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

New Hampshire Statutes-Title XXXVII-Chapter 420-E-Licensure of Medical Utilization Review Entities

04/19/2025 New Hampshire Section 420-E:1, 420-E:4, and 420-E:4-b

Definitions; Minimum Standards, Licensure of Medical Utilization Review Entities; Prior Authorization Standards for Managed Care Plans

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

Illinois Compiled Statutes-215 ILCS 134/-Managed Care Reform and Patient Rights Act

04/19/2025 Illinois Section 215 ILCS 185/85

Utilization review program registration

U.R. Criteria
State Law

Illinois Compiled Statutes-215 ILCS 134/-Managed Care Reform and Patient Rights Act

04/06/2025 Illinois Section 134/87

General standards for use of utilization review criteria

U.R. Criteria
State Law

Illinois Compiled Statutes-215 ILCS 134/-Managed Care Reform and Patient Rights Act

04/19/2025 Illinois Section 134/10

Definitions

Medical Necessity-Definition, Step Therapy Override, U.R. Criteria
State Law

HB 3190 (2024)-Health insurance: Ensuring Transparency in Prior Authorization Act;

01/17/2025 Oklahoma

Definitions; disclosure and review of prior authorization; adverse determinations; consultation; reviewing physicians; utilization review entity; exception; retrospective denial; length of prior authorization; continuity of care; standard for transmission of authorization; failure to comply; severability; effective date.

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

Maryland Statutes-Article 15-Insurance-Subtitle 10B. Private Review Agents

01/16/2025 Maryland Sections 15-10B-01, 15–10B–05, 15–10B–06 and 15-10B-11

Definitions; Certificates — Additional Information; Determinations by Private Review Agent; Determinations by Private Review Agent; Private Review Agent — Prohibitions

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

SB 2140 (2024) “Mississippi Prior Authorization Reform Act.”

08/06/2024 Mississippi Statutory sections have not yet been assigned
Amendments, Medical Necessity-Definition, Retroactive Denial, State Medical Necessity Decisions-Deadlines, U.R. Criteria
State Law

New Jersey Statutes-Title 17B. Insurance

06/20/2024 New Jersey Sections 17B:30-55.1 through 17B:30-56

Short title; Findings, declarations; Definitions; Payer, information, utilization management, processing, payment of claims; Payer, respond, hospital, health care provider request, prior authorization; Carrier, respond, prior authorization requests, medication coverage submitted, NCPDP SCRIPT Standard for ePA transactions; Prior authorization, chronic, long-term care condition, validity, exception, timeline; Prior authorization, denial, limitation imposed by payer, physician, scope of actions; Prior authorization, defined number, discrete services, set time frame, validity, exception; Payer to honor prior authorization granted to covered person by previous payer, initial coverage, upon receipt of documentation; Denial of prior authorization, communicated via written communication agreed to by payer, hospital, health care provider; Adverse determinations, appeal, reviewed by physician; Payer shall not deny reimbursement, hospital, health care provider in compliance, circumstances; Payer, reimbursement according to provider contract, medically necessary emergency, urgent care covered under plan; Failure by payer to comply with deadline, health care services subject to review, automatic authorization; Statistics available regarding prior authorization approvals, denials, website; Liberal construction; Rules, regulations

 

Medical Necessity-Definition, Retroactive Denial, State Medical Necessity Decisions-Deadlines, U.R. Criteria
Federal Law

Title 42-Chapter IV-Subchapter B-Part 422-Subpart C. Benefits and Beneficiary Protections

11/18/2024 42 CFR Section 422.101

Requirements relating to basic benefits

U.R. Criteria
State Law

Georgia Code-Title 33-Chapter 46-Certification of Private Review Agents. Article 1. General Provisions

08/01/2023 Georgia Section 33-46-6

Requirements for Certification; Utilization of Nationally Recognized Accreditation Standards; Website Identifying Nationally Recognized Accreditation Entities

U.R. Criteria