1.1                          A bill for an act 
  1.2             relating to health; modifying review organization 
  1.3             provisions; allowing review organizations to 
  1.4             participate in Internet-based information sharing 
  1.5             systems; permitting the release of certain data by 
  1.6             review organizations; amending Minnesota Statutes 
  1.7             2000, sections 145.61, subdivision 5; and 145.64, 
  1.8             subdivision 1, and by adding a subdivision.  
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 2000, section 145.61, 
  1.11  subdivision 5, is amended to read: 
  1.12     Subd. 5.  [REVIEW ORGANIZATION.] "Review organization" 
  1.13  means a nonprofit organization acting according to clause (k), a 
  1.14  committee as defined under section 144E.32, subdivision 2, or a 
  1.15  committee whose membership is limited to professionals, 
  1.16  administrative staff, and consumer directors, except where 
  1.17  otherwise provided for by state or federal law, and which is 
  1.18  established by one or more of the following:  a hospital, a 
  1.19  clinic, a nursing home, an ambulance service or first responder 
  1.20  service regulated under chapter 144E, one or more state or local 
  1.21  associations of professionals, an organization of professionals 
  1.22  from a particular area or medical institution, a health 
  1.23  maintenance organization as defined in chapter 62D, a community 
  1.24  integrated service network as defined in chapter 62N, a 
  1.25  nonprofit health service plan corporation as defined in chapter 
  1.26  62C, a preferred provider organization, a professional standards 
  1.27  review organization established pursuant to United States Code, 
  2.1   title 42, section 1320c-1 et seq., a medical review agent 
  2.2   established to meet the requirements of section 256B.04, 
  2.3   subdivision 15, or 256D.03, subdivision 7, paragraph (b), the 
  2.4   department of human services, a health provider cooperative 
  2.5   operating under sections 62R.17 to 62R.26, or a nonprofit 
  2.6   corporation organized under chapter 317A that owns, operates, or 
  2.7   is established by one or more of the above referenced entities, 
  2.8   to gather and review information relating to the care and 
  2.9   treatment of patients for the purposes of: 
  2.10     (a) evaluating and improving the quality and safety of 
  2.11  health care rendered in the area or medical institution or by 
  2.12  the entity or organization that established the review 
  2.13  organization; 
  2.14     (b) reducing morbidity or mortality; 
  2.15     (c) obtaining and disseminating statistics and information 
  2.16  relative to the safety of health care rendered to individuals 
  2.17  and to the treatment and prevention of diseases, illness and 
  2.18  injuries; 
  2.19     (d) developing and publishing guidelines showing the norms 
  2.20  of health care in the area or medical institution or in the 
  2.21  entity or organization that established the review organization; 
  2.22     (e) developing and publishing guidelines designed to keep 
  2.23  within reasonable bounds the cost of health care; 
  2.24     (f) developing and publishing guidelines designed to 
  2.25  improve the safety of health care rendered to individuals; and 
  2.26  reviewing the safety, quality, or cost of health care services 
  2.27  provided to enrollees of health maintenance organizations, 
  2.28  community integrated service networks, health service plans, 
  2.29  preferred provider organizations, and insurance companies; 
  2.30     (g) acting as a professional standards review organization 
  2.31  pursuant to United States Code, title 42, section 1320c-1 et 
  2.32  seq.; 
  2.33     (h) determining whether a professional shall be granted 
  2.34  staff privileges in a medical institution, membership in a state 
  2.35  or local association of professionals, or participating status 
  2.36  in a nonprofit health service plan corporation, health 
  3.1   maintenance organization, community integrated service network, 
  3.2   preferred provider organization, or insurance company, or 
  3.3   whether a professional's staff privileges, membership, or 
  3.4   participation status should be limited, suspended or revoked; 
  3.5      (i) reviewing, ruling on, or advising on controversies, 
  3.6   disputes or questions between: 
  3.7      (1) health insurance carriers, nonprofit health service 
  3.8   plan corporations, health maintenance organizations, community 
  3.9   integrated service networks, self-insurers and their insureds, 
  3.10  subscribers, enrollees, or other covered persons; 
  3.11     (2) professional licensing boards and health providers 
  3.12  licensed by them; 
  3.13     (3) professionals and their patients concerning diagnosis, 
  3.14  treatment or care, or the charges or fees therefor; 
  3.15     (4) professionals and health insurance carriers, nonprofit 
  3.16  health service plan corporations, health maintenance 
  3.17  organizations, community integrated service networks, or 
  3.18  self-insurers concerning a charge or fee for health care 
  3.19  services provided to an insured, subscriber, enrollee, or other 
  3.20  covered person; 
  3.21     (5) professionals or their patients and the federal, state, 
  3.22  or local government, or agencies thereof; 
  3.23     (j) providing underwriting assistance in connection with 
  3.24  professional liability insurance coverage applied for or 
  3.25  obtained by dentists, or providing assistance to underwriters in 
  3.26  evaluating claims against dentists; 
  3.27     (k) acting as a medical review agent under section 256B.04, 
  3.28  subdivision 15, or 256D.03, subdivision 7, paragraph (b); 
  3.29     (l) providing recommendations on the medical necessity of a 
  3.30  health service, or the relevant prevailing community standard 
  3.31  for a health service; 
  3.32     (m) providing quality assurance as required by United 
  3.33  States Code, title 42, sections 1396r(b)(1)(b) and 
  3.34  1395i-3(b)(1)(b) of the Social Security Act; 
  3.35     (n) providing information to group purchasers of health 
  3.36  care services when that information was originally generated 
  4.1   within the review organization for a purpose specified by this 
  4.2   subdivision; or 
  4.3      (o) providing information to other, affiliated or 
  4.4   nonaffiliated review organizations, when that information was 
  4.5   originally generated within the review organization for a 
  4.6   purpose specified by this subdivision, and as long as that 
  4.7   information will further the purposes of a review organization 
  4.8   as specified by this subdivision; or 
  4.9      (p) participating in a standardized incident reporting 
  4.10  system, including Internet-based applications, to share 
  4.11  information for the purpose of identifying and analyzing trends 
  4.12  in medical error and iatrogenic injury. 
