1.1 A bill for an act
1.2 relating to human services; modifying applicability of prior authorization clinical
1.3 criteria changes and utilization review provisions; amending Minnesota Statutes
1.4 2024, sections 62M.17, subdivision 2; 256B.0625, subdivision 25c.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.6 Section 1. Minnesota Statutes 2024, section 62M.17, subdivision 2, is amended to read:
1.7 Subd. 2.Effect of change in prior authorization clinical criteria.(a) If, during a plan
1.8year, or a calendar year for fee-for-service providers under chapters 256B and 256L, a
1.9utilization review organization changes coverage terms for a health care service or the
1.10clinical criteria used to conduct prior authorizations for a health care service, the change in
1.11coverage terms or change in clinical criteria shall not apply until the next plan year, or the
1.12next calendar year for fee-for-service providers under chapters 256B and 256L, for any
1.13enrollee who received prior authorization for a health care service using the coverage terms
1.14or clinical criteria in effect before the effective date of the change.
1.15 (b) Paragraph (a) does not apply if a utilization review organization changes coverage
1.16terms for a drug or device that has been deemed unsafe by the United States Food and Drug
1.17Administration (FDA); that has been withdrawn by either the FDA or the product
1.18manufacturer; or when an independent source of research, clinical guidelines, or
1.19evidence-based standards has issued drug- or device-specific warnings or recommended
1.20changes in drug or device usage.
1.21 (c) Paragraph (a) does not apply if a utilization review organization changes coverage
1.22terms for a service or the clinical criteria used to conduct prior authorizations for a service
1.23when an independent source of research, clinical guidelines, or evidence-based standards
1Section 1.
REVISOR EB/CH 25-0034502/17/25
State of Minnesota
This Document can be made available
in alternative formats upon request
HOUSE OF REPRESENTATIVES
H. F. No. 2482
NINETY-FOURTH SESSION
Authored by Bierman03/17/2025
The bill was read for the first time and referred to the Committee on Human Services Finance and Policy 2.1has recommended changes in usage of the service for reasons related to patient harm. This
2.2paragraph expires December 31, 2025, for health benefit plans offered, sold, issued, or
2.3renewed on or after that date.
2.4 (d) Effective January 1, 2026, and applicable to health benefit plans offered, sold, issued,
2.5or renewed on or after that date, paragraph (a) does not apply if a utilization review
2.6organization changes coverage terms for a service or the clinical criteria used to conduct
2.7prior authorizations for a service when an independent source of research, clinical guidelines,
2.8or evidence-based standards has recommended changes in usage of the service for reasons
2.9related to previously unknown and imminent patient harm.
2.10 (e) Paragraph (a) does not apply if a utilization review organization removes a brand
2.11name drug from its formulary or places a brand name drug in a benefit category that increases
2.12the enrollee's cost, provided the utilization review organization (1) adds to its formulary a
2.13generic or multisource brand name drug rated as therapeutically equivalent according to
2.14the FDA Orange Book, or a biologic drug rated as interchangeable according to the FDA
2.15Purple Book, at a lower cost to the enrollee, and (2) provides at least a 60-day notice to
2.16prescribers, pharmacists, and affected enrollees.
2.17 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 25c, is amended to read:
2.18 Subd. 25c.Applicability of utilization review provisions.Effective January 1, 2026,
2.19the following provisions of chapter 62M apply to the commissioner when delivering services
2.20under chapters 256B and 256L: 62M.02, subdivisions 1 to 5, 7 to 12, 13, 14 to 18, and 21;
2.2162M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions 1 to 3; 62M.07; 62M.072;
2.2262M.09; 62M.10; 62M.12; and 62M.17, subdivision 2; and 62M.18.
2Sec. 2.
REVISOR EB/CH 25-0034502/17/25