Bill > SF3712

This bill modifies standards for utilization review, which is the process insurance companies use to determine if a requested medical service or treatment is medically necessary and appropriate before it's provided. Key provisions include requiring utilization review organizations to have their reviewing physicians contact the attending healthcare professional for more information before denying a prior authorization, and mandating that adverse determination notifications be provided by telephone to the attending healthcare professional, in addition to written notification. The bill also establishes a fine for utilization review organizations if their adverse determinations are reversed in appeals at a rate exceeding 40%, and clarifies that applying deductibles or cost-sharing does not constitute a restriction on a prior authorization. Furthermore, it creates a new cause of action allowing individuals to sue utilization review organizations for wrongful denials of prior authorizations if the denial deviates from accepted medical practice, disregards the attending physician's judgment, and causes harm, with provisions for damages, attorney fees, and attorney general enforcement. Finally, health-related licensing boards will be required to oversee the utilization review performance of their licensees.

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https://www.revisor.mn.gov/bills/94/2026/0/SF/3712/