SF 205

1st Engrossment - 94th Legislature (2025 - 2026)

Posted on 03/11/2025 09:33 a.m.

A bill for an act
relating to health; prohibiting prior authorization of antineoplastic cancer treatment;
amending Minnesota Statutes 2024, section 62M.07, subdivision 2.

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

Section 1.

Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:

Subd. 2.

Prior authorization of certain services prohibited.

No utilization review
organization, health plan company, or claims administrator may conduct or require prior
authorization of:

(1) emergency confinement or an emergency service. The enrollee or the enrollee's
authorized representative may be required to notify the health plan company, claims
administrator, or utilization review organization as soon as reasonably possible after the
beginning of the emergency confinement or emergency service;

(2) outpatient mental health treatment or outpatient substance use disorder treatment,
except for treatment which is a medication. Prior authorizations required for medications
used for outpatient mental health treatment or outpatient substance use disorder treatment
must be processed according to section 62M.05, subdivision 3b, for initial determinations,
and according to section 62M.06, subdivision 2, for appeals;

(3) antineoplastic cancer treatment that is consistent with guidelines of the National
Comprehensive Cancer Network new text begin or nationally and internationally accepted standards of
care new text end , deleted text begin except for deleted text end new text begin including but not limited to new text end treatment deleted text begin which deleted text end new text begin that new text end is a medication deleted text begin . Prior
authorizations required for medications used for antineoplastic cancer treatment must be
processed according to section 62M.05, subdivision 3b, for initial determinations, and
according to section 62M.06, subdivision 2, for appeals deleted text end ;

(4) services that currently have a rating of A or B from the United States Preventive
Services Task Force, immunizations recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention, or preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130;

(5) pediatric hospice services provided by a hospice provider licensed under sections
144A.75 to 144A.755; and

(6) treatment delivered through a neonatal abstinence program operated by pediatric
pain or palliative care subspecialists.

Clauses (2) to (6) are effective January 1, 2026, and apply to health benefit plans offered,
sold, issued, or renewed on or after that date.

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2027, and applies to health
benefit plans offered, sold, issued, or renewed on or after that date.
new text end