reglab/housing_qa huggingface dataset:
MN Stat § 62L.21 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62L — Small Employer Insurance Reform|Section 62L.21 — Reinsurance Premiums.

62L.21 REINSURANCE PREMIUMS. Subdivision 1. Monthly premium. A health carrier ceding an individual to the reinsurance association shall be assessed a monthly reinsurance coverage premium that is 5.0 times the adjusted average market price. A health carrier ceding an entire group to the reinsurance association shall be assessed a monthly reinsurance coverage premium that is 1.5 times the adjusted average market price. The adjusted average market premium price must be established by the board of directors in accordance with its plan of operation. The board may consider benefit levels in establishing the reinsurance coverage premium. Subd. 2. Adjustment of premium rates. The board of directors shall establish operating rules to allocate adjustments to the reinsurance premium charge of no more than minus 25 percent of the monthly reinsurance premium for health carriers that can demonstrate administrative efficiencies and cost-effective handling of equivalent risks. The adjustment must be made monthly, unless the board provides for a different interval in its operating rules. The operating rules must establish objective and measurable criteria which must be met by a health carrier in order to be eligible for an adjustment. These criteria must include consideration of efficiency attributable to case management, but not consideration of such factors as provider discounts. Subd. 3. Liability for premium. A health carrier is liable for the cost of the reinsurance premium and may not directly charge the small employer for the costs. The reinsurance premium may be reflected only in the rating factors permitted in section 62L.08, as provided in section 62L.08, subdivision 10. History:  1992 c 549 art 2 s 21; 1994 c 625 art 10 s 48
MN Stat § 62L.23 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62L — Small Employer Insurance Reform|Section 62L.23 — Suspension Of Reinsurance Operations; Reactivation.

 62L.23 [Renumbered 62L.08, subd 11] 62L.23 SUSPENSION OF REINSURANCE OPERATIONS; REACTIVATION. Subdivision 1. Suspension. The commissioner may, by order, suspend the operation of sections 62L.13 to 62L.22, upon receipt of a recommendation for suspension from the association board of directors. The order is effective 30 days after publication in the State Register. Subd. 2. Suspension of reinsurance operations. Upon the issuance of an order issued pursuant to subdivision 1, the association shall suspend its operations in an orderly manner supervised by the commissioner and shall provide for the proper storage of the association's records. Notwithstanding the provisions of subdivision 1, the association may continue to levy assessments under section 62L.22 for the purpose of satisfying the association's presuspension expenses and the expenses associated with the association's suspension activities pursuant to this subdivision. The assessments must be approved by the commissioner. Subd. 3. No cancellation permitted. Effective upon the effective date of an order issued pursuant to subdivision 1, reinsurance must be terminated for any person reinsured by the association pursuant to section 62L.18. No health carrier may cancel or fail to renew a health benefit plan for any person whose reinsurance with the association has been terminated subsequently to the issuance of an order pursuant to subdivision 1 solely because of the termination of reinsurance. Subd. 4. Reactivation of reinsurance operations. The commissioner may, by order, reactivate the operation of sections 62L.13 to 62L.22, on a finding that the private market for reinsurance of health benefit plans has failed and that commercial reinsurance is unavailable to health carriers operating in the small employer market in Minnesota. The commissioner may not make findings or issue an order pursuant to this subdivision until a hearing is held pursuant to chapter 14. Subd. 5. Transition. After issuance of any order pursuant to subdivision 4, the commissioner shall immediately appoint an interim board of directors of the association. The terms of members of this interim board must be for a period not to exceed 18 months. The board shall cause the reinsurance operations of the association to be resumed within 180 days of an order issued pursuant to subdivision 4. Subd. 6. Modification of five-year rule. If the commissioner issues an order pursuant to subdivision 4, any health carrier may elect to participate in the reinsurance association, notwithstanding any departicipation by the health carrier within the preceding five years that, pursuant to section 62L.17, would have otherwise prohibited the health carrier's participation. History:   2001 c 215 s 23
MN Stat § 62M.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.01 — Citation, Jurisdiction, And Scope.

