Minnesota 2025-2026 Regular Session

Minnesota House Bill HF1758 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 insurance; requiring health plans to cover infertility treatment and
3	3	1.3 standard fertility preservation services; requiring medical assistance and
4	4	1.4 MinnesotaCare to cover infertility treatment and standard fertility preservation
5	5	1.5 services; appropriating money; amending Minnesota Statutes 2024, section
6	6	1.6 256B.0625, subdivision 13, by adding a subdivision; proposing coding for new
7	7	1.7 law in Minnesota Statutes, chapter 62Q.
8	8	1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
9	9	1.9 Section 1. [62Q.60] COVERAGE OF INFERTILITY TREATMENT.
10	10	1.10 Subdivision 1.Scope.This section applies to all health plans that provide maternity
11	11	1.11benefits to Minnesota residents.
12	12	1.12 Subd. 2.Definitions.(a) For the purposes of this section, the following terms have the
13	13	1.13meanings given.
14	14	1.14 (b) "Diagnosis of and treatment for infertility" means procedures and medications:
15	15	1.15 (1) to diagnose or treat infertility; and
16	16	1.16 (2) consistent with established, published, or approved medical practices or professional
17	17	1.17guidelines from the American College of Obstetricians and Gynecologists or the American
18	18	1.18Society for Reproductive Medicine.
19	19	1.19 (c) "Infertility" means a disease, condition, or status characterized by:
20	20	1.20 (1) the failure of a person with a uterus to establish a pregnancy or to carry a pregnancy
21	21	1.21to live birth after the following duration of unprotected sexual intercourse, regardless of
22	22	1.22whether a pregnancy resulted in miscarriage during such time:
23	23	1Section 1.
24	24	REVISOR SGS/DG 25-0273902/14/25
25	25	State of Minnesota
26	26	This Document can be made available
27	27	in alternative formats upon request
28	28	HOUSE OF REPRESENTATIVES
29	29	H. F. No. 1758
30	30	NINETY-FOURTH SESSION
31	31	Authored by Kotyza-Witthuhn, Engen and Long03/03/2025
32	32	The bill was read for the first time and referred to the Committee on Commerce Finance and Policy 2.1 (i) for a person under the age of 35, 12 months duration; or
33	33	2.2 (ii) for a person 35 years of age or older, six months duration;
34	34	2.3 (2) a person's inability to reproduce without medical intervention either as a single
35	35	2.4individual or with the person's partner; or
36	36	2.5 (3) a licensed health care provider's determination that a patient is infertile based on the
37	37	2.6patient's medical, sexual, and reproductive history; age; physical findings; or diagnostic
38	38	2.7testing.
39	39	2.8 (d) "Standard fertility preservation services" means procedures that are consistent with
40	40	2.9the established medical practices or professional guidelines published by the American
41	41	2.10Society for Reproductive Medicine or the American Society of Clinical Oncology for a
42	42	2.11person who has a medical condition or is expected to undergo medication therapy, surgery,
43	43	2.12radiation, chemotherapy, or other medical treatment that is recognized by medical
44	44	2.13professionals to cause a risk of impairment to fertility.
45	45	2.14 Subd. 3.Required coverage.(a) Health plans must provide comprehensive coverage
46	46	2.15for:
47	47	2.16 (1) diagnosis of and treatment for infertility; and
48	48	2.17 (2) standard fertility preservation services.
49	49	2.18 (b) Coverage under this section must include unlimited embryo transfers, but may impose
50	50	2.19a limit of four completed oocyte retrievals. Single embryo transfer must be used when
51	51	2.20medically appropriate and recommended by the treating health care provider.
52	52	2.21 (c) Coverage for surgical reversal of elective sterilization is not required under this
53	53	2.22section.
54	54	2.23 Subd. 4.Cost-sharing requirements.A health plan must not impose on the coverage
55	55	2.24under this section any cost-sharing requirement that is greater than the cost-sharing
56	56	2.25requirement imposed on maternity coverage under the plan, including but not limited to the
57	57	2.26following requirements:
58	58	2.27 (1) co-payment;
59	59	2.28 (2) deductible; or
60	60	2.29 (3) coinsurance.
61	61	2.30 Subd. 5.Exclusions and limitations.(a) A health plan must not impose any benefit
62	62	2.31maximum, waiting period, utilization review, referral requirement, or any other limitation
63	63	2Section 1.
