1.1                          A bill for an act 
  1.2             relating to insurance; automobile; regulating medical 
  1.3             expense benefits; authorizing reparation obligors to 
  1.4             offer medical expense benefits through certified 
  1.5             managed care plans; authorizing the commissioner of 
  1.6             commerce to certify these plans; requiring appropriate 
  1.7             premium reductions; requiring rules; amending 
  1.8             Minnesota Statutes 1994, section 65B.49, subdivision 
  1.9             2; proposing coding for new law in Minnesota Statutes, 
  1.10            chapter 65B. 
  1.11  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.12     Section 1.  [65B.445] [MANAGED CARE.] 
  1.13     Subdivision 1.  [APPLICATION.] A person or entity may make 
  1.14  written application to the commissioner to have a plan certified 
  1.15  that provides managed care for medical expense benefits 
  1.16  compensable under this chapter.  Each application for 
  1.17  certification must be accompanied by a reasonable fee prescribed 
  1.18  by the commissioner of commerce.  A certificate is valid for the 
  1.19  period the commissioner prescribes unless it is revoked or 
  1.20  suspended.  Application for certification must be made in the 
  1.21  form and manner and must set forth information regarding the 
  1.22  proposed plan for providing services as the commissioner may 
  1.23  prescribe.  A plan may be certified to provide services in a 
  1.24  limited geographic area.  The information must include, but not 
  1.25  be limited to: 
  1.26     (1) a list of the names of all health care providers who 
  1.27  will provide services under the managed care plan, together with 
  1.28  appropriate evidence of compliance with any licensing or 
  2.1   certification requirements for those providers to practice in 
  2.2   this state; 
  2.3      (2) a description of the places and manner of providing 
  2.4   services under the plan; and 
  2.5      (3) satisfactory evidence of ability to comply with any 
  2.6   financial requirements the commissioner prescribes to ensure 
  2.7   delivery of service according to the plan.  
  2.8      Subd. 2.  [CERTIFICATION.] The commissioner shall certify a 
  2.9   managed care plan if the commissioner finds that the plan: 
  2.10     (1) proposes to provide quality services that meet uniform 
  2.11  treatment standards adopted in rule by the commissioner of 
  2.12  commerce, and all medical and health care services that may be 
  2.13  required by this chapter in a manner that is timely, effective, 
  2.14  and convenient for the injured person; 
  2.15     (2) is reasonably geographically convenient to the injured 
  2.16  persons it serves; 
  2.17     (3) provides appropriate financial incentives to reduce 
  2.18  service costs and utilization without sacrificing the quality of 
  2.19  service; 
  2.20     (4) provides adequate methods of peer review, utilization 
  2.21  review, and dispute resolution to prevent inappropriate, 
  2.22  excessive, or not medically necessary treatment, to exclude 
  2.23  participation in the plan those individuals who violate these 
  2.24  treatment standards; 
  2.25     (5) provides a procedure for the resolution of medical 
  2.26  disputes; 
  2.27     (6) provides a timely and accurate method of collecting and 
  2.28  maintaining necessary information regarding medical and health 
  2.29  care service cost and utilization to enable the commissioner to 
  2.30  determine the effectiveness of the plan; 
  2.31     (7) authorizes necessary emergency medical treatment for an 
  2.32  injury provided by a health care provider not a part of the 
  2.33  managed care plan; 
  2.34     (8) does not discriminate against or exclude from 
  2.35  participation in the plan any category of health care provider 
  2.36  and includes an adequate number of each category of health care 
  3.1   providers to give injured persons convenient geographic 
  3.2   accessibility to all categories of providers; and 
  3.3      (9) complies with any other requirement the commissioner 
  3.4   determines is necessary to provide quality medical services and 
  3.5   health care to injured persons. 
  3.6      Subd. 3.  [REVOCATION, SUSPENSION, AND REFUSAL TO CERTIFY.] 
  3.7   The commissioner shall refuse to certify or shall revoke or 
  3.8   suspend the certification of a managed care plan if the 
  3.9   commissioner finds that:  (1) the plan for providing medical or 
  3.10  health care services fails to meet the requirements of this 
  3.11  section; or (2) service under the plan is not being provided 
  3.12  according to the terms of a certified plan. 
