SF 1856

1st Engrossment - 94th Legislature (2025 - 2026)

Posted on 03/19/2026 09:19 a.m.

A bill for an act
relating to health insurance; prohibiting the use of artificial intelligence in the
utilization review process; authorizing enforcement by the attorney general;
amending Minnesota Statutes 2024, sections 62M.02, by adding a subdivision;
62M.09, subdivision 3; proposing coding for new law in Minnesota Statutes,
chapter 62M.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2024, section 62M.02, is amended by adding a subdivision
to read:

new text begin Subd. 2a. new text end

new text begin Artificial intelligence. new text end

new text begin "Artificial intelligence" has the meaning given in
United States Code, title 15, section 9401.
new text end

Sec. 2.

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

Subd. 3.

Physician reviewer; adverse determinations.

(a) A physician must review
and make the adverse determination under section 62M.05 in all cases in which the utilization
review organization 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.

new text begin (f) The physician must attest in writing that artificial intelligence 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.
new text end

Sec. 3.

new text begin [62M.20] PROHIBITION ON ARTIFICIAL INTELLIGENCE.
new text end

new text begin (a) The use of artificial intelligence is prohibited in utilization review. Without limiting
the generality of the foregoing, a utilization review organization is prohibited from using
artificial intelligence in any part of its review, evaluation, determination, or appeals processes.
new text end

new text begin (b) Notwithstanding section 62M.14, any adverse determination made in violation of
this section is null and void.
new text end

new text begin (c) The attorney general may enforce this section under section 8.31.
new text end