64	64	REVISOR SGS/DG 25-0273902/14/25 3.1on the coverage under this section, except as provided in subdivision 3, paragraphs (b) and
65	65	3.2(c), that is not generally applicable to maternity coverage under the health plan.
66	66	3.3 (b) The prohibition under this subdivision includes but is not limited to any exclusion,
67	67	3.4limitation, or other restriction on:
68	68	3.5 (1) fertility medications that are different from those imposed on other prescription
69	69	3.6medications; and
70	70	3.7 (2) any fertility services based on an enrollee's participation in fertility services provided
71	71	3.8by or to a third party.
72	72	3.9 Subd. 6.Reimbursement.(a) The commissioner of commerce must reimburse health
73	73	3.10plan companies for coverage under this section. Reimbursement is available only for coverage
74	74	3.11that would not have been provided by the health plan without the requirements of this
75	75	3.12section. Treatments and services covered by the health plan as of January 1, 2025, are
76	76	3.13ineligible for payment under this subdivision by the commissioner of commerce.
77	77	3.14 (b) Health plan companies must report to the commissioner of commerce quantified
78	78	3.15costs attributable to the additional benefit under this section in a format developed by the
79	79	3.16commissioner. A health plan's coverage as of January 1, 2025, must be used by the health
80	80	3.17plan company as the basis for determining whether coverage would not have been provided
81	81	3.18by the health plan for purposes of this subdivision.
82	82	3.19 (c) The commissioner of commerce must evaluate submissions and make payments to
83	83	3.20health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
84	84	3.21 Subd. 7.Appropriation.Each fiscal year, an amount necessary to make payments to
85	85	3.22health plan companies to defray the cost of providing coverage under this section is
86	86	3.23appropriated to the commissioner of commerce.
87	87	3.24 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to all health
88	88	3.25plans issued or renewed on or after that date.
89	89	3.26 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to read:
90	90	3.27 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
91	91	3.28specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
92	92	3.29by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
93	93	3.30dispensing physician, or by a physician, a physician assistant, or an advanced practice
94	94	3.31registered nurse employed by or under contract with a community health board as defined
95	95	3.32in section 145A.02, subdivision 5, for the purposes of communicable disease control.
96	96	3Sec. 2.
97	97	REVISOR SGS/DG 25-0273902/14/25 4.1 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
98	98	4.2authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
99	99	4.390-day supply list published by the commissioner. The 90-day supply list shall be published
100	100	4.4by the commissioner on the department's website. The commissioner may add to, delete
101	101	4.5from, and otherwise modify the 90-day supply list after providing public notice and the
102	102	4.6opportunity for a 15-day public comment period. The 90-day supply list may include
103	103	4.7cost-effective generic drugs and shall not include controlled substances.
104	104	4.8 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
105	105	4.9ingredient" is defined as a substance that is represented for use in a drug and when used in
106	106	4.10the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
107	107	4.11drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
108	108	4.12for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
109	109	4.13excipients which are included in the medical assistance formulary. Medical assistance covers
110	110	4.14selected active pharmaceutical ingredients and excipients used in compounded prescriptions
111	111	4.15when the compounded combination is specifically approved by the commissioner or when
112	112	4.16a commercially available product:
113	113	4.17 (1) is not a therapeutic option for the patient;
114	114	4.18 (2) does not exist in the same combination of active ingredients in the same strengths
115	115	4.19as the compounded prescription; and
116	116	4.20 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
117	117	4.21prescription.
118	118	4.22 (d) Medical assistance covers the following over-the-counter drugs when prescribed by
119	119	4.23a licensed practitioner or by a licensed pharmacist who meets standards established by the
120	120	4.24commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
121	121	4.25planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
122	122	4.26with documented vitamin deficiencies, vitamins for children under the age of seven and
123	123	4.27pregnant or nursing women, and any other over-the-counter drug identified by the
124	124	4.28commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
125	125	4.29and cost-effective for the treatment of certain specified chronic diseases, conditions, or
126	126	4.30disorders, and this determination shall not be subject to the requirements of chapter 14. A
127	127	4.31pharmacist may prescribe over-the-counter medications as provided under this paragraph
128	128	4.32for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
129	129	4.33drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
130	130	4Sec. 2.
131	131	REVISOR SGS/DG 25-0273902/14/25 5.1necessity, provide drug counseling, review drug therapy for potential adverse interactions,
132	132	5.2and make referrals as needed to other health care professionals.
