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HF 3867

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.

2025-2026 Regular Session Introduced by Kristin Bahner and 7 co-sponsors

Minnesota bill creates patient lawsuits for wrongful healthcare prior authorization denials, empowers Attorney General enforcement, and authorizes Commerce Commissioner fines against utilization review organizations.

Introduction and first reading, referred to Commerce Finance and Policy
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Bill Summary · HF 3867

Legislative bill overview

HF 3867 establishes new performance standards for utilization review organizations (entities that approve/deny healthcare coverage) in Minnesota. The bill creates a legal right for patients to sue when prior authorizations are wrongfully denied, grants the Attorney General enforcement authority, and empowers the Commerce Commissioner to issue fines against non-compliant organizations.

Why is this important

Utilization review denials directly affect patient access to medical care and can delay necessary treatments. This bill aims to hold review organizations accountable for improper denials, potentially reducing barriers to care and providing recourse for patients harmed by erroneous coverage decisions. It represents a significant shift in patient protections against insurance gatekeeping practices.

Potential points of contention

  • Increased litigation costs: Creating a new cause of action may lead to more lawsuits, potentially raising healthcare and insurance costs that could be passed to consumers
  • Implementation burden: New compliance standards and oversight requirements may impose substantial operational changes and costs on utilization review organizations
  • Definition of "wrongful": The bill's effectiveness depends on clear standards for what constitutes an improper denial; ambiguous definitions could lead to inconsistent enforcement and litigation
  • Insurance market impact: Stricter requirements might cause some organizations to exit the Minnesota market or raise prices for their services

Compiled from official sources — confirm details with the bill’s official record.

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