SF 4502
Introduction - 94th Legislature (2025 - 2026)
Posted on 03/18/2026 09:29 a.m.
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A bill for an act
relating to health insurance; prohibiting quantity limits on coverage for home care
nursing services; defining home care nursing services; 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.
(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.
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(c) Notwithstanding section 62J.26, a health plan must not impose any quantity limitation
on the coverage under this section.
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(d) Notwithstanding section 62J.26, a health plan must refer to all services meeting the
definition of home care nursing services in paragraph (e) 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.
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(e) For purposes of this section, "home care nursing services" means ongoing, individual,
and continuous nursing services that are:
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(1) ordered by a physician, advanced practice registered nurse, or physician assistant;
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(2) provided by a registered nurse or licensed practical nurse acting within the provider's
scope of practice;
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(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
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(4) required for a duration or frequency that cannot be safely or effectively met through
intermittent, episodic, or visit-based nursing services.
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Paragraph (c) is effective January 1, 2026, and applies to policies
issued, offered, or renewed and causes of action accruing on or after that date. Paragraphs
(d) and (e) are effective August 1, 2026.
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