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

Miss. Admin. Code-Title 19-Part 3-Chapter 19. Minimum Standards for Utilization Review Agents Regulation

05/04/2025 Mississippi Rules 19.05, 19.09, 19.10, 19.11, 19.12, 19.13, 19.14, 19.15, 19.16, 19.17, 19.18, 19.19, 19.20, 19.21, 19.22, 19.23, 19.24, 19.25 and 19.26

Definitions; Utilization Review Standards; Appeals of Determinations Not to Certify; Computation of Time; Urgent Prior Authorization Requests; Access to Physicians; Notification for Adverse Determinations / Form; Qualifications of persons reviewing appeals; Change of patient status to emergency status after submission of prior authorization request; Length of Approvals; Approvals for chronic conditions; Continuity of Prior Approvals; Revocations of prior authorizations; Standardized electronic prior authorizations; Reports to the Department; Prior Authorization Statistics; Enforcement and administration; Penalties; Severability; Effective Date

Medical Necessity-Definition, State Medical Necessity Appeals-Deadlines, State Medical Necessity Decisions-Deadlines
State Law

Mississippi Code-Title 41-Chapter 83. Utilization Review of Availability of Hospital Resources And Medical Services

08/06/2024 Mississippi Sections 41-83-1, 41-83-5, 41-83-21, 41-83-23, 41-83-27, 41-83-31

Definitions; Certificate requirement for general in-house utilization review, exemptions; Certification of need of immediate hospital care, prima facie evidence;  Judicial review, other remedies; Other health insurance policies, certificate requirement, contract with private review agent, reimbursement under policy where medical necessity in dispute; Adverse determination to patient or health-care provider, discussion of reasons, denial of third party reimbursement or precertification, evaluation by trained specialist

State Medical Necessity Appeals-Deadlines
State Law

Wyoming Statutes-Title 26-Chapter 55. Ensuring Transparency In Prior Authorization Act

06/27/2024 Wyoming Sections 26-55-101 through 26-55-113

Short title; Definitions; Disclosure and review of prior authorization requirements; Persons qualified to make adverse determinations; Consultation after issuing an adverse determination; Requirements applicable to persons reviewing appeals; Health insurer or contracted utilization review entities’ obligations regarding prior authorization for nonurgent health care services; Health insurer or contracted utilization review entities’ obligations with respect to prior authorizations for urgent health care services; No prior authorization for medications for opioid use disorder; Length of authorization generally; revocation of prior authorizations prohibited; length of authorization for chronic or long-term care conditions; Continuity of care for enrollees; Provider exemptions from prior authorization requirements; Prior authorization for rehabilitative or habilitative services. 

Amendments, Retroactive Denial, State Medical Necessity Appeals-Deadlines
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