HF 3430

as introduced - 93rd Legislature (2023 - 2024) Posted on 02/13/2024 04:27pm

A bill for an act
relating to human services; clarifying medical assistance coverage of prescription
drugs in cases of cost-effective health insurance coverage; amending Minnesota
Statutes 2022, section 256B.0625, subdivisions 15, 25b.

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

Section 1.

Minnesota Statutes 2022, section 256B.0625, subdivision 15, is amended to
read:

Subd. 15.

Health plan premiums and co-payments.

(a) Medical assistance covers
health care prepayment plan premiums, insurance premiums, and co-payments if determined
to be cost-effective by the commissioner. For purposes of obtaining Medicare Part A and
Part B, and co-payments, expenditures may be made even if federal funding is not available. new text begin
If the commissioner determines that coverage of health care prepayment plan premiums,
insurance premiums, and co-payments is cost-effective for an individual with prescription
drug coverage provided by a commercial insurer, medical assistance must:
new text end

new text begin (1) cover cost-sharing for prescription drugs in the quantity approved by the commercial
insurer, even if the approved quantity exceeds a 34-day supply, without requiring the
prescriber to obtain approval by the commissioner or from the agency provider help desk;
and
new text end

new text begin (2) cover cost-sharing for prescription drugs approved by the commercial insurer, whether
or not the drug is on the preferred drug list established under subdivision 13g, without
requiring prior approval when the enrollee is subject to a deductible for prescription drug
coverage provided by the commercial insurer.
new text end

(b) Effective for all premiums due on or after June 30, 1997, medical assistance does
not cover premiums that a recipient is required to pay under a qualified or Medicare
supplement plan issued by the Minnesota Comprehensive Health Association. Medical
assistance shall continue to cover premiums for recipients who are covered under a plan
issued by the Minnesota Comprehensive Health Association on June 30, 1997, for a period
of six months following receipt of the notice of termination or until December 31, 1997,
whichever is later.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.0625, subdivision 25b, is amended to read:

Subd. 25b.

Authorization with third-party liability.

(a) Except as otherwise allowed
under this subdivision or required under federal or state regulations, the commissioner must
not consider a request for authorization of a service when the recipient has coverage from
a third-party payer unless the provider requesting authorization has made a good faith effort
to receive payment or authorization from the third-party payer. A good faith effort is
established by supplying with the authorization request to the commissioner the following:

(1) a determination of payment for the service from the third-party payer, a determination
of authorization for the service from the third-party payer, or a verification of noncoverage
of the service by the third-party payer; and

(2) the information or records required by the department to document the reason for
the determination or to validate noncoverage from the third-party payer.

(b) A provider requesting authorization for services covered by Medicare is not required
to bill Medicare before requesting authorization from the commissioner if the provider has
reason to believe that a service covered by Medicare is not eligible for payment. The provider
must document that, because of recent claim experiences with Medicare or because of
written communication from Medicare, coverage is not available for the service.

(c) Authorization is not required new text begin :
new text end

new text begin (1) new text end if a third-party payer has made payment that is equal to or greater than 60 percent
of the maximum payment amount for the service allowed under medical assistance new text begin ; or
new text end

new text begin (2) in cases of cost-effective prescription drug coverage when the prescription drug is
approved by the commercial insurer, whether or not the drug is on the preferred drug list
established under subdivision 13g, and the enrollee is subject to a deductible for prescription
drug coverage provided by the commercial insurer new text end .

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end