom are consumers, and none of whom is in a direct business relationship with the provider, insurer, or patient whose case is being reviewed. The committee shall be appointed by the executive director of the board or provided for by a contractual arrangement with the board, and may consist of different individuals for review of different cases.

(h) "Properly utilized services" means appropriate treatment services rendered, including frequency and duration, which are substantiated as being necessary and reasonable by clinical records and reports of the provider or any other facts or evidence pertinent to the controversy as reviewed by the peer review committee.

Subd. 2. Purpose. The board shall review directly or by contract information relating to certain chiropractic providers for the purposes identified in section 145.61.

It is the intention of the legislature that the peer review system and activities established under this chapter, including the board and the peer review committee and their officers, members, employees and agents, shall be exempt from challenge under federal or state antitrust laws or other similar laws in regulation of trade or commerce.

Subd. 3. Duties. The peer review committee shall advise the board as to its findings under subdivision 2. The peer review committee may hear, without qualification or threshold, any submission regarding the appropriateness, quality, or utilization of chiropractic services. The board may establish additional criteria for screening requests for peer review. The screening shall occur upon submission by a patient, the patient's representative, insurer, or chiropractor of an inquiry about a bill for treatment rendered to a patient by a health care provider.

Subd. 4. Fees for review. Any third party provider or chiropractor making a peer review request may be charged a fee to assist in defraying the administrative costs of performing the review.

Subd. 5. Conduct of review. Peer review occurs upon submission by a patient, the patient's representative, insurer, or chiropractor, in accordance with the procedures approved by the board, of an inquiry about a bill for treatment rendered to a patient by a chiropractor. The peer review committee shall examine each inquiry submitted to it and shall report its findings to the executive director of the board and furnish copies of the findings to the patient, chiropractor, and third-party payor. The findings of the peer review committee on each inquiry reviewed shall include a determination of whether or not the chiropractor properly utilized services and rendered or ordered appropriate treatment or services and whether or not the cost of the treatment was unconscionable.

Subd. 6. Annual report. An annual summary of the findings of the peer review committee shall be prepared by the committee and submitted to the board. The report may be made available to interested persons upon request and upon payment of necessary administrative costs to defray the expenses of reproduction. No report or summary submitted to the public by the board may disclose the name or identifier of any patient without the patient's consent.

Subd. 7. Treatment records. The acceptance of, or the request for, payment for treatment rendered to a patient by a doctor of chiropractic constitutes the consent of the doctor of chiropractic to the submission of all necessary records and other information concerning the treatment to the peer review committee.

Subd. 8. Rules. (a) The board may adopt rules it considers necessary and appropriate to implement the peer review system and activities established under this chapter.

(b) The decision by the board to refer the matter to a peer review committee, the establishment by the board of the procedures by which a peer review committee reviews the rendering of health care services, and the proceedings and findings of a peer review committee are not subject to the rulemaking provisions of chapter 14.

Subd. 9. Application of other law. (a) The provisions of section 145.62, apply to any person, firm, corporation, or other entity providing information to the board or the peer review committee.

(b) The provisions of section 145.63, apply to an officer, member, employee, or agent of the board and to an officer, member, employee, or agent of an entity with which the board has contracted under this section.

Subd. 10. Confidentiality of peer review records. All data and information acquired by the board or the peer review committee, in the exercise of its duties and functions, shall be subject to the same disclosure and confidentiality protections as provided for data and information of other review organizations under section 145.64. This subdivision does not limit or restrict the board or the peer review committee from fully performing their prescribed peer review duties and functions, nor does it apply to disciplinary and enforcement proceedings under sections 14.57 to 14.62, 148.10, 148.105, 214.10, and 214.11. The peer review committee shall file with the board a complaint against a health care provider if it determines that reasonable cause exists to believe the health care provider has violated any portion of this chapter or rules adopted under it, for which a licensed chiropractor may be disciplined. The peer review committee shall transmit all complaint information it possesses to the board. The data, information, and records are classified as private data on individuals for purposes of chapter 13. The patient records obtained by the board pursuant to this section must be used solely for the purposes of the board relating to peer review or the disciplinary process.

HIST: 1987 c 345 s 11

Official Publication of the State of Minnesota
Revisor of Statutes