Applicability of prior authorization clinical criteria changes and utilization review provisions modification
Impact
The legislation, set to be effective from January 1, 2026, significantly modifies how healthcare services are approved and covered in Minnesota. It emphasizes the importance of prior authorization and restricts utilization review organizations from implementing changes that could disadvantage patients midway through their treatment plans. Furthermore, it mandates a 60-day notice for any changes that would result in higher costs for the enrollee, thereby promoting transparency and forewarning.
Summary
SF2607, introduced as a modification to the regulations governing prior authorization clinical criteria and utilization review provisions, aims to protect patients from abrupt changes in healthcare coverage. The bill stipulates that if a health plan changes coverage terms or clinical criteria for healthcare services mid-year, such changes should not apply to enrollees who received prior authorization under the old terms. This provision is designed to ensure continuity of care for patients already under treatment and to safeguard them from potentially harmful disruptions.
Contention
Despite its patient-centered focus, the bill has attracted varied opinions from stakeholders in the healthcare system. Advocates argue that it ensures patient safety and prevents insurance companies from unfairly withdrawing previously authorized care without due warning. Critics, however, suggest that these restrictions may complicate the management of healthcare services and delay necessary adjustments to coverage based on emerging clinical evidence, potentially hindering healthcare organizations' ability to respond swiftly to new information about patient care.
Prior authorization and coverage of health services requirements modification; ground for disciplinary action against physicians modification; commissioner of commerce and legislature report requirements; classifying data
Health care service prior authorization and coverage requirements modified, ground for disciplinary action against physicians modified, reports to the commissioner of commerce and the legislature required, data classified, and rulemaking authorized.