MN HF3867

Requires reviewing physicians at utilization review organizations to directly contact the attending health care professional before issuing an adverse determination, eliminating the option to merely attempt contact.

Creates a private cause of action allowing enrollees to sue utilization review organizations for wrongful prior authorization denials that deviate from accepted medical norms, cause injury, and disregard the attending provider's judgment; courts may award general, special, and punitive damages plus attorney fees.

Mandates the Commissioner of Commerce impose fines on utilization review organizations when their adverse determination reversal rate exceeds 40% over any 12-month period for expedited appeals, standard appeals, or external reviews.

Grants the Attorney General enforcement authority over utilization review regulations under section 8.31 and requires health-related licensing boards to apply professional conduct standards to licensees performing utilization review.

Reclassifies application of deductibles, coinsurance, or cost-sharing requirements as a limit, condition, or restriction on prior authorizations (reversing current law that exempted such requirements).