June 8, 2001; Delta Dental
6/8/2001 10:14:43 AM
This is an opinion of the Commissioner of Administration issued pursuant to section 13.072 of Minnesota Statutes, Chapter 13 - the Minnesota Government Data Practices Act. It is based on the facts and information available to the Commissioner as described below.
Facts and Procedural History:For purposes of simplification, the information presented by the person who requested this opinion and the response from the government entity with which the person disagrees are presented in summary form. Copies of the complete submissions are on file at the offices of IPA and, except for any data classified as not public, are available for public access. On April 16, 2001, IPA received a letter dated April 13, 2001, from Charles Thomas, an attorney representing the Southern Minnesota Regional Legal Services, Inc. (SMRLS). In his letter, Mr. Thomas asked the Commissioner to issue an opinion regarding his clients' access to certain data that Delta Dental Plan of Minnesota (Delta Dental) maintains. Mr. Thomas wrote that Delta Dental acts as a subcontractor for the BluePlus health care plan operated by Blue Cross Blue Shield of Minnesota, under contract to the Minnesota Department of Human Services (DHS). He added that this method of providing Medical Assistance coverage to eligible individuals is called the Prepaid Medical Assistance Program (PMAP). IPA, on behalf of the Commissioner, wrote to Michael Walsh, President of Delta Dental, in response to Mr. Thomas' request. The purposes of this letter, dated April 20, 2001, were to inform him of Mr. Thomas' request and to ask him to provide information or support for Delta Dental's position. On May 2, 2001, IPA received comments, dated same, from David Morse, Legal Counsel for Delta Dental. A summary of the facts as presented by Mr. Thomas is as follows. He wrote: ...[SMRLS] provides free legal assistance in civil cases to low income persons...including cases involving public assistance benefit programs which are administered under the authority of [DHS]. Appeals of assistance are heard by appeals referees under authority of Minn. Stat. section 256.045. Mr. Thomas stated that in two recent cases, SMLRS represented individuals who each appealed a decision by Delta Dental denying prior authorization for orthodontic treatment for their minor children. In the course of the appeal proceedings, SMLRS requested access to all the private data on the individual clients that Delta Dental had stored, generated, collected, or disseminated in regard to the denials for orthodontia. Mr. Thomas wrote, Specifically, SMLRS requested the names and credentials of the orthodontists or other dentists for Delta Dental who apparently had internally reviewed the initial requests and denied approval. Delta Dental responded by providing a copy of the notes that were used as the basis for its decision/denial for orthodontia services but, citing Minnesota Statutes, section 72A.285, refused to provide the identity of the orthodontist who had conducted the prior authorization review. The appeals referee did not address the issue of the orthodontist's identification. Issue:In his request for an opinion, Mr. Thomas asked the Commissioner to address the following issue:
Discussion:There appears to be no dispute that, for purposes of this opinion, Delta Dental is subject to certain requirements of Minnesota Statutes, Chapter 13. In his opinion request, Mr. Thomas wrote, There was no dispute that Delta Dental is subject to the same contract provisions as BluePlus with respect to [Chapter 13]. Mr. Thomas also included a copy of a Model Contract for Prepaid Medical Assistance Program Services (PMAP) between the Department of Human Services (DHS) and a given health plan. Relevant language in this contract states, All records collected, used, disseminated and stored by the HEALTH PLAN pertaining to Enrollees shall be maintained in accordance with Minnesota Statutes Chapter 13... (See section 9.7.1.) The Model Contract also states, For purposes of executing its responsibilities, and to the extent set forth in this Contract, the HEALTH PLAN shall be considered part of the welfare system as defined in Minnesota Statutes, Section 13.46, Subdivision 1. (See section 9.7.4.) At issue here is whether Delta Dental is required to release the identifying information about the orthodontist who reviewed the SMRLS case files. In his comments to the Commissioner, Mr. Morse wrote that pursuant to Minnesota Statutes section 72A.285, Delta Dental did not have to release those data. That provision states: ...when a review organization...has conducted a review of health services given or proposed to be given to an insured or claimant in connection with or in anticipation of a claim for insurance benefits, a complete summary of the review findings must be furnished by the insurer to the provider who requested the review or to the insured or claimant, upon that person's request.... Nothing in this section requires the disclosure of the identity of the person conducting the review. The Commissioner respectfully disagrees with Mr. Morse's assertion. Here, section 72A.285 cannot be read alone. As stated above, All records collected, used, disseminated and stored by [Delta Dental] pertaining to Enrollees shall be maintained in accordance with Minnesota Statutes Chapter 13... The notes the reviewer created are data that Delta Dental used that pertain to the enrollees (SMRLS clients). Therefore, those notes are subject to the provisions of Chapter 13. Minnesota Statutes, section 72A.285, is clear that Nothing in this section requires disclosing the identity of the person who conducted the interview. However, SMRLS is seeking access to data identifying the reviewer under section 13.04 of Chapter 13. Although data identifying reviewers are not data about Mr. Thomas' clients, they are data that Delta Dental must release to the public because they are public data under Chapter 13. Via its contract with DHS, Delta Dental has agreed to subject itself to certain requirements in Chapter 13. The presumption in section 13.03, subdivision 1, that all government are public unless otherwise classified, provides that the identifying data are available to Mr. Thomas and his clients. Opinion:Based on the facts and information provided, my opinion on the issue that Mr. Thomas raised is as follows:
Signed:
David F. Fisher
Dated: June 8, 2001 |
Contracts/privatization
Entities bound by contract
