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 a reviewing physician must contact the attending healthcare professional before issuing an adverse determination. 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, the bill empowers the commissioner of commerce to impose fines on utilization review organizations if their rate of reversed adverse determinations exceeds 40% over a 12-month period. It also clarifies that prior authorizations cannot be revoked unless there is evidence of fraud or misinformation. The attorney general is granted enforcement authority, and health-related licensing boards are tasked with overseeing the standards of professional conduct in utilization review. The new provisions are set to take effect on August 1, 2026, and will apply to causes of action accruing on or after that date.

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