1998 Minnesota Statutes

     62Q.58 Access to specialty care. 

    Subdivision 1.    Standing referral.  A health plan 
 company shall establish a procedure by which an enrollee may 
 apply for a standing referral to a health care provider who is a 
 specialist if a referral to a specialist is required for 
 coverage.  This procedure for a standing referral must specify 
 the necessary criteria and conditions, which must be met in 
 order for an enrollee to obtain a standing referral. 

    Subd. 2.    Coordination of services.  A primary care 
 provider or primary care group shall remain responsible for 
 coordinating the care of an enrollee who has received a standing 
 referral to a specialist.  The specialist shall not make any 
 secondary referrals related to primary care services without 
 prior approval by the primary care provider or primary care 
 group.  However, an enrollee with a standing referral to a 
 specialist may request primary care services from that 
 specialist.  The specialist, in agreement with the enrollee and 
 primary care provider or primary care group, may elect to 
 provide primary care services to that enrollee according to 
 procedures established by the health plan company.  

    Subd. 3.    Disclosure.  Information regarding referral 
 procedures must be included in member contracts or certificates 
 of coverage and must be provided to an enrollee or prospective 
 enrollee by a health plan company upon request. 

    HIST: 1997 c 237 s 13