SF3081 Summary

• Creates new section 62D.115 requiring health maintenance organizations (HMOs) to develop written policies for receipt, investigation, and resolution of quality of care complaints, including classification by severity level and medical director review when patient harm is potential.

• Requires HMOs to report quality of care complaints meeting the highest severity level to the commissioner of health within 10 calendar days, with the commissioner investigating and forwarding relevant complaints to health-related licensing boards with enrollee consent.

• Amends section 62D.08 to require HMOs to report complaint data by category (access, communication and behavior, health plan administration, facilities and environment, coordination of care, and technical competence) beginning calendar year 2018, with categories defined by the commissioner by July 1, 2017.

• Directs the commissioner of health to develop a uniform definition of medically necessary care for HMOs and recommendations for the determination process, to be submitted to legislative committees by January 15, 2017.

• Requires the commissioner to consult with stakeholders and submit recommendations by January 15, 2017 regarding when quality of care investigations should be subject to peer review confidentiality and circumstances for disclosing peer review final determinations to the public.