State Laws

Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.

State Law

Georgia Code-Title 33-Chapter 46-Certification of Private Review Agents. Article 2. Prior Authorizations

08/01/2023 Georgia Section 33-46-20

Prior Authorization Requirements Posted on Website; Statistical Reporting

State Law

Texas Statutes-Insurance Code-Title 8-Subtitle D-Chapter 1301- Subchapter B. Relations with Physicians or Health Care Providers

07/18/2023 Texas Section 1301.0642

Contract Provisions Allowing Certain Adverse Material Changes Prohibited

State Law

Indiana Code-Title 27-Article 1-Chapter 37.5-Health Care Service Prior Authorization

07/12/2023 Indiana Sections 27-1-37.5-1 through 27-1-37.5-14, and 27-1-37.5-17.

Application of Chapter; “Adverse Determination;” “Covered individual;” “CPT Code;” “Health Care Service;” “Health Plan;” “Participating Provider;” “Prior Authorization;” “Urgent Care Situation;” Availability of Prior Authorization Information; Requirements; New Requirements; Address Change; Notices; Request for Prior Authorization; Electronic Transmission; Standardized Form; Response to Request for Prior Authorization; Timing; Incomplete Request; Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim; Unanticipated, Medically Necessary Health Care Service; Denial; CPT codes exempt from prior authorization; Payment for Health Care Service With Prior Authorization; Contrary Contract Provision Void; Peer to peer review.

Amendments, Retroactive Denial, State Medical Necessity Decisions-Deadlines
State Law

Tennessee Code-Title 56-Chapter 7- Part 36. Prior Authorization Fairness Act

07/08/2023 Tennessee Sections 3601-3622

Short title; Part definitions; Requirements for initial adverse determinations; Appeals of an electronic and non-electronic initial adverse determination; Prior authorization submissions; Chronic conditions; Clinical criteria; Electronic prior authorization; Expiration date for a prior authorization; Prior authorization and opioid use disorder; Medical necessity; Changing prior authorization requirements; Payment; Prior authorization transfers; Related service; Reviewer criteria; Statistics; Prior authorization requirements; Website notice requirements; Applicability; Provider notification to health carrier; Rules.

Amendments, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

Maryland Statutes-Article 15. Insurance

08/07/2023 Maryland Section 15-113

Health Insurance – Two–Sided Incentive Arrangements

Amendments, Fee Schedules, Overpayments / Recoupments, Participation in Products, Plans, or Networks, Payment Edits, Payment Rules, Prohibited financial incentives, Prompt Payment Deadlines, Risk—Physicians Taking
State Law

Michigan Compiled Laws-Chapter 500. Insurance Code of 1956-Chapter 22. The Insurance Contract

08/12/2022 Michigan Section 2212e

Standard electronic prior authorization transaction process; requirements; adverse determination process; denial and appeals; standard report; modification program; definitions.

Amendments, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

Tennessee Code-Title 56-Chapter 6-Part 7. Health Care Service Utilization Review Act

08/24/2023 Tennessee Section 56-6-705

Utilization Review Agents — Minimum Standards

Amendments, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

New Mexico Admin. Code-Title 13-Chapter 10-Part 31. Prior Authorization

10/04/2021 New Mexico Sections, through

Scope; Definitions; General Requirements; Prior Authorization Submission; Documentation and Transparency; Auto-Adjudication; Reserved; Penalties; Severability

Amendments, Retroactive Denial
State Law

Illinois Compiled Statutes-215 ILCS 200. Prior Authorization Reform Act.

08/03/2023 Illinois Sections 1 through 85

See the text for the various section titles.

Amendments, Medical Necessity-Definition, Retroactive Denial, U.R. Criteria
State Law

Nebraska Rev. Statutes-Chapter 68. Medical Assistance Act

08/10/2023 Nebraska Section 68-998

Managed care organization; provider contract; material change; notice