Standards for utilization review performance modified, cause of action created for wrongful denials of prior authorizations by utilization review organizations, attorney general enforcement provided, fines by commissioner of commerce authorized, and oversight required.

This bill modifies how utilization review organizations in Minnesota handle prior authorization requests for healthcare services and establishes new enforcement mechanisms. It requires these organizations to contact physicians before denying requests and mandates that adverse determinations be communicated within five business days with clear explanations and appeal information. The legislation also authorizes the commissioner of commerce to impose fines on organizations that reverse more than 40 percent of appeals over a 12-month period and creates a cause of action for wrongful denials. Additionally, the bill restricts the ability to revoke previously authorized services unless fraud or legal conflicts are proven, while requiring oversight from health licensing boards.