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

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

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 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

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

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

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

04/06/2025 Illinois Sections 1 through 85

Short title; Purpose; Applicability, scope; Definitions; Disclosure and review of prior authorization requirements; Personnel qualified to make adverse determinations of a prior authorization request; Requirements for adverse determination; Requirements applicable to the personnel who can review appeals; Review of prior authorization requirements; Denial; Length of prior authorization approval; Length of prior authorization approval for treatment for chronic or long-term conditions; Continuity of care for enrollees; Health care services deemed authorized if a health insurance issuer or its contracted utilization review organization fails to comply with the requirements of this Act; Severability; Administration and enforcement

Amendments, Medical Necessity-Definition, Retroactive Denial, 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 33-46-2 through 33-46-4

Application; Legislative Purposes and Intent; Definitions

Medical Necessity-Definition, U.R. Criteria