62M.01 CITATION, JURISDICTION, AND SCOPE. Subdivision 1. Popular name. This chapter may be cited as the "Minnesota Utilization Review Act of 1992." Subd. 2. Jurisdiction. This chapter applies to any insurance company licensed under chapter 60A to offer, sell, or issue a policy of accident and sickness insurance as defined in section 62A.01; a health service plan licensed under chapter 62C; a health maintenance organization licensed under chapter 62D; the Minnesota Comprehensive Health Association created under chapter 62E; a community integrated service network licensed under chapter 62N; an accountable provider network operating under chapter 62T; a fraternal benefit society operating under chapter 64B; a joint self-insurance employee health plan operating under chapter 62H; a multiple employer welfare arrangement, as defined in section 3 of the Employee Retirement Income Security Act of 1974 (ERISA), United States Code, title 29, section 1103, as amended; a third-party administrator licensed under section 60A.23, subdivision 8, that provides utilization review services for the administration of benefits under a health benefit plan as defined in section 62M.02; any other entity that provides, offers, or administers hospital, outpatient, medical, prescription drug, or other health benefits to individuals treated by a health professional under a policy, plan, or contract; or any entity performing utilization review on behalf of a business entity in this state pursuant to a health benefit plan covering a Minnesota resident. Subd. 3. Scope. (a) Nothing in this chapter applies to review of claims after submission to determine eligibility for benefits under a health benefit plan. The appeal procedure described in section 62M.06 applies to any complaint as defined under section 62Q.68, subdivision 2, that requires a medical determination in its resolution. (b) This chapter does not apply to managed care plans or county-based purchasing plans when the plan is providing coverage to state public health care program enrollees under chapter 256B or 256L. History:  1992 c 574 s 1; 1999 c 239 s 3; 2006 c 255 s 31; 2020 c 114 art 1 s 1,2; art 2 s 20
MN Stat § 62M.03 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.03 — Compliance With Standards.

62M.03 COMPLIANCE WITH STANDARDS. Subdivision 1. Licensed utilization review organization. Beginning January 1, 1993, any organization that meets the definition of utilization review organization in section 62M.02, subdivision 21, must be licensed under chapter 60A, 62C, 62D, 62N, 62T, or 64B, or registered under this chapter and must comply with this chapter and section 72A.201, subdivisions 8 and 8a. Each licensed community integrated service network or health maintenance organization that has an employed staff model of providing health care services shall comply with this chapter and section 72A.201, subdivisions 8 and 8a, for any services provided by providers under contract. Subd. 2. Nonlicensed utilization review organization. An organization that meets the definition of a utilization review organization under section 62M.02, subdivision 21, that is not licensed in this state that performs utilization review services for Minnesota residents must register with the commissioner of commerce and must certify compliance with this chapter. Initial registration must occur no later than January 1, 1993. The registration is effective for two years and may be renewed. Applications for initial and renewal registrations must be made on forms prescribed by the commissioner. Each utilization review organization registered under this chapter shall notify the commissioner of commerce within 30 days of any change in the name, address, or ownership of the organization. The organization shall pay to the commissioner of commerce a fee of $1,000 for the initial registration application and $1,000 for each two-year renewal. Subd. 3. Penalties and enforcements. If a utilization review organization fails to comply with this chapter, the organization may not provide utilization review services for any Minnesota resident. The commissioner of commerce may issue a cease and desist order under section 45.027, subdivision 5, to enforce this provision. The cease and desist order is subject to appeal under chapter 14. A nonlicensed utilization review organization that fails to comply with the provisions of this chapter is subject to all applicable penalty and enforcement provisions of section 72A.201. Each utilization review organization licensed under chapter 60A, 62C, 62D, 62N, 62T, or 64B shall comply with this chapter as a condition of licensure. History:  1992 c 574 s 3; 1994 c 625 art 2 s 9-11; 1997 c 225 art 2 s 62; 1999 c 239 s 17,18; 2001 c 215 s 24; 2002 c 330 s 27; 2020 c 114 art 2 s 20
MN Stat § 62M.07 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.07 — Prior Authorization Of Services.

62M.07 PRIOR AUTHORIZATION OF SERVICES. Subdivision 1. Written standards. 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 authorizing and making adverse determinations regarding prior authorization requests; (4) written procedures to appeal adverse determinations of prior authorization requests 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. Subd. 2. Prior authorization of emergency services prohibited. No utilization review organization, health plan company, or claims administrator may conduct or require prior authorization of emergency confinement or an emergency service. 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 as reasonably possible after the beginning of the emergency confinement or emergency service. Subd. 3. Retrospective revocation or limitation of prior authorization. No utilization review organization, health plan company, or claims administrator may revoke, limit, condition, or restrict a prior authorization that has been authorized unless there is evidence that the prior authorization was authorized based on fraud or misinformation or a previously approved prior authorization conflicts with state or federal law. Application of a deductible, coinsurance, or other cost-sharing requirement does not constitute a limit, condition, or restriction under this subdivision. Subd. 4. Submission of prior authorization requests. If prior authorization for a health care service is required, the utilization review organization, health plan company, or claim administrator must allow providers to submit requests for prior authorization of the health care services without unreasonable delay by telephone, facsimile, or voice mail or through an electronic mechanism 24 hours a day, seven days a week. This subdivision does not apply to dental service covered under MinnesotaCare or medical assistance. History:  1992 c 574 s 7; 1994 c 485 s 65; 1995 c 234 art 8 s 12; 1999 c 239 s 25; 2004 c 246 s 1; 2016 c 158 art 2 s 22; 2020 c 114 art 1 s 15
MN Stat § 62M.072 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.072 — Use Of Evidence-based Standards.

