This bill aims to modify the standards for utilization review performance in Minnesota by amending section 62M.04 of the Minnesota Statutes. It introduces new requirements for utilization review organizations, including the necessity for reviewing physicians to contact the attending healthcare professional for additional information before issuing an adverse determination regarding prior authorizations. The bill also clarifies the definition of "significant lack of agreement" between the utilization review organization and the provider, ensuring that proper communication occurs during the review or appeal process.

Additionally, the bill establishes a cause of action for enrollees who experience wrongful denials of prior authorizations. Enrollees can sue utilization review organizations if their adverse determinations deviate from accepted medical practices and cause injury. The bill also allows for medical malpractice actions against reviewing physicians under specific conditions and provides for enforcement by the attorney general. Importantly, it protects attending healthcare professionals from civil liability related to these denials.

Statutes affected:
Introduction: 62M.04