Bill > HF3867

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 is provided. Specifically, it requires that before denying a prior authorization for a medical service, the reviewing physician for the utilization review organization must contact the attending healthcare professional to get more details about the medical necessity of the service. It also changes the notification process for adverse determinations, meaning denials, by requiring written notification to be sent by facsimile or secure electronic mail and also by telephone call from the physician who made the adverse determination. The bill introduces a new cause of action, allowing individuals to sue utilization review organizations if they are harmed by a wrongful denial of a prior authorization that deviates from accepted medical practices and the attending healthcare professional's recommendation. Furthermore, it empowers the Attorney General to enforce these utilization review standards and authorizes the Commissioner of Commerce to impose fines on utilization review organizations if their adverse determinations are overturned in appeals at a rate exceeding 40 percent. Finally, health-related licensing boards will be required to oversee and enforce these utilization review standards for their licensees.

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https://www.revisor.mn.gov/bills/94/2026/0/HF/3867/