HF3045 Summary

• Amends Minnesota Statutes section 62D.04, subdivision 1, to require health maintenance organizations (HMOs) to have arrangements for ongoing evaluation of health care quality including a peer review process as part of certificate of authority applications.

• Creates new section 62D.115 establishing requirements for HMOs to develop written policies and procedures for investigating quality of care complaints, including severity classifications, medical director reviews when patient harm is potential, and tracking complaints by provider and issue type.

• Requires HMOs to submit annual complaint data to the commissioner categorized by access, communication and behavior, health plan administration, facilities and environment, coordination of care, and technical competence and appropriateness.

• Mandates HMOs maintain quality of care complaint records for five years and make them available to the commissioner; information provided is classified as confidential data on individuals.

• Directs the commissioner to define complaints subject to peer protection confidentiality and establish complaint categories in consultation with stakeholders by January 1, 2018.