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

Code of Massachusetts Regs-Title 958-Part 3. Health Insurance Consumer Protection

07/26/2023 Massachusetts Sections 958 CMR 3.020, 3.100, 3.101, 3.305, 3.306, 3.309, 3.310, and 3.311

Definitions; Clinical Decisions; Carrier’s Medical Necessity Guidelines; Time Limits for Resolution of Non-expedited Internal Grievances; Review of Internal Grievances; Expedited Internal Review of Adverse Determinations; Additional Requirements for Expedited Internal Review; Failure of Carrier to Meet Time Limits

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

West Virginia Code-Chapter 33-Article 16-Group Accident and Sickness Insurance

07/10/2023 West Virginia Section 33-16-3dd

Prior authorization

State Medical Necessity Appeals-Deadlines, 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

Texas Admin. Code-Title 28-Part 1-Chapter 19-Subchapter R. Utilization Reviews for Health Care Provided under a Health Benefit Plan or Health Insurance Policy

08/24/2023 Texas Section 1711

Written Procedures for Appeal of Adverse Determinations

State Medical Necessity Appeals-Deadlines
State Law

Office of the Commissioner of Insurance-Chapter Ins. 18-Subchapter II. Grievance Procedures

08/29/2023 Wisconsin Section 18.05

Expedited grievance procedure

State Medical Necessity Appeals-Deadlines
State Law

Office of the Commissioner of Insurance-Chapter Ins. 18-Subchapter II. Grievance Procedures

08/29/2023 Wisconsin Section 18.03

Grievances

State Medical Necessity Appeals-Deadlines
State Law

Dept. of Prof. & Fin. Regulation-Chapter 850-Health Plan Accountability

08/07/2023 Maine Sections 1-10

Purpose; Authority; Applicability and Scope; Affordable Care Act; Definitions; Quality Assurance Standards; Access to Services; Adverse Health Care Treatment Decisions; Grievance Register and Grievance Procedures; Reporting Requirements; Effective Date

Credentialing-Deadlines, Credentialing-Due Process-Denial of Contract, Network Adequacy, Retroactive Denial, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

The Laws Of New York-Consolidated Laws-Public Health-Article 49-Title 1. Certification of Agents and Utilization Review Process

08/16/2023 New York Section 4904

Appeal of adverse determinations by utilization review agents

State Medical Necessity Appeals-Deadlines
State Law

Missouri Statutes-Title XXIV-Chapter 376. Life, Health and Accident Ins-Health Care Utilization Review

08/09/2023 Missouri Section 376.1385

Second-level review procedures

State Medical Necessity Appeals-Deadlines