Minnesota 2023-2024 Regular Session

Minnesota Senate Bill SF831 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	1.1 A bill for an act
2	2	1.2 relating to health insurance; establishing supply requirements for prescription
3	3	1.3 contraceptives; requiring health plans to cover contraceptive methods, sterilization,
4	4	1.4 and related medical services, patient education, and counseling; establishing
5	5	1.5 accommodations for eligible organizations; amending Minnesota Statutes 2022,
6	6	1.6 section 256B.0625, subdivision 13; proposing coding for new law in Minnesota
7	7	1.7 Statutes, chapter 62Q.
8	8	1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
9	9	1.9 Section 1. [62Q.522] COVERAGE OF CONTRACEPTIVE METHODS AND
10	10	1.10SERVICES.
11	11	1.11 Subdivision 1.Definitions.(a) The definitions in this subdivision apply to this section.
12	12	1.12 (b) "Closely held for-profit entity" means an entity that:
13	13	1.13 (1) is not a nonprofit entity;
14	14	1.14 (2) has more than 50 percent of the value of its ownership interest owned directly or
15	15	1.15indirectly by five or fewer individuals, or has an ownership structure that is substantially
16	16	1.16similar; and
17	17	1.17 (3) has no publicly traded ownership interest, having any class of common equity
18	18	1.18securities required to be registered under United States Code, title 15, section 781.
19	19	1.19For purposes of this paragraph:
20	20	1.20 (i) ownership interests owned by a corporation, partnership, estate, or trust are considered
21	21	1.21owned proportionately by that entity's shareholders, partners, or beneficiaries;
22	22	1Section 1.
23	23	23-01099 as introduced01/17/23 REVISOR SGS/LN
24	24	SENATE
25	25	STATE OF MINNESOTA
26	26	S.F. No. 831NINETY-THIRD SESSION
27	27	(SENATE AUTHORS: PAPPAS)
28	28	OFFICIAL STATUSD-PGDATE
29	29	Introduction and first reading01/26/2023
30	30	Referred to Health and Human Services 2.1 (ii) ownership interests owned by a nonprofit entity are considered owned by a single
31	31	2.2owner;
32	32	2.3 (iii) ownership interests owned by an individual are considered owned, directly or
33	33	2.4indirectly, by or for the individual's family. For purposes of this item, "family" means
34	34	2.5brothers and sisters, including half-brothers and half-sisters, a spouse, ancestors, and lineal
35	35	2.6descendants; and
36	36	2.7 (iv) if an individual or entity holds an option to purchase an ownership interest, the
37	37	2.8individual or entity is considered to be the owner of those ownership interests.
38	38	2.9 (c) "Contraceptive method" means a drug, device, or other product approved by the Food
39	39	2.10and Drug Administration to prevent unintended pregnancy.
40	40	2.11 (d) "Contraceptive service" means consultation, examination, procedures, and medical
41	41	2.12services related to the prevention of unintended pregnancy. This includes but is not limited
42	42	2.13to voluntary sterilization procedures, patient education, counseling on contraceptives, and
43	43	2.14follow-up services related to contraceptive methods or services, management of side effects,
44	44	2.15counseling for continued adherence, and device insertion or removal.
45	45	2.16 (e) "Eligible organization" means an organization that opposes providing coverage for
46	46	2.17some or all contraceptive methods or services on account of religious objections and that
47	47	2.18is:
48	48	2.19 (1) organized as a nonprofit entity and holds itself as a religious organization; or
49	49	2.20 (2) organized and operates as a closely held for-profit entity, and the organization's
50	50	2.21highest governing body has adopted, under the organization's applicable rules of governance
51	51	2.22and consistent with state law, a resolution or similar action establishing that it objects to
52	52	2.23covering some or all contraceptive methods or services on account of the owners' sincerely
53	53	2.24held religious beliefs.
54	54	2.25 (f) "Medical necessity" includes but is not limited to considerations such as severity of
55	55	2.26side effects, difference in permanence and reversability of a contraceptive method or service,
56	56	2.27and ability to adhere to the appropriate use of the contraceptive method or service, as
57	57	2.28determined by the attending provider.
