SF 3859
2nd Engrossment - 94th Legislature (2025 - 2026)
Posted on 03/20/2026 01:40 p.m.
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A bill for an act
relating to health insurance; mandating coverage without cost-sharing of
immunizations for routine use without a prescription; requiring the commissioner
of commerce to make defrayal payments to health plan companies; establishing
the Minnesota Science-Based Vaccine Advisory Council; establishing advisory
council duties; requiring reports; appropriating money; amending Minnesota
Statutes 2024, section 62Q.46, subdivision 1, by adding subdivisions; proposing
coding for new law in Minnesota Statutes, chapter 145.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 62Q.46, subdivision 1, is amended to read:
Subdivision 1.
Coverage for preventive items and services.
(a) "Preventive items and
services" has the meaning specified in the Affordable Care Act. Preventive items and services
includes:
(1) evidence-based items or services that have in effect a rating of A or B in the current
recommendations of the United States Preventive Services Task Force with respect to the
individual involved;
(2) immunizations for routine use in children, adolescents, and adults that have in effectnew text begin
with respect to the individual involvednew text end a recommendation fromnew text begin :
new text end
new text begin (i) new text end the Advisory Committee on Immunization Practices of the Centers for Disease Control
and Prevention with respect to the individual involved. For purposes of this deleted text begin clausedeleted text end new text begin itemnew text end , a
recommendation from the Advisory Committee on Immunization Practices of the Centers
for Disease Control and Prevention is considered in effect after the recommendation has
been adopted by the Director of the Centers for Disease Control and Prevention, and a
recommendation is considered to be for routine use if the recommendation is listed on the
Immunization Schedules of the Centers for Disease Control and Prevention;
new text begin
(ii) the American Academy of Pediatrics. For purposes of this item, a recommendation
from the American Academy of Pediatrics is considered in effect and for routine use if the
recommendation is listed on the American Academy of Pediatrics' Recommended Child
and Adolescent Immunization Schedule; or
new text end
new text begin
(iii) the Minnesota Science-Based Vaccine Advisory Council established under section
145.675;
new text end
(3) with respect to infants, children, and adolescents, evidence-informed preventive care
and screenings provided for in comprehensive guidelines supported by the Health Resources
and Services Administration;
(4) with respect to women, additional preventive care and screenings that are not listed
with a rating of A or B by the United States Preventive Services Task Force but that are
provided for in comprehensive guidelines supported by the Health Resources and Services
Administration;
(5) all contraceptive methods established in guidelines published by the United States
Food and Drug Administration;
(6) screenings for human immunodeficiency virus for:
(i) all individuals at least 15 years of age but less than 65 years of age; and
(ii) all other individuals with increased risk of human immunodeficiency virus infection
according to guidance from the Centers for Disease Control;
(7) all preexposure prophylaxis when used for the prevention or treatment of human
immunodeficiency virus, including but not limited to all preexposure prophylaxis, as defined
in any guidance by the United States Preventive Services Task Force or the Centers for
Disease Control, including the June 11, 2019, Preexposure Prophylaxis for the Prevention
of HIV Infection United States Preventive Services Task Force Recommendation Statement;
and
(8) all postexposure prophylaxis when used for the prevention or treatment of human
immunodeficiency virus, including but not limited to all postexposure prophylaxis as defined
in any guidance by the United States Preventive Services Task Force or the Centers for
Disease Control.
(b) A health plan company must provide coverage for preventive items and services at
a participating provider without imposing cost-sharing requirements, including a deductible,
coinsurance, or co-payment. Nothing in this section prohibits a health plan company that
has a network of providers from excluding coverage or imposing cost-sharing requirements
for preventive items or services that are delivered by an out-of-network provider.
(c) A health plan company is not required to provide coverage for any items or services
specified in any recommendation or guideline described in paragraph (a) if the
recommendation or guideline is no longer included as a preventive item or service as defined
in paragraph (a). Annually, a health plan company must determine whether any additional
items or services must be covered without cost-sharing requirements or whether any items
or services are no longer required to be covered.
(d) Nothing in this section prevents a health plan company from using reasonable medical
management techniques to determine the frequency, method, treatment, or setting for a
preventive item or service to the extent not specified in the recommendation or guideline.
