1.1 A bill for an act
1.2 relating to insurance; requiring health plans to cover infertility treatment and
1.3 standard fertility preservation services; requiring medical assistance and
1.4 MinnesotaCare to cover infertility treatment and standard fertility preservation
1.5 services; appropriating money; amending Minnesota Statutes 2024, section
1.6 256B.0625, subdivision 13, by adding a subdivision; proposing coding for new
1.7 law in Minnesota Statutes, chapter 62Q.
1.8BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
1.9 Section 1. [62Q.60] COVERAGE OF INFERTILITY TREATMENT.
1.10 Subdivision 1.Scope.This section applies to all health plans that provide maternity
1.11benefits to Minnesota residents.
1.12 Subd. 2.Definitions.(a) For the purposes of this section, the following terms have the
1.13meanings given.
1.14 (b) "Diagnosis of and treatment for infertility" means procedures and medications:
1.15 (1) to diagnose or treat infertility; and
1.16 (2) consistent with established, published, or approved medical practices or professional
1.17guidelines from the American College of Obstetricians and Gynecologists or the American
1.18Society for Reproductive Medicine.
1.19 (c) "Infertility" means a disease, condition, or status characterized by:
1.20 (1) the failure of a person with a uterus to establish a pregnancy or to carry a pregnancy
1.21to live birth after the following duration of unprotected sexual intercourse, regardless of
1.22whether a pregnancy resulted in miscarriage during such time:
1Section 1.
25-02739 as introduced02/14/25 REVISOR SGS/DG
SENATE
STATE OF MINNESOTA
S.F. No. 1961NINETY-FOURTH SESSION
(SENATE AUTHORS: MAYE QUADE, Mann, Coleman, Abeler and Duckworth)
OFFICIAL STATUSD-PGDATE
Introduction and first reading02/27/2025
Referred to Commerce and Consumer Protection 2.1 (i) for a person under the age of 35, 12 months duration; or
2.2 (ii) for a person 35 years of age or older, six months duration;
2.3 (2) a person's inability to reproduce without medical intervention either as a single
2.4individual or with the person's partner; or
2.5 (3) a licensed health care provider's determination that a patient is infertile based on the
2.6patient's medical, sexual, and reproductive history; age; physical findings; or diagnostic
2.7testing.
2.8 (d) "Standard fertility preservation services" means procedures that are consistent with
2.9the established medical practices or professional guidelines published by the American
2.10Society for Reproductive Medicine or the American Society of Clinical Oncology for a
2.11person who has a medical condition or is expected to undergo medication therapy, surgery,
2.12radiation, chemotherapy, or other medical treatment that is recognized by medical
2.13professionals to cause a risk of impairment to fertility.
2.14 Subd. 3.Required coverage.(a) Health plans must provide comprehensive coverage
2.15for:
2.16 (1) diagnosis of and treatment for infertility; and
2.17 (2) standard fertility preservation services.
2.18 (b) Coverage under this section must include unlimited embryo transfers, but may impose
2.19a limit of four completed oocyte retrievals. Single embryo transfer must be used when
2.20medically appropriate and recommended by the treating health care provider.
2.21 (c) Coverage for surgical reversal of elective sterilization is not required under this
2.22section.
2.23 Subd. 4.Cost-sharing requirements.A health plan must not impose on the coverage
2.24under this section any cost-sharing requirement that is greater than the cost-sharing
2.25requirement imposed on maternity coverage under the plan, including but not limited to the
2.26following requirements:
2.27 (1) co-payment;
2.28 (2) deductible; or
2.29 (3) coinsurance.
2.30 Subd. 5.Exclusions and limitations.(a) A health plan must not impose any benefit
2.31maximum, waiting period, utilization review, referral requirement, or any other limitation
2Section 1.
25-02739 as introduced02/14/25 REVISOR SGS/DG 3.1on the coverage under this section, except as provided in subdivision 3, paragraphs (b) and
3.2(c), that is not generally applicable to maternity coverage under the health plan.