58	58	2.29 (g) "Religious organization" means an organization that is organized and operates as a
59	59	2.30nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
60	60	2.31Revenue Code of 1986, as amended.
61	61	2Section 1.
62	62	23-01099 as introduced01/17/23 REVISOR SGS/LN 3.1 (h) "Therapeutic equivalent version" means a drug, device, or product that can be expected
63	63	3.2to have the same clinical effect and safety profile when administered to a patient under the
64	64	3.3conditions specified in the labeling, and that:
65	65	3.4 (1) is approved as safe and effective;
66	66	3.5 (2) is a pharmaceutical equivalent, (i) containing identical amounts of the same active
67	67	3.6drug ingredient in the same dosage form and route of administration, and (ii) meeting
68	68	3.7compendial or other applicable standards of strength, quality, purity, and identity;
69	69	3.8 (3) is bioequivalent in that:
70	70	3.9 (i) the drug, device, or product does not present a known or potential bioequivalence
71	71	3.10problem and meets an acceptable in vitro standard; or
72	72	3.11 (ii) if the drug, device, or product does present a known or potential bioequivalence
73	73	3.12problem, it is shown to meet an appropriate bioequivalence standard;
74	74	3.13 (4) is adequately labeled; and
75	75	3.14 (5) is manufactured in compliance with current manufacturing practice regulations.
76	76	3.15 Subd. 2.Required coverage; cost sharing prohibited.(a) A health plan must provide
77	77	3.16coverage for contraceptive methods and services.
78	78	3.17 (b) A health plan company must not impose cost-sharing requirements, including co-pays,
79	79	3.18deductibles, or co-insurance, for contraceptive methods or services.
80	80	3.19 (c) Notwithstanding paragraph (b), a health plan that is a high-deductible health plan in
81	81	3.20conjunction with a health savings account must include cost-sharing for contraceptive
82	82	3.21methods and services at the minimum level necessary to preserve the enrollee's ability to
83	83	3.22make tax exempt contributions and withdrawals from the health savings account, as provided
84	84	3.23by section 223 of the Internal Revenue Code of 1986, as amended.
85	85	3.24 (d) A health plan company must not impose any referral requirements, restrictions, or
86	86	3.25delays for contraceptive methods or services.
87	87	3.26 (e) A health plan must include at least one of each type of Food and Drug Administration
88	88	3.27approved contraceptive method in its formulary. If more than one therapeutic equivalent
89	89	3.28version of a contraceptive method is approved, a health plan must include at least one
90	90	3.29therapeutic equivalent version in its formulary, but is not required to include all therapeutic
91	91	3.30equivalent versions.
92	92	3.31 (f) For each health plan, a health plan company must list the contraceptive methods and
93	93	3.32services that are covered without cost-sharing in a manner that is easily accessible to
94	94	3Section 1.
95	95	23-01099 as introduced01/17/23 REVISOR SGS/LN 4.1enrollees, health care providers, and representatives of health care providers. The list for
96	96	4.2each health plan must be promptly updated to reflect changes to the coverage.
97	97	4.3 (g) If an enrollee's attending provider recommends a particular contraceptive method or
98	98	4.4service based on a determination of medical necessity for that enrollee, the health plan must
99	99	4.5cover that contraceptive method or service without cost-sharing. The health plan company
100	100	4.6issuing the health plan must defer to the attending provider's determination that the particular
101	101	4.7contraceptive method or service is medically necessary for the enrollee.
102	102	4.8 Subd. 3.Religious employers; exempt(a) A religious employer is not required to cover
103	103	4.9contraceptive methods or services if the employer has religious objections to the coverage.
104	104	4.10A religious employer that chooses to not provide coverage for contraceptive methods and
105	105	4.11services must notify employees as part of the hiring process and to all employees at least
106	106	4.1230 days before:
107	107	4.13 (1) an employee enrolls in the health plan; or
108	108	4.14 (2) the effective date of the health plan, whichever occurs first.
109	109	4.15 (b) If the religious employer provides coverage for some contraceptive methods or
110	110	4.16services, the notice must provide a list of the contraceptive methods or services the employer
111	111	4.17refuses to cover.