62M.072 USE OF EVIDENCE-BASED STANDARDS. If no independently developed evidence-based standards exist for a particular treatment, testing, or imaging procedure, then an insurer or utilization review organization shall not deny coverage of the treatment, testing, or imaging based solely on the grounds that the treatment, testing, or imaging does not meet an evidence-based standard. This section does not prohibit an insurer or utilization review organization from denying coverage for services that are investigational, experimental, or not medically necessary. History:   2006 c 255 s 32
MN Stat § 62M.08 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.08 — Confidentiality.

62M.08 CONFIDENTIALITY. Subdivision 1. Written procedures to ensure confidentiality. A utilization review organization must have written procedures for ensuring that patient-specific information obtained during the process of utilization review will be: (1) kept confidential in accordance with applicable federal and state laws; (2) used solely for the purposes of utilization review, quality assurance, discharge planning, and case management; and (3) shared only with those organizations or persons that have the authority to receive such information. Subd. 2. Summary data. Summary data is not subject to this section if it does not provide sufficient information to allow identification of individual patients. History:   1992 c 574 s 8
MN Stat § 62M.11 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.11 — Complaints To Commerce Or Health.

62M.11 COMPLAINTS TO COMMERCE OR HEALTH. Notwithstanding the provisions of this chapter, an enrollee may file a complaint regarding an adverse determination directly to the commissioner responsible for regulating the utilization review organization. History:  1992 c 574 s 11; 2020 c 114 art 2 s 15
MN Stat § 62M.12 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.12 — Prohibition Of Inappropriate Incentives.

62M.12 PROHIBITION OF INAPPROPRIATE INCENTIVES. No individual who is performing utilization review may receive any financial incentive based on the number of adverse determinations made by such individual, provided that utilization review organizations may establish medically appropriate performance standards. This prohibition does not apply to financial incentives established between health plan companies and providers. History:  1992 c 574 s 12; 1999 c 239 s 30; 2020 c 114 art 2 s 16
MN Stat § 62M.13 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.13 — Severability.

62M.13 SEVERABILITY. If any provisions of this chapter are held invalid, illegal, or unenforceable for any reason and in any respect, the holding does not affect the validity of the remainder of this chapter. History:  1992 c 574 s 13; 2020 c 114 art 2 s 20
MN Stat § 62M.14 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.14 — Effect Of Compliance.

62M.14 EFFECT OF COMPLIANCE. Evidence of a utilization review organization's compliance or noncompliance with the provisions of this chapter shall not be determinative in an action alleging that services denied were medically necessary and covered under the terms of the enrollee's health benefit plan. History:  1992 c 574 s 14; 2020 c 114 art 2 s 20
MN Stat § 62M.15 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.15 — Applicability Of Other Chapter Requirements.

62M.15 APPLICABILITY OF OTHER CHAPTER REQUIREMENTS. The requirements of this chapter regarding the conduct of utilization review are in addition to any specific requirements contained in chapter 62A, 62C, 62D, 62Q, 62T, or 72A. History:  1992 c 574 s 15; 1999 c 239 s 31
MN Stat § 62M.16 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.16 — Rulemaking.

62M.16 RULEMAKING. If it is determined that rules are reasonable and necessary to accomplish the purpose of this chapter, the rules must be adopted through a joint rulemaking process by both the Department of Commerce and the Department of Health. History:  1992 c 574 s 16; 2020 c 114 art 2 s 20
MN Stat § 62M.18 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62M — Utilization Review Of Health Care|Section 62M.18 — Annual Posting On Website; Prior Authorizations.

62M.18 ANNUAL POSTING ON WEBSITE; PRIOR AUTHORIZATIONS. (a) By April 1, 2022, and each April 1 thereafter, a health plan company must post on the health plan company's public website the following data for the immediately preceding calendar year for each commercial product: (1) the number of prior authorization requests for which an authorization was issued; (2) the number of prior authorization requests for which an adverse determination was issued and sorted by: (i) health care service; (ii) whether the adverse determination was appealed; and (iii) whether the adverse determination was upheld or reversed on appeal; (3) the number of prior authorization requests that were submitted electronically and not by facsimile or e-mail or other method pursuant to section 62J.497; and (4) the reasons for prior authorization denial including but not limited to: (i) patient did not meet prior authorization criteria; (ii) incomplete information submitted by the provider to the utilization review organization; (iii) change in treatment program; and (iv) the patient is no longer covered by the plan. (b) All information posted under this section must be written in easily understandable language. History:   2020 c 114 art 1 s 20
MN Stat § 62N.01 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62N — Community Integrated Service Network|Section 62N.01 — Citation And Purpose.

