1997 Minnesota Statutes

     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