Table 1: UM Regulations: State Scope & Applicability

States

UM Regulations in State

Organizational Type

HMO

Insurer

URO

ACO

PPO

TPA

Exemptions?

Alabama

x

x

x

x

x

x

x

x

Alaska

x

x

x

x

x

x

American Samoa

Arizona

x

x

x

x

x

x

x

x

Arkansas

x

x

x

x

x

x

x

x

California

x

x

x

x

Colorado

x

x

x

x

x

Connecticut

x

x

x

x

x

x

x

Delaware

x

x

x

x

District of Columbia

Florida

Georgia

x

x

x

x

x (if acting as MCP)

x

x

x

Guam

Hawaii

x

x

x

x

x

x

x

x

Idaho

x

x

x

x

x (if acting as MCO or performing UR)

x

x

Illinois

x

x

x

x

x (if conducting UR programs)

x

x

x

Indiana

x

x

x

x

x (if acting as UR agent or performing UR)

x

x

x

Iowa

x

x

x

x (indirectly)

x (if acting as third-party payor)

x

x

x

Kansas

x

x

x

x

x

x

x

x

Kentucky

x

x

x

x

x (if UM is completed in conjunction with HBP or LSP)

x

x

x

Louisiana

x

x

x

x (if acting as health issuer that offers HBPs)

x

x

Maine

x

x

x

x (if performing UR services)

x

x

x

x

Maryland

x

x

x

x

x (if acting as insurer or conducting UR)

x

x

Massachusetts

x

x

x

x (if acting as carrier)

x

x

Michigan

x

x

x

x (if acting on behalf of carrier that provides or performs UR)

x (if acting as health carrier)

x

x (if acting on behalf of carrier that provides or performs UR)

x

Minnesota

x

x

x

x

x

x

x

Mississippi

x

x

x

x

x (if certified as private review agent or health plan)

x

x

x

Missouri

x

x

x

x

x (if conducting UR)

x

x

Montana

x

x

x

x

x (if conducting UR)

x

x

x

Nebraska

x

x

x

x

x (if conducting UR)

x

x

x

Nevada

x

x

x

x

New Hampshire

x

x (except for UR license requirement)

x (except for UR license requirement)

x

x (if conducting UR)

x

x

x

New Jersey

x

x

x

x

x

New Mexico

x

x

x

x

x (if licensed as a MCP or other applicable entity licensed in NM)

x

x

x

New York

x

x

x

x

x (if conducting UR)

x

x

x

North Carolina

x

x

x

x (if acting as insurer)

x

x (if conducting UM)

x

North Dakota

x

x

x

x

x (if acting as UR agent)

x

x

x

Ohio

x

x

x

x

x (if conducting UR)

x

x (if conducting UR)

x

Oklahoma

x

x

x (except insurers with certified private review agents or that perform in-house UR)

x

x (if conducting UR)

x

x

x

Oregon

x

x

x

x

x (if acting as an insurer or conducting UR)

x

x

x

Pennsylvania

x

x

x (if conducting UR on behalf of MCPs)

x (if conducting UR on behalf of MCPs)

x

x

x

Puerto Rico

x

x

x (if the HMO offers a health plan or performs UR)

x

Rhode Island

x

x

x

x

x (if conducting UR)

x

x

x

South Carolina

x

x

x

South Dakota

x

x

x

x

x

x

x

x

Tennessee

x

x

x

x

x

x

x

x

Texas

x

x

x

x

x (if conducting UR)

x

x

x

Utah

Vermont

x

x

x

x

x

x

x

Virgin Islands

Virginia

x

x

x

x

x (if acting as UR entity or private review agent)

x

x

x

Washington

x

x

x

x

x

West Virginia

x

x

x

x

Wisconsin

Wyoming

x

x

x

x

x (if acting as an insurance carrier)

x

x

x