62N.01 CITATION AND PURPOSE. Subdivision 1. Citation. This chapter may be cited as the "Minnesota Community Integrated Service Network Act." Subd. 2.  [Repealed, 1997 c 225 art 2 s 63] History:  1993 c 345 art 1 s 2; 1Sp1993 c 6 s 36; 1994 c 625 art 8 s 33; 1997 c 225 art 2 s 31
MN Stat § 62N.02 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62N — Community Integrated Service Network|Section 62N.02 — Definitions.

62N.02 DEFINITIONS. Subdivision 1. Application. The definitions in this section apply to this chapter. Subd. 2.  [Repealed, 1997 c 225 art 2 s 63] Subd. 3.  [Repealed, 1997 c 225 art 2 s 63] Subd. 4. Commissioner. "Commissioner" means the commissioner of health or the commissioner's designated representative. Subd. 4a. Community integrated service network or community network. (a) "Community integrated service network" or "community network" means a formal arrangement licensed by the commissioner under section 62N.25 for providing prepaid health services to enrolled populations of 50,000 or fewer enrollees, including enrollees who are residents of other states. (b) [Expired] Subd. 4b.  [Repealed, 1997 c 225 art 2 s 63] Subd. 4c.  [Repealed, 1997 c 225 art 2 s 63] Subd. 5. Enrollee. "Enrollee" means an individual, including a member of a group, to whom a network is obligated to provide health services under this chapter. Subd. 6.  [Repealed, 1997 c 225 art 2 s 63] Subd. 6a. Health carrier. "Health carrier" has the meaning given in section 62A.011. Subd. 7.  [Repealed, 1997 c 225 art 2 s 63] Subd. 8.  [Repealed, 1997 c 225 art 2 s 63] Subd. 9.  [Repealed, 1997 c 225 art 2 s 63] Subd. 10.  [Repealed, 1997 c 225 art 2 s 63] Subd. 11. Price. "Price" means the actual amount of money paid, after discounts or other adjustments, by the person or organization paying money to buy health care coverage and health care services. "Price" does not mean the cost or costs incurred by a network or other entity to provide health care services to individuals. Subd. 12.  [Repealed, 1997 c 225 art 2 s 63] History:  1993 c 345 art 1 s 3; 1994 c 625 art 1 s 3,4; art 8 s 34; 1995 c 234 art 1 s 10,11
MN Stat § 62N.22 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62N — Community Integrated Service Network|Section 62N.22 — Disclosure Of Commissions.

62N.22 DISCLOSURE OF COMMISSIONS. Before selling any coverage or enrollment in a community integrated service network, a person selling the coverage or enrollment shall disclose in writing to the prospective purchaser the amount of any commission or other compensation the person will receive as a direct result of the sale. The disclosure may be expressed in dollars or as a percentage of the premium. The amount disclosed need not include any anticipated renewal commissions. History:  1993 c 345 art 1 s 18; 1994 c 625 art 8 s 38; 1997 c 225 art 2 s 32
MN Stat § 62N.23 (2021)
2021 Minnesota Statutes|Chapters 59A - 79A — Insurance|Chapter 62N — Community Integrated Service Network|Section 62N.23 — Technical Assistance; Loans.

62N.23 TECHNICAL ASSISTANCE; LOANS. (a) The commissioner shall provide technical assistance to parties interested in establishing or operating a community integrated service network. This shall be known as the community integrated service network technical assistance program (CISNTAP). The technical assistance program shall offer seminars on the establishment and operation of community integrated service networks in all regions of Minnesota. The commissioner shall advertise these seminars in local and regional newspapers, and attendance at these seminars shall be free. The commissioner shall write a guide to establishing and operating a community integrated service network. The guide must provide basic instructions for parties wishing to establish a community integrated service network. The guide must be provided free of charge to interested parties. The commissioner shall update this guide when appropriate. The commissioner shall establish a toll-free telephone line that interested parties may call to obtain assistance in establishing or operating a community integrated service network. (b) The commissioner shall grant loans for organizational and start-up expenses to entities forming community integrated service networks, or to networks less than one year old, to the extent of any appropriation for that purpose. The commissioner shall allocate the available funds among applicants based upon the following criteria, as evaluated by the commissioner within the commissioner's discretion: (1) the applicant's need for the loan; (2) the likelihood that the loan will foster the formation or growth of a network; and (3) the likelihood of repayment. The commissioner shall determine any necessary application deadlines and forms. History:  1993 c 345 art 1 s 19; 1994 c 625 art 12 s 1; 1997 c 187 art 2 s 2; 1997 c 225 art 2 s 33