(e) A health plan shall not require prior authorization or step therapy for preexposure
prophylaxis or postexposure prophylaxis, except that: if the United States Food and Drug
Administration has approved one or more therapeutic equivalents of a drug, device, or
product for the prevention of HIV, this paragraph does not require a health plan to cover
all of the therapeutically equivalent versions without prior authorization or step therapy, if
at least one therapeutically equivalent version is covered without prior authorization or step
therapy.
(f) This section does not apply to grandfathered plans.
(g) This section does not apply to plans offered by the Minnesota Comprehensive Health
Association.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2026, for health plans offered,
issued, sold, or renewed on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2024, section 62Q.46, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Reimbursement. new text end
new text begin
(a) The commissioner of commerce must reimburse health
plan companies for coverage described under subdivision 1, paragraph (a), clause (2), items
(ii) and (iii). Treatments and services covered by the health plan as of January 1, 2023, are
ineligible for payment under this subdivision by the commissioner of commerce.
new text end
new text begin
(b) Health plan companies must report to the commissioner of commerce quantified
costs attributable to the benefit described under subdivision 1, paragraph (a), clause (2),
items (ii) and (iii), in a format developed by the commissioner.
new text end
new text begin
(c) The commissioner of commerce must evaluate submissions and make payments to
health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.
new text end
Sec. 3.
Minnesota Statutes 2024, section 62Q.46, is amended by adding a subdivision to
read:
new text begin Subd. 5. new text end
new text begin Appropriation. new text end
new text begin
Beginning in fiscal year 2028, an amount necessary to make
payments to health plan companies to defray the cost of providing coverage, as described
in subdivision 4, is annually appropriated from the general fund to the commissioner of
commerce. The amount appropriated under this subdivision must include the administrative
costs incurred by the commissioner to make the defrayal payments.
new text end
Sec. 4.
new text begin
[145.675] MINNESOTA SCIENCE-BASED VACCINE ADVISORY
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health must establish the Minnesota
Science-Based Vaccine Advisory Council.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
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(a) The advisory council must consist of at least 14 members
who are trusted scientists, clinicians, and public health leaders with knowledge of and
backgrounds in vaccines and immunization, including:
new text end
new text begin
(1) the commissioner of health or a designee;
new text end
new text begin
(2) one physician licensed and practicing in the state, appointed by the Minnesota Medical
Association;
new text end
new text begin
(3) one physician licensed and practicing in the state in the area of internal medicine,
appointed by the American College of Physicians, Minnesota Chapter;
new text end
new text begin
(4) one physician licensed and practicing in the state in the area of pediatrics, appointed
by the American Academy of Pediatrics, Minnesota Chapter;
new text end
new text begin
(5) one physician licensed and practicing in the state in the area of family medicine,
appointed by the Minnesota Academy of Family Physicians;
new text end
new text begin
(6) one physician licensed and practicing in the state in the area of obstetrics and
gynecology, appointed by the American College of Obstetricians and Gynecologists,
Minnesota Section;
new text end
new text begin
(7) one registered nurse or advanced practice registered nurse licensed and practicing
in the state, appointed by the Minnesota Nurses Association;
new text end
new text begin
(8) one pediatric nurse practitioner licensed and practicing in the state, appointed by the
National Association of Pediatric Nurse Practitioners, Minnesota Chapter;
new text end
new text begin
(9) one licensed school nurse practicing in the state in a public elementary or secondary
school, appointed by the School Nurse Organization of Minnesota;
new text end
new text begin
(10) one pharmacist licensed and practicing in the state with experience providing
immunization services to patients, appointed by the Minnesota Pharmacists Association;
new text end
new text begin
(11) one member of a Tribal Nation health department appointed by the Minnesota
Indian Affairs Council;
new text end
new text begin
(12) one representative specializing in infectious disease research, appointed by the
Infectious Disease Society of America;
new text end
new text begin
(13) one representative appointed by the Minnesota Council of Health Plans; and
new text end
new text begin
(14) one representative appointed by the director of the Center for Infectious Disease
Research and Policy at the University of Minnesota who is employed by or who is conducting
research for the center.
new text end
new text begin
(b) Each appointing authority must make appointments by September 1, 2026.
new text end
new text begin
(c) An appointing authority may designate an alternate member to attend and participate
in advisory council meetings in the appointed member's place, including replacing an
appointed member at the appointing authority's discretion. An appointing authority may
replace any member who steps down from the advisory committee or who, in the judgment
of the appointing authority, fails to attend a sufficient number of advisory council meetings.
