SF 3967

2nd Engrossment - 94th Legislature (2025 - 2026)

Posted on 05/20/2026 01:45 p.m.

A bill for an act
relating to health; modifying coverage of home care nursing; amending Minnesota
Statutes 2024, section 62Q.545.

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

Section 1.

Minnesota Statutes 2024, section 62Q.545, is amended to read:

62Q.545 COVERAGE OF HOME CARE NURSING.

new text begin Subdivision 1. new text end

new text begin Home care nursing services mandated coverage. new text end

(a) Home care nursing
services, as provided under section 256B.0625, subdivision 7, with the exception of section
256B.0654, subdivision 4, shall be covered under a health plan for persons who are
concurrently covered by both the health plan and enrolled in medical assistance under
chapter 256B.

(b) For purposes of this section, a period of home care nursing services may be subject
to the co-payment, coinsurance, deductible, or other enrollee cost-sharing requirements that
apply under the health plan. Cost-sharing requirements for home care nursing services must
not place a greater financial burden on the insured or enrollee than those requirements
applied by the health plan to other similar services or benefits. Nothing in this section is
intended to prevent a health plan company from requiring prior authorization by the health
plan company for such services as required by section 256B.0625, subdivision 7, or use of
contracted providers under the applicable provisions of the health plan.

new text begin (c) Notwithstanding section 62J.26, a health plan must not impose any quantity limitation
on the coverage under this section.
new text end

new text begin Subd. 2. new text end

new text begin Legislative findings and purpose. new text end

new text begin The mandated coverage on home care
nursing services in subdivision 1 has been intended, since its enactment in 2010, to require
health plans to cover all prescribed, medically necessary home care nursing services. Pursuant
to Code of Federal Regulations, title 45, section 155.170, a benefit required by state action
taking place before December 31, 2011, is considered an EHB, such that the state is not
required to make payments to defray the cost of benefits. To minimize unnecessary state
payments, including costs to the medical assistance program for potential coverage of
recipients of home care nursing services, the commissioner must not make payments to
defray the cost of benefits under this section and must facilitate the provision of
comprehensive coverage of home care nursing services in the private insurance market.
new text end

new text begin Subd. 3. new text end

new text begin Use of terminology. new text end

new text begin (a) Notwithstanding section 62J.26, a health plan must
refer to all services meeting the definition of home care nursing services in paragraph (b)
as home care nursing services in the health plan's policy, certificate, contract, or other
evidence of coverage and related documents, including but not limited to utilization review
policies, claims forms, instructions, and communications to enrollees and providers.
new text end

new text begin (b) For purposes of this subdivision, "home care nursing services" means ongoing,
individual, and continuous nursing services that are:
new text end

new text begin (1) ordered by a physician, advanced practice registered nurse, or physician assistant;
new text end

new text begin (2) provided by a registered nurse or licensed practical nurse acting within the provider's
scope of practice;
new text end

new text begin (3) medically necessary to maintain, stabilize, or restore the recipient's health due to
medical complexity or the need for sustained skilled nursing assessment, intervention, or
monitoring; and
new text end

new text begin (4) required for a duration or frequency that cannot be safely or effectively met through
intermittent, episodic, or visit-based nursing services.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin Subdivisions 1 and 2 are effective retroactively from January 1,
2026, and apply to policies issued, offered, or renewed and causes of action accruing on or
after that date. Subdivision 3 is effective August 1, 2026.
new text end