Laws 2026, chapter 124 (H.F. 4188), article 3, section 6: utilization review may not rely on automated processing alone for adverse determinations (Minn. Stat. 62M.09, subd. 3)

Summary

Minnesota's 2026 commerce omnibus adds a paragraph to the utilization review statute: a utilization review organization may not use any form of automated processing alone, without review by an appropriate health professional as the section already requires, when making an adverse determination. The rule sits in the provision that already requires a physician or other qualified clinician to review and make adverse determinations, and applies to health plans offered, sold, issued or renewed on or after January 1, 2027. The statute's wording is technology-neutral ('any form of automated processing'), so it reaches algorithmic and AI-assisted denial tools as well as simpler rules engines. Enforcement follows the existing utilization review chapter (62M), overseen by the Commerce and Health commissioners; the session law itself was not read for a new penalty.

Key dates

1. May 27, 2026Enacted
2. October 16, 2026Checked against sources
3. October 21, 2026Checked against sources

Developments are added when the record is reviewed. Next review: January 15, 2027.

Evidence

Each passage is quoted from its source. The quoted passages are re-checked against the live pages every month.

1. A utilization review organization is prohibited from using any form of automated processing alone without a clinician review by an appropriate health professional, as required under this section, when making an adverse determination.

   Supports: Core prohibition

   This section is effective January 1, 2027, and applies to health plans offered, sold, issued, or renewed on or after that date.

   Supports: Effective date

   Minnesota Statutes 2024, section 62M.09, subdivision 3, is amended to read:

   Supports: Section amended

   Presented to the governor May 20, 2026 Signed by the governor May 27, 2026

   Supports: Signing date

   Laws of Minnesota 2026, chapter 124 (H.F. 4188) Minnesota Office of the Revisor of Statutes Primary source

2. 2026 Subd. 3 Amended 2026 c 124 art 3 s 6

   Supports: Article and section citation

   Minn. Stat. 62M.09, Staff and program qualifications Minnesota Office of the Revisor of Statutes Primary source