3.3 (b) The prohibition under this subdivision includes but is not limited to any exclusion,
3.4limitation, or other restriction on:
3.5 (1) fertility medications that are different from those imposed on other prescription
3.6medications; and
3.7 (2) any fertility services based on an enrollee's participation in fertility services provided
3.8by or to a third party.
3.9 Subd. 6.Reimbursement.(a) The commissioner of commerce must reimburse health
3.10plan companies for coverage under this section. Reimbursement is available only for coverage
3.11that would not have been provided by the health plan without the requirements of this
3.12section. Treatments and services covered by the health plan as of January 1, 2025, are
3.13ineligible for payment under this subdivision by the commissioner of commerce.
3.14 (b) Health plan companies must report to the commissioner of commerce quantified
3.15costs attributable to the additional benefit under this section in a format developed by the
3.16commissioner. A health plan's coverage as of January 1, 2025, must be used by the health
3.17plan company as the basis for determining whether coverage would not have been provided
3.18by the health plan for purposes of this subdivision.
3.19 (c) The commissioner of commerce must evaluate submissions and make payments to
3.20health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
3.21 Subd. 7.Appropriation.Each fiscal year, an amount necessary to make payments to
3.22health plan companies to defray the cost of providing coverage under this section is
3.23appropriated to the commissioner of commerce.
3.24 EFFECTIVE DATE.This section is effective January 1, 2026, and applies to all health
3.25plans issued or renewed on or after that date.
3.26 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to read:
3.27 Subd. 13.Drugs.(a) Medical assistance covers drugs, except for fertility drugs when
3.28specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
3.29by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
3.30dispensing physician, or by a physician, a physician assistant, or an advanced practice
3.31registered nurse employed by or under contract with a community health board as defined
3.32in section 145A.02, subdivision 5, for the purposes of communicable disease control.
3Sec. 2.
25-02739 as introduced02/14/25 REVISOR SGS/DG 4.1 (b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless
4.2authorized by the commissioner or as provided in paragraph (h) or the drug appears on the
4.390-day supply list published by the commissioner. The 90-day supply list shall be published
4.4by the commissioner on the department's website. The commissioner may add to, delete
4.5from, and otherwise modify the 90-day supply list after providing public notice and the
4.6opportunity for a 15-day public comment period. The 90-day supply list may include
4.7cost-effective generic drugs and shall not include controlled substances.
4.8 (c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
4.9ingredient" is defined as a substance that is represented for use in a drug and when used in
4.10the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
4.11drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
4.12for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
4.13excipients which are included in the medical assistance formulary. Medical assistance covers
4.14selected active pharmaceutical ingredients and excipients used in compounded prescriptions
4.15when the compounded combination is specifically approved by the commissioner or when
4.16a commercially available product:
4.17 (1) is not a therapeutic option for the patient;
4.18 (2) does not exist in the same combination of active ingredients in the same strengths
4.19as the compounded prescription; and
4.20 (3) cannot be used in place of the active pharmaceutical ingredient in the compounded
4.21prescription.
4.22 (d) Medical assistance covers the following over-the-counter drugs when prescribed by
4.23a licensed practitioner or by a licensed pharmacist who meets standards established by the
4.24commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
4.25planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
4.26with documented vitamin deficiencies, vitamins for children under the age of seven and
4.27pregnant or nursing women, and any other over-the-counter drug identified by the
4.28commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
4.29and cost-effective for the treatment of certain specified chronic diseases, conditions, or
4.30disorders, and this determination shall not be subject to the requirements of chapter 14. A
4.31pharmacist may prescribe over-the-counter medications as provided under this paragraph
4.32for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
4.33drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
4Sec. 2.
25-02739 as introduced02/14/25 REVISOR SGS/DG 5.1necessity, provide drug counseling, review drug therapy for potential adverse interactions,
5.2and make referrals as needed to other health care professionals.
