1999 Minnesota Statutes

     62M.07 Prior authorization of services. 

    (a) Utilization review organizations conducting prior 
 authorization of services must have written standards that meet 
 at a minimum the following requirements: 

    (1) written procedures and criteria used to determine 
 whether care is appropriate, reasonable, or medically necessary; 

    (2) a system for providing prompt notification of its 
 determinations to enrollees and providers and for notifying the 
 provider, enrollee, or enrollee's designee of appeal procedures 
 under clause (4); 

    (3) compliance with section 62M.05, subdivisions 3a and 3b, 
 regarding time frames for approving and disapproving prior 
 authorization requests; 

    (4) written procedures for appeals of denials of prior 
 authorization which specify the responsibilities of the enrollee 
 and provider, and which meet the requirements of sections 62M.06 
 and 72A.285, regarding release of summary review findings; and 

    (5) procedures to ensure confidentiality of 
 patient-specific information, consistent with applicable law. 

    (b) No utilization review organization, health plan 
 company, or claims administrator may conduct or require prior 
 authorization of emergency confinement or emergency treatment.  
 The enrollee or the enrollee's authorized representative may be 
 required to notify the health plan company, claims 
 administrator, or utilization review organization as soon after 
 the beginning of the emergency confinement or emergency 
 treatment as reasonably possible. 

    HIST: 1992 c 574 s 7; 1994 c 485 s 65; 1995 c 234 art 8 s 12; 
 1999 c 239 s 25 

*   NOTE:  The amendment to this section by Laws 1999, chapter 
*239, section 25, is effective April 1, 2000, and applies to 
*contracts issued or renewed on or after that date.  Upon 
*request, the commissioner of health or commerce shall grant an 
*extension of up to three months to any health plan company or 
*utilization review organization that is unable to comply with 
*Laws 1999, chapter 239, sections 1, 3 to 42, and 43, paragraphs 
*(a) and (c) by April 1, 2000, due to circumstances beyond the 
*control of the health plan company or utilization review 
*organization.  Laws 1999, chapter 239, section 44.