WHAT THIS BILL REGULATES · 1 REQUIREMENT TYPE
How Is This Bill Enforced
Verbatim statutory text on the left; plain-language analysis and a per-section checklist on the right. Numbered markers cross-link to the matching checklist row.
subd. 2a Subd. 2a. Artificial intelligenceArtificial intelligence"Artificial intelligence" has the meaning given in United States Code, title 15, section 9401.Minn. Stat. § 62M.02, subd. 2a. "Artificial intelligenceArtificial intelligence"Artificial intelligence" has the meaning given in United States Code, title 15, section 9401.Minn. Stat. § 62M.02, subd. 2a" has the meaning given in United States Code, title 15, section 9401.
Section 1 of the bill adds a new subdivision to the existing definitions section of Minnesota's utilization review statute (chapter 62M). It defines artificial intelligence by reference to the federal definition in 15 U.S.C. § 9401, which provides a broad, technology-neutral definition encompassing machine-based systems that make predictions, recommendations, or decisions.
(a) A physician must review and make the adverse determination under section 62M.05 in all cases in which the utilization review organizationUtilization review organizationA utilization review organization as used in Minnesota Statutes chapter 62M, referring to entities conducting utilization review of health care services.Minn. Stat. § 62M (existing law) has concluded that an adverse determination for clinical reasons is appropriate.
(b) The physician conducting the review and making the adverse determination must: (1) hold a current, unrestricted license to practice medicine in this state; and (2) have the same or similar medical specialty as a provider that typically treats or manages the condition for which the health care service has been requested. This paragraph does not apply to reviews conducted in connection with policies issued by a health plan company that is assessed less than three percent of the total amount assessed by the Minnesota Comprehensive Health Association.
(c) The physician should be reasonably available by telephone to discuss the determination with the attending health care professional.
(d) Notwithstanding paragraph (a), a review of an adverse determination involving a prescription drug must be conducted by a licensed pharmacist or physician who is competent to evaluate the specific clinical issues presented in the review.
(e) This subdivision does not apply to outpatient mental health or substance abuse services governed by subdivision 3a.
(f) 1 The physician must attest in writing that artificial intelligenceArtificial intelligence"Artificial intelligence" has the meaning given in United States Code, title 15, section 9401.Minn. Stat. § 62M.02, subd. 2a was not used in the utilization review process. Notwithstanding section 62M.14, any adverse determination made in violation of this paragraph is null and void.
Section 2 amends the existing physician reviewer requirements for adverse determinations. It adds a new paragraph (f) requiring the reviewing physician to attest in writing that artificial intelligence was not used in the utilization review process. Any adverse determination made in violation of this attestation requirement is null and void, notwithstanding the existing enforcement framework in section 62M.14.
The existing paragraphs (a) through (e) — requiring physician review, licensure, specialty matching, telephone availability, prescription drug review by pharmacist or physician, and the mental health/substance abuse carve-out — remain unchanged. The new paragraph (f) adds the AI attestation as a procedural requirement layered on top of the existing physician review obligation.
(a) 2 The use of artificial intelligenceArtificial intelligence"Artificial intelligence" has the meaning given in United States Code, title 15, section 9401.Minn. Stat. § 62M.02, subd. 2a is prohibited in utilization review. Without limiting the generality of the foregoing, a utilization review organizationUtilization review organizationA utilization review organization as used in Minnesota Statutes chapter 62M, referring to entities conducting utilization review of health care services.Minn. Stat. § 62M (existing law) is prohibited from using artificial intelligenceArtificial intelligence"Artificial intelligence" has the meaning given in United States Code, title 15, section 9401.Minn. Stat. § 62M.02, subd. 2a in any part of its review, evaluation, determination, or appeals processes.
(b) 2 Notwithstanding section 62M.14, any adverse determination made in violation of this section is null and void.
(c) The attorney general may enforce this section under section 8.31.
Section 3 creates a new standalone prohibition on the use of artificial intelligence in utilization review. Paragraph (a) states the categorical ban and clarifies that it extends to every part of the review, evaluation, determination, and appeals processes — not merely the final adverse determination. Paragraph (b) voids any adverse determination made in violation. Paragraph (c) grants enforcement authority to the Minnesota Attorney General under section 8.31.
This is the broadest provision in the bill. While section 2's amendment to § 62M.09 focuses on the physician's attestation duty, this section addresses the organizational prohibition: the utilization review organization itself is prohibited from using AI anywhere in its processes.