HF 3268

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/12/2024 01:53pm

A bill for an act
relating to insurance; requiring a prior authorization report; proposing coding for
new law in Minnesota Statutes, chapter 62M.

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

Section 1.

new text begin [62M.19] PRIOR AUTHORIZATION REPORT.
new text end

new text begin (a) On or before September 1 each year, a utilization review organization must annually
report to the commissioner of commerce, on a form and in a manner specified by the
commissioner of commerce, information regarding prior authorization requests for the
previous calendar year. The report submitted under this paragraph must include:
new text end

new text begin (1) the number total of prior authorization requests received for the year for the following
category of services:
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new text begin (i) medical procedures;
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new text begin (ii) diagnostic tests and diagnostic images;
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new text begin (iii) prescription medications; and
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new text begin (iv) other;
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new text begin (2) the number of prior authorizations for which an authorization was approved for each
category under clause (1);
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new text begin (3) the number of prior authorization requests for which an adverse determination was
issued and the service was denied for each category under clause (1);
new text end

new text begin (4) the number of adverse determinations that were appealed, and whether the adverse
determination was upheld or reversed on appeal, for each category under clause (1); and
new text end

new text begin (5) the reasons for prior authorization denial, including but not limited to:
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new text begin (i) the patient did not meet prior authorization criteria;
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new text begin (ii) incomplete information was submitted by the provider to the utilization review
organization;
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new text begin (iii) the treatment program changed; or
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new text begin (iv) the patient is no longer covered by the plan.
new text end

new text begin (b) The commissioner of commerce must report to the legislature no later than February
15, 2024, regarding the practices of utilization review organizations related to the use of
prior authorization. The report must include the total number of prior authorizations:
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new text begin (1) requested;
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new text begin (2) approved without the need for an appeal;
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new text begin (3) denied; and
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new text begin (4) approved after an appeal.
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new text begin (c) The commissioner of commerce must analyze the submitted data and issue a report
on the use of utilization management tools, including prior authorization, and the effect
utilization management tools have on patient access to care, the administrative burden on
health care providers, and system cost. When developing the report, the commissioner must
consult with, as appropriate, health care providers, insurers, consumers, and other health
care experts. The report must include but is not limited to recommendations regarding how
to:
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new text begin (1) simplify health insurance prior authorization standards and processes to improve
health care access and reduce the burden on health care providers;
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new text begin (2) maximize health care access and quality of care; and
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new text begin (3) focus utilization review tools on services that the commissioner of commerce
determines are overutilized.
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new text begin (d) If the commissioner determines that, with respect to a service described in paragraph
(a) that currently requires prior authorization, the utilization review organization is approving
at least 80 percent of the prior authorization requests for the service, the commissioner must
include in the recommendations made under paragraph (c) an additional recommendation
to prohibit prior authorization for the service receiving at least 80 percent approval for
services provided on or after August 1, 2024.
new text end