112	112	4.18 Subd. 4.Accommodation for eligible organizations.(a) A health plan established or
113	113	4.19maintained by an eligible organization complies with the requirements of subdivision 2 to
114	114	4.20provide coverage of contraceptive methods and services if the eligible organization provides
115	115	4.21notice to any health plan company the eligible organization contracts with that it is an eligible
116	116	4.22organization and that the eligible organization has a religious objection to coverage for all
117	117	4.23or a subset of contraceptive methods or services.
118	118	4.24 (b) The notice from an eligible organization to a health plan company under paragraph
119	119	4.25(a) must include (1) the name of the eligible organization, (2) a statement that it objects to
120	120	4.26coverage for some or all of contraceptive methods or services, including a list of the
121	121	4.27contraceptive methods or services the eligible organization objects to, if applicable, and (3)
122	122	4.28the health plan name. The notice must be executed by a person authorized to provide notice
123	123	4.29on behalf of the eligible organization.
124	124	4.30 (c) An eligible organization must provide a copy of the notice under paragraph (b) to
125	125	4.31prospective employees as part of the hiring process and to all employees at least 30 days
126	126	4.32before:
127	127	4.33 (1) an employee enrolls in the health plan; or
128	128	4Section 1.
129	129	23-01099 as introduced01/17/23 REVISOR SGS/LN 5.1 (2) the effective date of the health plan, whichever occurs first.
130	130	5.2 (d) A health plan company that receives a copy of the notice under paragraph (a) with
131	131	5.3respect to a health plan established or maintained by an eligible organization must:
132	132	5.4 (1) expressly exclude coverage for some or all contraceptive methods or services from
133	133	5.5the health plan; and
134	134	5.6 (2) provide separate payments for any contraceptive methods or services required to be
135	135	5.7covered under subdivision 2 for enrollees as long as the enrollee remains enrolled in the
136	136	5.8health plan.
137	137	5.9 (e) The health plan company must not impose any cost-sharing requirements, including
138	138	5.10co-pays, deductibles, or co-insurance, or directly or indirectly impose any premium, fee, or
139	139	5.11other charge for contraceptive services or methods on the eligible organization, health plan,
140	140	5.12or enrollee.
141	141	5.13 (f) On January 1, 2025, and every year thereafter a health plan company must notify the
142	142	5.14commissioner, in a manner to be determined by the commissioner, regarding the number
143	143	5.15of eligible organizations granted an accommodation under this subdivision.
144	144	5.16 EFFECTIVE DATE.This section is effective January 1, 2024, and applies to coverage
145	145	5.17offered, sold, issued, or renewed on or after that date.
146	146	5.18 Sec. 2. [62Q.523] COVERAGE FOR PRESCRIPTION CONTRACEPTIVES;
147	147	5.19SUPPLY REQUIREMENTS.
148	148	5.20 Subdivision 1.Scope of coverage.Except as otherwise provided in section 62Q.522,
149	149	5.21subdivision 3, all health plans that provide prescription coverage must comply with the
150	150	5.22requirements of this section.
151	151	5.23 Subd. 2.Definition.For purposes of this section, "prescription contraceptive" means
152	152	5.24any drug or device that requires a prescription and is approved by the Food and Drug
153	153	5.25Administration to prevent pregnancy. Prescription contraceptive does not include an
154	154	5.26emergency contraceptive drug that prevents pregnancy when administered after sexual
155	155	5.27contact.
156	156	5.28 Subd. 3.Required coverage.(a) Health plan coverage for a prescription contraceptive
157	157	5.29must provide a 12-month supply for any prescription contraceptive, regardless of whether
158	158	5.30the enrollee was covered by the health plan at the time of the first dispensing.
159	159	5.31 (b) The prescribing health care provider must determine the appropriate number of
160	160	5.32months to prescribe the prescription contraceptives for, up to 12 months.
161	161	5Sec. 2.
162	162	23-01099 as introduced01/17/23 REVISOR SGS/LN 6.1 EFFECTIVE DATE.This section is effective January 1, 2024, and applies to coverage
163	163	6.2offered, sold, issued, or renewed on or after that date.
