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

Utah Admin Code-Title R590-Rule R590-192. Unfair Accident and Health Claims Settlement Practices

05/12/2025 Utah Sections R590-192-3 to R590-192-10
Definitions; File and Record Documentation; Disclosure of Policy Provisions; Notice and Proof of Loss; Notification; Minimum Standards for Prompt, Fair, and Equitable Benefit Determination and Settlement; Additional Standards for Prompt, Fair, and Equitable Benefit Determination and Settlement for Income Replacement Insurance; Unfair Claim Settlement Practices
Medical Necessity-Definition, State Medical Necessity Decisions-Deadlines
State Law

California Code of Regulations Title 28-Managed Health Care Division 1-The Department of Managed Health Care Chapter 2-Health Care Service Plans Article 8. Self-Policing Procedures

05/08/2025 California Section 1300.71.4

Emergency Medical Condition and Post-Stabilization Responsibilities for Medically Necessary Health Care Services

State Medical Necessity Decisions-Deadlines
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

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

Maryland Statutes-Article 15-Insurance-Subtitle 10A. Complaint Process for Adverse Decisions or Grievances

01/16/2025 Maryland Sections 15–10A–01 and 15–10A–02

Definitions; Carrier Internal Grievance Process

Retroactive Denial, State Medical Necessity Decisions-Deadlines
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
State Law

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

08/01/2023 Georgia Sections 33-46-23, 33-46-26, 33-46-27, 33-46-28 and 33-46-29

Restrictions on Authorizations When Service Timely Rendered; Timely Notification of Prior Authorization or Adverse Determination; Notification Time for Prior Authorization or Adverse Determination; Honoring of Prior Authorizations; Noncompliance Resulting in Automatic Authorization

Retroactive Denial, State Medical Necessity Decisions-Deadlines
State Law

LA. Rev. Statutes-Title 22-Insurance. Utilization Review Standards

07/16/2023 Louisiana Sections 22:1260.41 through 1260.48

Definitions; Documented prior authorization program, requirements; Timeframes for determinations, concurrent review, retrospective review, adverse determination; Documentation; Utilization review, determinations, appeals; Prior authorization, denial of claims; Reviews for fraud, waste or abuse

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