HF 529

1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to insurance; requiring coverage for amino acid based elemental
formulas; amending Minnesota Statutes 2006, sections 62A.26; 256B.0625, by
adding a subdivision.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2006, section 62A.26, is amended to read:

62A.26 COVERAGE FOR deleted text begin PHENYLKETONURIA TREATMENT deleted text end new text begin CERTAIN
DIETARY FORMULAS new text end .

Subdivision 1.

Scope of coverage.

This section applies to all policies of accident
and health insurance new text begin regulated under this chapter new text end , health maintenance contracts regulated
under chapter 62D, health benefit certificates offered through a fraternal benefit society
regulated under chapter 64B, and deleted text begin group deleted text end subscriber contracts offered by nonprofit health
service plan corporations regulated under chapter 62C, but does not apply to policies
designed primarily to provide coverage payable on a per diem, fixed indemnity or
nonexpense incurred basis, or policies that provide only accident coverage.

Subd. 2.

Required coverage new text begin for special dietary formulas for inborn errors
of metabolism new text end .

Every policy, plan, certificate, or contract referred to in subdivision
1 deleted text begin issued or renewed after August 1, 1985, deleted text end must provide coverage for special dietary
new text begin formulas essential to the treatment of inborn errors of metabolism, including new text end treatment
for phenylketonuria when recommended by a physician.

new text begin Subd. 3. new text end

new text begin Required coverage for amino acid based elemental formulas
for certain conditions. new text end

new text begin (a) Every policy, plan, certificate, or contract referred to in
subdivision 1 issued or renewed after August 1, 2007, must provide coverage for amino
acid based elemental formulas when ordered by a physician for diagnosed cases of cystic
fibrosis; amino acid, organic acid, and fatty acid metabolic and malabsorption disorders;
IgE mediated allergies to food proteins; food protein-induced enterocolitis syndrome;
eosinophilic esophagitis; eosinophilic gastroenteritis; and eosinophilic colitis, when those
conditions are diagnosed by an allergist, gastroenterologist, or pediatrician. Coverage
of amino-acid based elemental formulas for enrollees diagnosed with an IgE mediated
condition is limited to enrollees age five years and under.
new text end

new text begin (b) A policy, plan, certificate, or contract described in paragraph (a) may require
that an enrollee obtain prior authorization for the coverage described in this subdivision.
When requesting coverage, ordering physicians may be required to submit documentation
of diagnosis, expected course of treatment, and duration of use of amino acid based
elemental formulas. Coverage may be provided for up to 90 days when requested by a
physician while actively seeking diagnosis. Documentation of symptoms and referral
for diagnosis may be required.
new text end

new text begin (c) No special deductible, co-payment, waiting period, or other special restriction for
the coverage specified in this subdivision may be imposed if not imposed under the policy,
plan, certificate, or contract for nonpreventive treatment or prescription drugs in general.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:

new text begin Subd. 3g. new text end

new text begin Amino acid based elemental formulas. new text end

new text begin Medical assistance covers amino
acid based elemental formulas on the same terms and conditions required of policies,
plans, and certificates under section 62A.26.
new text end