| 1 | 1 | | 1.1 A bill for an act |
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| 2 | 2 | | 1.2 relating to insurance; prohibiting prior authorization for services resulting in health |
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| 3 | 3 | | 1.3 plan company liability of equal to or less than $100; amending Minnesota Statutes |
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| 4 | 4 | | 1.4 2024, section 62M.07, subdivision 2. |
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| 5 | 5 | | 1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: |
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| 6 | 6 | | 1.6 Section 1. Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read: |
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| 7 | 7 | | 1.7 Subd. 2.Prior authorization of certain services prohibited.No utilization review |
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| 8 | 8 | | 1.8organization, health plan company, or claims administrator may conduct or require prior |
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| 9 | 9 | | 1.9authorization of: |
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| 10 | 10 | | 1.10 (1) emergency confinement or an emergency service. The enrollee or the enrollee's |
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| 11 | 11 | | 1.11authorized representative may be required to notify the health plan company, claims |
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| 12 | 12 | | 1.12administrator, or utilization review organization as soon as reasonably possible after the |
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| 13 | 13 | | 1.13beginning of the emergency confinement or emergency service; |
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| 14 | 14 | | 1.14 (2) outpatient mental health treatment or outpatient substance use disorder treatment, |
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| 15 | 15 | | 1.15except for treatment which is a medication. Prior authorizations required for medications |
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| 16 | 16 | | 1.16used for outpatient mental health treatment or outpatient substance use disorder treatment |
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| 17 | 17 | | 1.17must be processed according to section 62M.05, subdivision 3b, for initial determinations, |
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| 18 | 18 | | 1.18and according to section 62M.06, subdivision 2, for appeals; |
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| 19 | 19 | | 1.19 (3) antineoplastic cancer treatment that is consistent with guidelines of the National |
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| 20 | 20 | | 1.20Comprehensive Cancer Network, except for treatment which is a medication. Prior |
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| 21 | 21 | | 1.21authorizations required for medications used for antineoplastic cancer treatment must be |
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| 22 | 22 | | 1.22processed according to section 62M.05, subdivision 3b, for initial determinations, and |
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| 23 | 23 | | 1.23according to section 62M.06, subdivision 2, for appeals; |
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| 24 | 24 | | 1Section 1. |
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| 25 | 25 | | 25-01651 as introduced12/20/24 REVISOR SGS/NS |
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| 26 | 26 | | SENATE |
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| 27 | 27 | | STATE OF MINNESOTA |
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| 28 | 28 | | S.F. No. 731NINETY-FOURTH SESSION |
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| 29 | 29 | | (SENATE AUTHORS: ABELER, Mann, Wiklund, Klein and Utke) |
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| 30 | 30 | | OFFICIAL STATUSD-PGDATE |
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| 31 | 31 | | Introduction and first reading01/27/2025 |
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| 32 | 32 | | Referred to Commerce and Consumer Protection 2.1 (4) services that currently have a rating of A or B from the United States Preventive |
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| 33 | 33 | | 2.2Services Task Force, immunizations recommended by the Advisory Committee on |
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| 34 | 34 | | 2.3Immunization Practices of the Centers for Disease Control and Prevention, or preventive |
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| 35 | 35 | | 2.4services and screenings provided to women as described in Code of Federal Regulations, |
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| 36 | 36 | | 2.5title 45, section 147.130; |
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| 37 | 37 | | 2.6 (5) pediatric hospice services provided by a hospice provider licensed under sections |
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| 38 | 38 | | 2.7144A.75 to 144A.755; and |
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| 39 | 39 | | 2.8 (6) treatment delivered through a neonatal abstinence program operated by pediatric |
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| 40 | 40 | | 2.9pain or palliative care subspecialists.; and |
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| 41 | 41 | | 2.10 (7) any service, item, or treatment for which a health plan company's liability would be |
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| 42 | 42 | | 2.11equal to or less than $100 if the service, item, or treatment were approved. |
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| 43 | 43 | | 2.12Clauses (2) to (6) (7) are effective January 1, 2026, and apply to health benefit plans offered, |
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| 44 | 44 | | 2.13sold, issued, or renewed on or after that date. |
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| 45 | 45 | | 2Section 1. |
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| 46 | 46 | | 25-01651 as introduced12/20/24 REVISOR SGS/NS |
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