133	133	5.3 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
134	134	5.4under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
135	135	5.5Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
136	136	5.6for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
137	137	5.7Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
138	138	5.8individuals, medical assistance may cover drugs from the drug classes listed in United States
139	139	5.9Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
140	140	5.1013g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
141	141	5.11not be covered.
142	142	5.12 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
143	143	5.13Program and dispensed by 340B covered entities and ambulatory pharmacies under common
144	144	5.14ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
145	145	5.15through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
146	146	5.16 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
147	147	5.17contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
148	148	5.18151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
149	149	5.19licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
150	150	5.20used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
151	151	5.21pharmacist in accordance with section 151.37, subdivision 16.
152	152	5.22 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
153	153	5.23supply for any prescription contraceptive if a 12-month supply is prescribed by the
154	154	5.24prescribing health care provider. The prescribing health care provider must determine the
155	155	5.25appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
156	156	5.26For purposes of this paragraph, "prescription contraceptive" means any drug or device that
157	157	5.27requires a prescription and is approved by the Food and Drug Administration to prevent
158	158	5.28pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
159	159	5.29approved to prevent pregnancy when administered after sexual contact. For purposes of this
160	160	5.30paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
161	161	5.31 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval,
162	162	5.32whichever is later. The commissioner of human services shall notify the revisor of statutes
163	163	5.33when federal approval is obtained.
164	164	5Sec. 2.
165	165	REVISOR SGS/DG 25-0273902/14/25 6.1 Sec. 3. Minnesota Statutes 2024, section 256B.0625, is amended by adding a subdivision
166	166	6.2to read:
167	167	6.3 Subd. 77.Infertility treatment.(a) Medical assistance covers:
168	168	6.4 (1) diagnosis of and treatment for infertility; and
169	169	6.5 (2) standard fertility preservation services.
170	170	6.6 (b) Medical assistance must meet the same requirements that would otherwise apply to
171	171	6.7a health plan that provides maternity benefits to Minnesota residents under section 62Q.60,
172	172	6.8except that medical assistance is not required to comply with any provision of section 62Q.60
173	173	6.9if compliance with the provision would:
174	174	6.10 (1) prevent the state from receiving federal financial participation for the coverage under
175	175	6.11this subdivision; or
176	176	6.12 (2) result in a lower level of coverage or reduced access to coverage for medical assistance
177	177	6.13enrollees.
178	178	6.14 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval,
179	179	6.15whichever is later. The commissioner of human services shall notify the revisor of statutes
180	180	6.16when federal approval is obtained.
181	181	6.17 Sec. 4. APPROPRIATIONS; INFERTILITY TREATMENT COVERAGE.
182	182	6.18 Subdivision 1.Medical assistance.$....... in fiscal year 2026 and $....... in fiscal year
183	183	6.192027 are appropriated from the general fund to the commissioner of human services for
184	184	6.20medical assistance coverage of infertility treatment and fertility preservation services under
185	185	6.21Minnesota Statutes, section 256B.0625, subdivision 77. The base for this appropriation is
186	186	6.22$....... in fiscal year 2028.
187	187	6.23 Subd. 2.MinnesotaCare.$....... in fiscal year 2026 and $....... in fiscal year 2027 are
188	188	6.24appropriated from the health care access fund to the commissioner of human services for
189	189	6.25MinnesotaCare coverage of infertility treatment and fertility preservation services under
190	190	6.26Minnesota Statutes, section 256L.03, subdivision 1. The base for this appropriation is $.......
191	191	6.27in fiscal year 2028.
192	192	6.28 Subd. 3.Defrayal of costs.$....... in fiscal year 2027 is appropriated from the general
193	193	6.29fund to the commissioner of commerce for the estimated amount of defrayal costs for
194	194	6.30mandated coverage of infertility treatment and fertility preservation services. The base for
195	195	6.31this appropriation is $....... in fiscal year 2028.
196	196	6Sec. 4.
197	197	REVISOR SGS/DG 25-0273902/14/25 7.1 Subd. 4.Administrative costs.$....... in fiscal year 2027 is appropriated from the general
198	198	7.2fund to the commissioner of commerce for administrative costs to implement mandated
199	199	7.3coverage of infertility treatment and fertility preservation services. The base for this
200	200	7.4appropriation is $....... in fiscal year 2028.
201	201	7Sec. 4.
202	202	REVISOR SGS/DG 25-0273902/14/25