MN SF3712

Creates a private cause of action allowing enrollees injured by wrongful prior authorization denials to sue utilization review organizations for general damages, punitive damages, injunctive relief, and attorney fees, effective August 1, 2026

Requires the Commissioner of Commerce to fine utilization review organizations when their adverse determination reversal rate exceeds 40% over any 12-month period for expedited appeals, standard appeals, or external reviews

Mandates that reviewing physicians must actually speak with (not just attempt to contact) the attending health care professional before issuing an adverse determination on prior authorization requests

Redefines application of deductibles, coinsurance, or cost-sharing as constituting a "limit, condition, or restriction" on prior authorizations, reversing previous interpretation

Grants the Attorney General enforcement authority over utilization review laws and requires health-related licensing boards to apply professional conduct standards to licensees performing utilization review