  3.13     Subd. 4.  [REVIEW.] Utilization review, quality assurance 
  3.14  and peer review activities according to this section, and 
  3.15  authorization of medical services to be provided by other than a 
  3.16  member of the managed care plan, are subject to review by the 
  3.17  commissioner.  Data generated by or received in connection with 
  3.18  these activities, including written reports, notes, or records 
  3.19  of these activities or of the commissioner's review, are 
  3.20  confidential, and must be disclosed except as considered 
  3.21  necessary by the commissioner in the administration of this 
  3.22  section.  
  3.23     Subd. 5.  [USE OF DATA.] No data generated by, or received 
  3.24  in connection with, a review under subdivision 4 shall be used 
  3.25  in an action, suit, or proceeding except to the extent 
  3.26  considered necessary by the commissioner in the administration 
  3.27  of this section.  The commissioner may report professional 
  3.28  misconduct to an appropriate licensing board.  
  3.29     Subd. 6.  [CIVIL LIABILITY PRIVILEGES.] A person 
  3.30  participating in a review according to subdivision 4 must not be 
  3.31  examined as to any communication made in the course of these 
  3.32  activities or their findings, nor is a person subject to an 
  3.33  action for civil damages for affirmative actions taken or 
  3.34  statements made in good faith. 
  3.35     Subd. 7.  [INTENT TO FORM ORGANIZATION; CIVIL LIABILITY.] 
  3.36  No person who participates in forming managed care plans, 
  4.1   collectively negotiates fees, or otherwise solicits or enters 
  4.2   into contracts in a good faith effort to provide medical or 
  4.3   health care services according to this section shall be examined 
  4.4   or subject to administrative or civil liability regarding 
  4.5   participation except under the commissioner's active supervision 
  4.6   of the activities and the managed care organization.  Before 
  4.7   engaging in these activities, the person shall provide notice of 
  4.8   intent to the commissioner on a prescribed form.  
  4.9      Subd. 8.  [MEDICAL RECORD CONFIDENTIALITY.] This section 
  4.10  does not affect the confidentiality or admission in evidence of 
  4.11  a claimant's medical treatment records. 
  4.12     Subd. 9.  [RULES.] The commissioner shall adopt rules 
  4.13  necessary to implement this section including rules regulating 
  4.14  the form and content of notices to insureds regarding the 
  4.15  precise consequences of electing to obtain medical expense 
  4.16  benefits through certified managed care plans. 
  4.17     Sec. 2.  Minnesota Statutes 1994, section 65B.49, 
  4.18  subdivision 2, is amended to read: 
  4.19     Subd. 2.  [BASIC ECONOMIC LOSS.] Each plan of reparation 
  4.20  security shall provide for payment of basic economic loss 
  4.21  benefits.  A reparation obligor may make available a policy 
  4.22  endorsement that provides medical expense benefits under section 
  4.23  65B.44, subdivision 2, solely through managed care plans 
  4.24  certified under section 65B.445.  If made available, the insured 
  4.25  may elect this policy endorsement at the time of the policy 
  4.26  application or renewal.  Once elected, this policy endorsement 
  4.27  remains effective for as long as the policy is in effect, or 
  4.28  until written revocation of it by the insured is received by the 
  4.29  reparation obligor.  
  4.30     The liability of a reparation obligor for medical expense 
  4.31  benefits provided through a managed care plan is limited to the 
  4.32  maximum fee allowed under the relative value fee schedule 
  4.33  adopted in rule by the commissioner of commerce. 
  4.34     In exchange for electing this policy endorsement, the 
  4.35  insured shall receive an appropriate premium reduction. 
  4.36     Sec. 3.  [EFFECTIVE DATE.] 
  5.1      Sections 1 and 2 are effective August 1, 1995, except for 
  5.2   the rulemaking authority, which is effective the day following 
  5.3   final enactment.