new text end
new text begin
(d) The commissioner of health must develop an application process and required
documents that each appointing authority must collect and review prior to appointing an
applicant to the advisory council, including at minimum:
new text end
new text begin
(1) two letters of support for an applicant submitted by an individual with an established
professional relationship with the applicant and who is a trusted scientist, clinician, and
public health leader;
new text end
new text begin
(2) disclosure by the applicant and their immediate family members of any financial
interests that may be considered a conflict of interest if the applicant participates in the
advisory council as a member; and
new text end
new text begin
(3) evidence of completing a background study.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
Members appointed under subdivision 2, clauses (2) to (14), serve a
four-year term.
new text end
new text begin Subd. 4. new text end
new text begin Organization and meetings. new text end
new text begin
(a) The advisory council must select a chair from
the advisory council's membership. The chair serves as chair for a two-year term. The
advisory council must meet at least four times per year, and more frequently at the call of
the chair or at the request of a majority of advisory council members. The advisory council
must provide opportunities for public input at meetings, including oral public testimony.
new text end
new text begin
(b) Members of the advisory council receive no compensation for their service but shall
be reimbursed as provided in section 15.059 for expenses incurred as a result of their duties
as members of the advisory council.
new text end
new text begin
(c) Advisory council meetings are subject to the Open Meeting Law under chapter 13D.
new text end
new text begin Subd. 5. new text end
new text begin Duties and powers. new text end
new text begin
(a) The advisory council must:
new text end
new text begin
(1) develop and publish recommended schedules of vaccines in the state for adults,
infants, children, and adolescents on an annual basis;
new text end
new text begin
(2) recommend to the commissioner modifications, if any, to the specific immunizations
required for enrollment in elementary or secondary schools or child care facilities under
section 121A.15 and Minnesota Rules, chapter 4604; and
new text end
new text begin
(3) recommend to the commissioner modifications, if any, to the specific immunizations
required for enrollment in postsecondary institutions under section 135A.14 and Minnesota
Rules, chapter 4604.
new text end
new text begin
(b) In developing science-based vaccine and immunization recommendations, the advisory
council must consider current peer-reviewed scientific studies and sound public health
policy.
new text end
new text begin
(c) If the advisory council chair determines that the commissioner does not adequately
consider the advisory council's recommendations when considering updates to the required
immunization schedules, the chair may call for an override vote. If two-thirds of the advisory
council vote to override the existing state vaccine schedules, the advisory council may
republish the advisory council's own recommendations to serve as the state vaccine schedules.
The advisory council's recommendations must serve as the state vaccine schedules for no
less than six months.
new text end
new text begin Subd. 6. new text end
new text begin Administration. new text end
new text begin
The commissioner must provide meeting space and
administrative services for the advisory council.
new text end
new text begin Subd. 7. new text end
new text begin Reports. new text end
new text begin
The council must submit a report by July 1, in each even-numbered
year, to the chairs and ranking minority members of the legislative committees with primary
jurisdiction over health policy. The report must describe the committee's work to fulfill the
duties prescribed in subdivision 5.
new text end
new text begin Subd. 8. new text end
new text begin Expiration. new text end
new text begin
This section expires July 1, 2036.
new text end
Sec. 5. new text begin MINNESOTA SCIENCE-BASED VACCINE ADVISORY COUNCIL; FIRST
APPOINTMENTS AND FIRST MEETING.
new text end
new text begin Subdivision 1. new text end
new text begin First appointments. new text end
new text begin
The first members appointed to the Minnesota
Science-Based Vaccine Advisory Council under Minnesota Statutes, section 145.675,
subdivision 2, clauses (2) to (8), serve a term of two years.
new text end
new text begin Subd. 2. new text end
new text begin First meeting. new text end
new text begin
The commissioner of health must convene the first meeting of
the Minnesota Science-Based Vaccine Advisory Council by January 1, 2027. At the first
meeting, the advisory council must select a chair from among its members.
new text end
Sec. 6. new text begin APPROPRIATION; MINNESOTA SCIENCE-BASED VACCINE ADVISORY
COUNCIL.
new text end
new text begin
(a) $....... in fiscal year 2027 is appropriated from the general fund to the commissioner
of health for the Minnesota Science-Based Vaccine Advisory Council under Minnesota
Statutes, section 145.675.
new text end
new text begin
(b) The general fund base for this appropriation is $....... in fiscal year 2028 and $.......
in fiscal year 2029.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2026.
new text end