This bill aims to enhance the standards for utilization review performance in Minnesota's healthcare system. It introduces new provisions that require utilization review organizations to provide additional information when there is a significant lack of agreement with healthcare providers regarding prior authorizations. Specifically, it mandates that reviewing physicians contact attending healthcare professionals before issuing adverse determinations. The bill also establishes a cause of action for enrollees who experience wrongful denials of prior authorizations, allowing them to seek damages if the denial deviates from accepted medical practices and causes injury. Furthermore, it empowers the commissioner of commerce to impose fines on utilization review organizations that have high rates of reversed adverse determinations.

In addition to these provisions, the bill includes measures for oversight by health-related licensing boards to ensure compliance with professional conduct standards in utilization review. It also grants the attorney general enforcement authority to uphold the new regulations. Key amendments to existing statutes include the clarification of conditions under which prior authorizations can be revoked and the establishment of a structured process for notifying providers and enrollees about determinations. The bill is set to take effect on August 1, 2026, and applies to causes of action accruing on or after that date.

Statutes affected:
Introduction: 62M.04, 62M.05, 62M.06, 62M.07