5.3 (e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
5.4under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
5.5Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
5.6for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
5.7Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
5.8individuals, medical assistance may cover drugs from the drug classes listed in United States
5.9Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
5.1013g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
5.11not be covered.
5.12 (f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
5.13Program and dispensed by 340B covered entities and ambulatory pharmacies under common
5.14ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
5.15through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
5.16 (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
5.17contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
5.18151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
5.19licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
5.20used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
5.21pharmacist in accordance with section 151.37, subdivision 16.
5.22 (h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
5.23supply for any prescription contraceptive if a 12-month supply is prescribed by the
5.24prescribing health care provider. The prescribing health care provider must determine the
5.25appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
5.26For purposes of this paragraph, "prescription contraceptive" means any drug or device that
5.27requires a prescription and is approved by the Food and Drug Administration to prevent
5.28pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
5.29approved to prevent pregnancy when administered after sexual contact. For purposes of this
5.30paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
5.31 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval,
5.32whichever is later. The commissioner of human services shall notify the revisor of statutes
5.33when federal approval is obtained.
5Sec. 2.
25-02739 as introduced02/14/25 REVISOR SGS/DG 6.1 Sec. 3. Minnesota Statutes 2024, section 256B.0625, is amended by adding a subdivision
6.2to read:
6.3 Subd. 77.Infertility treatment.(a) Medical assistance covers:
6.4 (1) diagnosis of and treatment for infertility; and
6.5 (2) standard fertility preservation services.
6.6 (b) Medical assistance must meet the same requirements that would otherwise apply to
6.7a health plan that provides maternity benefits to Minnesota residents under section 62Q.60,
6.8except that medical assistance is not required to comply with any provision of section 62Q.60
6.9if compliance with the provision would:
6.10 (1) prevent the state from receiving federal financial participation for the coverage under
6.11this subdivision; or
6.12 (2) result in a lower level of coverage or reduced access to coverage for medical assistance
6.13enrollees.
6.14 EFFECTIVE DATE.This section is effective January 1, 2026, or upon federal approval,
6.15whichever is later. The commissioner of human services shall notify the revisor of statutes
6.16when federal approval is obtained.
6.17 Sec. 4. APPROPRIATIONS; INFERTILITY TREATMENT COVERAGE.
6.18 Subdivision 1.Medical assistance.$....... in fiscal year 2026 and $....... in fiscal year
6.192027 are appropriated from the general fund to the commissioner of human services for
6.20medical assistance coverage of infertility treatment and fertility preservation services under
6.21Minnesota Statutes, section 256B.0625, subdivision 77. The base for this appropriation is
6.22$....... in fiscal year 2028.
6.23 Subd. 2.MinnesotaCare.$....... in fiscal year 2026 and $....... in fiscal year 2027 are
6.24appropriated from the health care access fund to the commissioner of human services for
6.25MinnesotaCare coverage of infertility treatment and fertility preservation services under
6.26Minnesota Statutes, section 256L.03, subdivision 1. The base for this appropriation is $.......
6.27in fiscal year 2028.
6.28 Subd. 3.Defrayal of costs.$....... in fiscal year 2027 is appropriated from the general
6.29fund to the commissioner of commerce for the estimated amount of defrayal costs for
6.30mandated coverage of infertility treatment and fertility preservation services. The base for
6.31this appropriation is $....... in fiscal year 2028.
6Sec. 4.
25-02739 as introduced02/14/25 REVISOR SGS/DG 7.1 Subd. 4.Administrative costs.$....... in fiscal year 2027 is appropriated from the general
7.2fund to the commissioner of commerce for administrative costs to implement mandated
7.3coverage of infertility treatment and fertility preservation services. The base for this
7.4appropriation is $....... in fiscal year 2028.
7Sec. 4.
25-02739 as introduced02/14/25 REVISOR SGS/DG