164	164	6.3 Sec. 3. Minnesota Statutes 2022, section 256B.0625, subdivision 13, is amended to read:
165	165	6.4 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
166	166	6.5specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
167	167	6.6by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
168	168	6.7dispensing physician, or by a physician, a physician assistant, or an advanced practice
169	169	6.8registered nurse employed by or under contract with a community health board as defined
170	170	6.9in section 145A.02, subdivision 5, for the purposes of communicable disease control.
171	171	6.10 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
172	172	6.11unless authorized by the commissioner or the drug appears on the 90-day supply list published
173	173	6.12by the commissioner. The 90-day supply list shall be published by the commissioner on the
174	174	6.13department's website. The commissioner may add to, delete from, and otherwise modify
175	175	6.14the 90-day supply list after providing public notice and the opportunity for a 15-day public
176	176	6.15comment period. The 90-day supply list may include cost-effective generic drugs and shall
177	177	6.16not include controlled substances as provided in paragraph (h).
178	178	6.17 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
179	179	6.18ingredient" is defined as a substance that is represented for use in a drug and when used in
180	180	6.19the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
181	181	6.20drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
182	182	6.21for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
183	183	6.22excipients which are included in the medical assistance formulary. Medical assistance covers
184	184	6.23selected active pharmaceutical ingredients and excipients used in compounded prescriptions
185	185	6.24when the compounded combination is specifically approved by the commissioner or when
186	186	6.25a commercially available product:
187	187	6.26 (1) is not a therapeutic option for the patient;
188	188	6.27 (2) does not exist in the same combination of active ingredients in the same strengths
189	189	6.28as the compounded prescription; and
190	190	6.29 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
191	191	6.30prescription.
192	192	6.31 (d) Medical assistance covers the following over-the-counter drugs when prescribed by
193	193	6.32a licensed practitioner or by a licensed pharmacist who meets standards established by the
194	194	6.33commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
195	195	6Sec. 3.
196	196	23-01099 as introduced01/17/23 REVISOR SGS/LN 7.1planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
197	197	7.2with documented vitamin deficiencies, vitamins for children under the age of seven and
198	198	7.3pregnant or nursing women, and any other over-the-counter drug identified by the
199	199	7.4commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
200	200	7.5and cost-effective for the treatment of certain specified chronic diseases, conditions, or
201	201	7.6disorders, and this determination shall not be subject to the requirements of chapter 14. A
202	202	7.7pharmacist may prescribe over-the-counter medications as provided under this paragraph
203	203	7.8for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
204	204	7.9drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
205	205	7.10necessity, provide drug counseling, review drug therapy for potential adverse interactions,
206	206	7.11and make referrals as needed to other health care professionals.
207	207	7.12 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
208	208	7.13under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
209	209	7.14Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
210	210	7.15for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
211	211	7.16Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
212	212	7.17individuals, medical assistance may cover drugs from the drug classes listed in United States
213	213	7.18Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
214	214	7.1913g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
215	215	7.20not be covered.
216	216	7.21 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
217	217	7.22Program and dispensed by 340B covered entities and ambulatory pharmacies under common
218	218	7.23ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
219	219	7.24through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
220	220	7.25 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
221	221	7.26contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
222	222	7.27151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
223	223	7.28licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
224	224	7.29used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
225	225	7.30pharmacist in accordance with section 151.37, subdivision 16.
226	226	7.31 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
227	227	7.32supply for any prescription contraceptive, regardless of whether the enrollee was covered
228	228	7.33by medical assistance or the health plan at the time of the first dispensing. The prescribing
229	229	7.34health care provider must determine the appropriate number of months to prescribe the
230	230	7.35prescription contraceptives for, up to 12 months.
231	231	7Sec. 3.
232	232	23-01099 as introduced01/17/23 REVISOR SGS/LN 8.1For purposes of this paragraph, "prescription contraceptive" means any drug or device that
233	233	8.2requires a prescription and is approved by the Food and Drug Administration to prevent
234	234	8.3pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
235	235	8.4approved to prevent pregnancy when administered after sexual contact. For purposes of this
236	236	8.5paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
237	237	8.6 EFFECTIVE DATE.This section applies to medical assistance and MinnesotaCare
238	238	8.7coverage effective January 1, 2024.
239	239	8Sec. 3.
240	240	23-01099 as introduced01/17/23 REVISOR SGS/LN