  4.13     Sec. 2.  Minnesota Statutes 2000, section 145.64, 
  4.14  subdivision 1, is amended to read: 
  4.15     Subdivision 1.  [DATA AND INFORMATION.] All (a) Except as 
  4.16  provided in subdivision 2 or 4, data and information acquired by 
  4.17  a review organization, in the exercise of its duties and 
  4.18  functions, or by an individual or other entity acting at the 
  4.19  direction of a review organization, shall be held in confidence, 
  4.20  shall not be disclosed to anyone except to the extent necessary 
  4.21  to carry out one or more of the purposes of the review 
  4.22  organization, and shall not be subject to subpoena or 
  4.23  discovery.  No person described in section 145.63 shall disclose 
  4.24  what transpired at a meeting of a review organization except to 
  4.25  the extent necessary to carry out one or more of the purposes of 
  4.26  a review organization.  The proceedings and records of a review 
  4.27  organization shall not be subject to discovery or introduction 
  4.28  into evidence in any civil action against a professional arising 
  4.29  out of the matter or matters which are the subject of 
  4.30  consideration by the review organization.  Information, 
  4.31  documents or records otherwise available from original sources 
  4.32  shall not be immune from discovery or use in any civil action 
  4.33  merely because they were presented during proceedings of a 
  4.34  review organization, nor shall any person who testified before a 
  4.35  review organization or who is a member of it be prevented from 
  4.36  testifying as to matters within the person's knowledge, but a 
  5.1   witness cannot be asked about the witness' testimony before a 
  5.2   review organization or opinions formed by the witness as a 
  5.3   result of its hearings.  For purposes of this subdivision, 
  5.4   records of a review organization include Internet-based data 
  5.5   derived from data shared for the purposes of participating in 
  5.6   the standardized incident reporting system described in section 
  5.7   145.61, subdivision 5, clause (p).  A review organization may 
  5.8   release data that do not identify individual patients and that 
  5.9   are aggregate trend data on medical errors and iatrogenic 
  5.10  injuries without violating this section; being subjected to a 
  5.11  penalty under section 145.66; or compromising the protections 
  5.12  provided by chapter 145 to the reporter of such data, the review 
  5.13  organization and its sponsoring organizations and members, and 
  5.14  the underlying data and reports.  
  5.15     (b) The confidentiality protection and protection from 
  5.16  discovery or introduction into evidence provided in this 
  5.17  subdivision shall also apply to the governing body of the review 
  5.18  organization and shall not be waived as a result of referral of 
  5.19  a matter from the review organization to the governing body or 
  5.20  consideration by the governing body of decisions, 
  5.21  recommendations, or documentation of the review organization. 
  5.22     (c) The governing body of a hospital, health maintenance 
  5.23  organization, or community integrated service network, that is 
  5.24  owned or operated by a governmental entity, may close a meeting 
  5.25  to discuss decisions, recommendations, deliberations, or 
  5.26  documentation of the review organization.  A meeting may not be 
  5.27  closed except by a majority vote of the governing body in a 
  5.28  public meeting.  The closed meeting must be tape recorded and 
  5.29  the tape must be retained by the governing body for five years.  
  5.30     Sec. 3.  Minnesota Statutes 2000, section 145.64, is 
  5.31  amended by adding a subdivision to read: 
  5.32     Subd. 4.  [STANDARDIZED INCIDENT REPORTING SYSTEM DATA.] A 
  5.33  review organization that is participating in a standardized 
  5.34  incident reporting system described in section 145.61, 
  5.35  subdivision 5, clause (p), may release data for purposes of 
  5.36  participating in the reporting system provided that the data do 
  6.1   not identify any individual and are not released in a manner in 
  6.2   which an individual may be identified.