Bill > HF3334

This bill modifies standards for utilization review (UR) organizations, which are entities that review the medical necessity and appropriateness of healthcare services, and creates new legal protections for patients. The bill amends existing law to require that before issuing an adverse determination (a denial of a requested healthcare service), a UR organization's reviewing physician must contact the patient's attending healthcare professional to obtain more details about the medical necessity of the service. Additionally, the bill establishes a new cause of action that allows patients to sue a UR organization or its reviewing physician if certain conditions are met, such as when the denial deviates from accepted medical practice standards, contradicts the attending healthcare professional's recommendation, and causes injury to the patient. Patients must provide documentation showing the UR organization disregarded the attending professional's judgment, and they may file a complaint with the relevant commissioner before, during, or after legal action. The bill also empowers the attorney general to investigate and take action against UR organizations that violate these standards. Importantly, the bill explicitly protects attending healthcare professionals from civil liability in these situations, focusing legal accountability on the UR organizations and their reviewing physicians.

Health and Social Services

https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF3334&ssn=0&y=2025