1.1                          A bill for an act 
  1.2             relating to utilization review organizations; 
  1.3             requiring a peer of the treating mental health or 
  1.4             substance abuse provider to review a utilization 
  1.5             review organization's determination not to certify a 
  1.6             mental health or substance abuse service; amending 
  1.7             Minnesota Statutes 1996, section 62M.09, subdivision 
  1.8             3, and by adding a subdivision. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1996, section 62M.09, 
  1.11  subdivision 3, is amended to read: 
  1.12     Subd. 3.  [PHYSICIAN REVIEWER INVOLVEMENT.] A physician 
  1.13  must review all cases in which the utilization review 
  1.14  organization has concluded that a determination not to certify 
  1.15  for clinical reasons is appropriate.  The physician should be 
  1.16  reasonably available by telephone to discuss the determination 
  1.17  with the attending physician.  This subdivision does not apply 
  1.18  to outpatient mental health or substance abuse services governed 
  1.19  by subdivision 3a.  
  1.20     Sec. 2.  Minnesota Statutes 1996, section 62M.09, is 
  1.21  amended by adding a subdivision to read: 
  1.22     Subd. 3a.  [MENTAL HEALTH AND SUBSTANCE ABUSE REVIEWS.] A 
  1.23  peer of the treating mental health or substance abuse provider 
  1.24  must review all requests for outpatient services in which the 
  1.25  utilization review organization has concluded that a 
  1.26  determination not to certify a mental health or substance abuse 
  1.27  service for clinical reasons is appropriate and an appeal has 
  2.1   been made by the treating provider, enrollee, or designee.