SF 3306

Introduction - 94th Legislature (2025 - 2026)

Posted on 04/11/2025 09:15 a.m.

A bill for an act
relating to health insurance; prohibiting prior authorization on medications
prescribed for antineoplastic cancer treatment; prohibiting prior authorization
denials based on timing of the provided health care service; requiring expedited
prior authorization review for prescriptions that have previously been authorized
or covered; amending Minnesota Statutes 2024, section 62M.07, subdivisions 2,
4, by adding a subdivision.

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 deleted text begin , except for treatment which is a medication. 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 new text begin or nationally and internationally
accepted standards of care new 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.

Sec. 2.

Minnesota Statutes 2024, section 62M.07, subdivision 4, is amended to read:

Subd. 4.

Submission of prior authorization requests.

(a) If prior authorization for a
health care service is required, the utilization review organization, health plan company, or
claim administrator must allow providers to submit requests for prior authorization of the
health care services without unreasonable delay by telephone, facsimile, or voice mail or
through an electronic mechanism 24 hours a day, seven days a week. This subdivision does
not apply to dental service covered under MinnesotaCare or medical assistance.

(b) Effective January 1, 2027, for health benefit plans offered, sold, issued, or renewed
on or after that date, utilization review organizations, health plan companies, and claims
administrators must have and maintain a prior authorization application programming
interface (API) that automates the prior authorization process for health care services,
excluding prescription drugs and medications. The API must allow providers to determine
whether a prior authorization is required for health care services, identify prior authorization
information and documentation requirements, and facilitate the exchange of prior
authorization requests and determinations from provider electronic health records or practice
management systems. The API must use the Health Level Seven (HL7) Fast Healthcare
Interoperability Resources (FHIR) standard in accordance with Code of Federal Regulations,
title 45, section 170.215 (a)(1), and the most recent standards and guidance adopted by the
United States Department of Health and Human Services to implement that section. Prior
authorization submission requests for prescription drugs and medications must comply with
the requirements of section 62J.497.

new text begin (c) Utilization review organizations, health plan companies, and claim administrators
must accept for review all prior authorization requests submitted within seven days of the
health care service being provided. Utilization review organizations, health plan companies,
and claim administrators are prohibited from denying a request or appeal because the request
or appeal was not received or approved prior to such time.
new text end

Sec. 3.

Minnesota Statutes 2024, section 62M.07, is amended by adding a subdivision to
read:

new text begin Subd. 6. new text end

new text begin Review of existing medications. new text end

new text begin Utilization review organizations, health plan
companies, and claim administrators must process prior authorizations required for
medications previously authorized or covered for a patient by the utilization review
organization, health plan company, or claim administrator, including authorization or
coverage in a previous plan year, according to section 62M.05, subdivision 3b, for initial
determinations, and according to section 62M.06, subdivision 2, for appeals, provided that
the medication has continued to be prescribed for the patient since the previous authorization
or coverage.
new text end