Subdivision 1. Scope.
As used in sections
the terms defined in this section
have the meanings given them.
Subd. 2. Professional.
"Professional" means a person licensed or registered to practice a
healing art under chapter 147 or 148, to practice dentistry under chapter 150A, to practice as a
pharmacist under chapter 151, or to practice podiatry under chapter 153.
Subd. 3. Professional service.
"Professional service" means service rendered by a
professional of the type such professional is licensed to perform.
Subd. 4. Health care.
"Health care" means professional services rendered by a professional
or an employee of a professional and services furnished by a hospital, sanitarium, nursing home
or other institution for the hospitalization or care of human beings.
Subd. 4a. Administrative staff.
"Administrative staff" means the staff of a hospital, clinic,
nursing home, nonprofit health service plan corporation, or health maintenance organization.
Subd. 4b. Consumer director.
"Consumer director" means a director of a health service
plan corporation or health maintenance organization who is not a licensed or registered health
Subd. 4c. Preferred provider organization.
"Preferred provider organization" means an
organization that contracts with insurance carriers or other entities to arrange a network of health
care providers whose services are offered to the insureds or other covered persons.
Subd. 5. Review organization.
"Review organization" means a nonprofit organization
acting according to clause (l), a committee as defined under section
144E.32, subdivision 2
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 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
, paragraph (b), the Department of Human Services, or a nonprofit corporation 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;
(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) developing and publishing guidelines designed to improve the safety of care provided
(g) reviewing the safety, 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;
(h) acting as a professional standards review organization pursuant to United States Code,
title 42, section 1320c-1 et seq.;
(i) 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
(j) 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
(k) 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;
(l) acting as a medical review agent under section
256B.04, subdivision 15
, paragraph (b);
(m) providing recommendations on the medical necessity of a health service, or the relevant
prevailing community standard for a health service;
(n) 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;
(o) 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;
(p) 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; or
(q) participating in a standardized incident reporting system, including Internet-based
applications, to share information for the purpose of identifying and analyzing trends in medical
error and iatrogenic injury.
History: 1971 c 283 s 1; 1974 c 295 s 1,2; 1975 c 73 s 1; 1976 c 173 s 49; 1982 c 424 s 133;
1982 c 546 s 1; 1985 c 184 s 1; 1989 c 282 art 3 s 30; 1991 c 137 s 1-3; 1992 c 400 s 1,2; 1992 c
549 art 7 s 6; 1993 c 345 art 3 s 18; 1994 c 497 s 1,2; 1996 c 305 art 1 s 37; 1996 c 451 art 4 s
24; 1999 c 51 s 2; 1999 c 84 s 2; 2001 c 7 s 33; 2001 c 120 s 1