Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF2607 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 human services; modifying applicability of prior authorization clinical
3	3	1.3 criteria changes and utilization review provisions; amending Minnesota Statutes
4	4	1.4 2024, sections 62M.17, subdivision 2; 256B.0625, subdivision 25c.
5	5	1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
6	6	1.6 Section 1. Minnesota Statutes 2024, section 62M.17, subdivision 2, is amended to read:
7	7	1.7 Subd. 2.Effect of change in prior authorization clinical criteria.(a) If, during a plan
8	8	1.8year, or a calendar year for fee-for-service providers under chapters 256B and 256L, a
9	9	1.9utilization review organization changes coverage terms for a health care service or the
10	10	1.10clinical criteria used to conduct prior authorizations for a health care service, the change in
11	11	1.11coverage terms or change in clinical criteria shall not apply until the next plan year, or the
12	12	1.12next calendar year for fee-for-service providers under chapters 256B and 256L, for any
13	13	1.13enrollee who received prior authorization for a health care service using the coverage terms
14	14	1.14or clinical criteria in effect before the effective date of the change.
15	15	1.15 (b) Paragraph (a) does not apply if a utilization review organization changes coverage
16	16	1.16terms for a drug or device that has been deemed unsafe by the United States Food and Drug
17	17	1.17Administration (FDA); that has been withdrawn by either the FDA or the product
18	18	1.18manufacturer; or when an independent source of research, clinical guidelines, or
19	19	1.19evidence-based standards has issued drug- or device-specific warnings or recommended
20	20	1.20changes in drug or device usage.
21	21	1.21 (c) Paragraph (a) does not apply if a utilization review organization changes coverage
22	22	1.22terms for a service or the clinical criteria used to conduct prior authorizations for a service
23	23	1.23when an independent source of research, clinical guidelines, or evidence-based standards
24	24	1Section 1.
25	25	25-00345 as introduced02/17/25 REVISOR EB/CH
26	26	SENATE
27	27	STATE OF MINNESOTA
28	28	S.F. No. 2607NINETY-FOURTH SESSION
29	29	(SENATE AUTHORS: KUPEC)
30	30	OFFICIAL STATUSD-PGDATE
31	31	Introduction and first reading03/17/2025
32	32	Referred to Health and Human Services 2.1has recommended changes in usage of the service for reasons related to patient harm. This
33	33	2.2paragraph expires December 31, 2025, for health benefit plans offered, sold, issued, or
34	34	2.3renewed on or after that date.
35	35	2.4 (d) Effective January 1, 2026, and applicable to health benefit plans offered, sold, issued,
36	36	2.5or renewed on or after that date, paragraph (a) does not apply if a utilization review
37	37	2.6organization changes coverage terms for a service or the clinical criteria used to conduct
38	38	2.7prior authorizations for a service when an independent source of research, clinical guidelines,
39	39	2.8or evidence-based standards has recommended changes in usage of the service for reasons
40	40	2.9related to previously unknown and imminent patient harm.
41	41	2.10 (e) Paragraph (a) does not apply if a utilization review organization removes a brand
42	42	2.11name drug from its formulary or places a brand name drug in a benefit category that increases
43	43	2.12the enrollee's cost, provided the utilization review organization (1) adds to its formulary a
44	44	2.13generic or multisource brand name drug rated as therapeutically equivalent according to
45	45	2.14the FDA Orange Book, or a biologic drug rated as interchangeable according to the FDA
46	46	2.15Purple Book, at a lower cost to the enrollee, and (2) provides at least a 60-day notice to
47	47	2.16prescribers, pharmacists, and affected enrollees.
48	48	2.17 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 25c, is amended to read:
49	49	2.18 Subd. 25c.Applicability of utilization review provisions.Effective January 1, 2026,
50	50	2.19the following provisions of chapter 62M apply to the commissioner when delivering services
51	51	2.20under chapters 256B and 256L: 62M.02, subdivisions 1 to 5, 7 to 12, 13, 14 to 18, and 21;
52	52	2.2162M.04; 62M.05, subdivisions 1 to 4; 62M.06, subdivisions 1 to 3; 62M.07; 62M.072;
53	53	2.2262M.09; 62M.10; 62M.12; and 62M.17, subdivision 2; and 62M.18.
54	54	2Sec. 2.
55	55	25-00345 as introduced02/17/25 REVISOR EB/CH