Minnesota 2025-2026 Regular Session

Minnesota Senate Bill SF3123 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 state government; establishing a state employee group insurance program
3	3	1.3 utilization review pilot program; requiring reports.
4	4	1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
5	5	1.5 Section 1. STATE EMPLOYEE GROUP INSURANCE PROGRAM UTILIZATION
6	6	1.6REVIEW PILOT PROGRAM.
7	7	1.7 Subdivision 1.Definitions.(a) For purposes of this section, the following terms have
8	8	1.8the meanings given.
9	9	1.9 (b) "Enrollee" means an individual covered by a health plan offered through the state
10	10	1.10employee group insurance program.
11	11	1.11 (c) "Health carrier" means a nonprofit health service plan corporation operating under
12	12	1.12Minnesota Statutes, chapter 62C, or health maintenance organization operating under
13	13	1.13Minnesota Statutes, chapter 62D, with which the commissioner of management and budget
14	14	1.14contracts for purposes of the state employee group insurance program.
15	15	1.15 (d) "Health plan" means a health plan as defined in Minnesota Statutes, section 62A.011,
16	16	1.16subdivision 3, that is offered through the state employee group insurance program.
17	17	1.17 (e) "Medically necessary care" has the meaning given in Minnesota Statutes, section
18	18	1.1862Q.53, subdivision 2.
19	19	1.19 (f) "Prior authorization" has the meaning given in Minnesota Statutes, section 62M.02,
20	20	1.20subdivision 15.
21	21	1Section 1.
22	22	25-04111 as introduced03/06/25 REVISOR SS/ES
23	23	SENATE
24	24	STATE OF MINNESOTA
25	25	S.F. No. 3123NINETY-FOURTH SESSION
26	26	(SENATE AUTHORS: ABELER)
27	27	OFFICIAL STATUSD-PGDATE
28	28	Introduction and first reading04/01/2025
29	29	Referred to State and Local Government 2.1 (g) "Retrospective utilization review" means the evaluation, after the provision of a
30	30	2.2service or procedure or facility admission, of the necessity, appropriateness, and efficacy
31	31	2.3of the health care service or procedure or facility admission by an individual or entity other
32	32	2.4than the attending health care professional.
33	33	2.5 (h) "State employee group insurance program" means the state employee group insurance
34	34	2.6program under Minnesota Statutes, sections 43A.22 to 43A.31.
35	35	2.7 Subd. 2.Pilot program established.The commissioner of management and budget
36	36	2.8must establish and administer a utilization review pilot program under the state employee
37	37	2.9group insurance program between January 1, 2026, and December 31, 2030, to evaluate the
38	38	2.10efficacy, costs, and benefits of using retrospective utilization review as compared with using
39	39	2.11prior authorization to evaluate the necessity, appropriateness, and efficacy of health care
40	40	2.12services and procedures and facility admissions for enrollees. Under the pilot program,
41	41	2.13health plans must use retrospective utilization review, and may but are not required to use
42	42	2.14prior authorization, to evaluate the necessity, appropriateness, and efficacy of health care
43	43	2.15services and procedures and facility admissions for enrollees. Under the pilot program,
44	44	2.16retrospective utilization review and, if conducted, prior authorization must be conducted
45	45	2.17according to the requirements and timelines for utilization review in Minnesota Statutes,
46	46	2.18chapter 62M.
47	47	2.19 Subd. 3.Quality and payment audits.During the pilot program, health carriers must
48	48	2.20conduct quality and payment audits of retrospective utilization review determinations and
49	49	2.21prior authorization determinations made under the pilot program to evaluate the effects of
50	50	2.22the pilot program on enrollee access to medically necessary care and on payments to health
51	51	2.23care providers and facilities for health care services and procedures and facility admissions.
52	52	2.24 Subd. 4.Payment.(a) A health carrier may decline to pay a health care provider or
53	53	2.25facility for a health care service or procedure or facility admission for which an adverse
54	54	2.26determination is made and, if applicable, upheld on appeal.
55	55	2.27 (b) A health care provider or facility must not bill an enrollee or guarantor for, or
56	56	2.28otherwise seek to collect from an enrollee or guarantor, any amount for a health care service
57	57	2.29or procedure or facility admission for which the enrollee's health carrier made an adverse
58	58	2.30determination and that, if applicable, was upheld on appeal.
59	59	2.31 Subd. 5.Termination.The commissioner of management and budget may terminate
60	60	2.32the operation of the pilot program upon:
61	61	2.33 (1) a determination by the commissioner that the pilot program is having a significant
62	62	2.34negative impact on enrollee access to medically necessary care through the state employee
63	63	2Section 1.
64	64	25-04111 as introduced03/06/25 REVISOR SS/ES 3.1group insurance program or on costs to enrollees or the state for health care provided through
65	65	3.2the state employee group insurance program; and
66	66	3.3 (2) provision of notice to health carriers and to the chairs and ranking minority members
67	67	3.4of the legislative committees with jurisdiction over state government and health care, of the
68	68	3.5commissioner's intent to terminate the operation of the pilot program. This notice must be
69	69	3.6provided by July 1 of the calendar year prior to the year in which the commissioner intends
70	70	3.7to terminate the pilot program.
71	71	3.8Upon satisfaction by the commissioner of the requirements in clauses (1) and (2), the pilot
72	72	3.9program shall cease operations on January 1 of the year following the year in which notice
73	73	3.10was provided under clause (2).
74	74	3.11 Subd. 6.Reports.The commissioner of management and budget, in collaboration with
75	75	3.12the commissioner of health, must:
76	76	3.13 (1) evaluate the impacts of the pilot program on the cost to enrollees and to the state for
77	77	3.14health care provided under the state employee group insurance program and on enrollee
78	78	3.15access to care and the quality of health care provided to enrollees;
79	79	3.16 (2) develop recommendations on whether to continue the pilot program or expand the
80	80	3.17pilot program to other populations; and
81	81	3.18 (3) issue reports on these impacts and recommendations to the legislative committees
82	82	3.19with jurisdiction over health care and state government by March 1, 2027, and March 1 of
83	83	3.20each year thereafter through March 1, 2031.
84	84	3Section 1.
85	85	25-04111 as introduced03/06/25 REVISOR SS/ES