SF 4659

Introduction - 94th Legislature (2025 - 2026)

Posted on 03/24/2026 10:28 a.m.

A bill for an act
relating to health; establishing a state rapid start program; providing for the
operation of local rapid start programs to treat patients who are HIV-positive;
prohibiting prior authorization, cost sharing, and step therapy for antiretroviral
therapy and HIV prevention services; authorizing rulemaking; requiring reports;
appropriating money; proposing coding for new law in Minnesota Statutes, chapters
62Q; 145.

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

Section 1. new text begin SHORT TITLE.
new text end

new text begin This act shall be known as the "Rapid Start HIV Treatment Act of 2026."
new text end

Sec. 2.

new text begin [62Q.1842] PROHIBITION ON PRIOR AUTHORIZATION, USE OF STEP
THERAPY, AND COST SHARING FOR ANTIRETROVIRAL THERAPY AND
HIV PREVENTION SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given.
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new text begin (b) "Antiretroviral therapy" has the meaning given in section 145.9235, subdivision 1.
new text end

new text begin (c) "HIV prevention services" means ancillary or supportive services that are necessary
to:
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new text begin (1) ensure that a preexposure prophylaxis drug is prescribed or administered to an
individual who is HIV negative to prevent HIV transmission, provided the person has no
medical contraindications to the use of a preexposure prophylaxis drug; and
new text end

new text begin (2) monitor an individual described in clause (1) to ensure the individual's safe and
effective ongoing use of a preexposure prophylaxis drug through office visits, laboratory
testing, testing for sexually transmitted infections, medication self-management and
adherence counseling, or any other health service specified as part of comprehensive HIV
prevention drug services by the United States Department of Health and Human Services,
the United States Centers for Disease Control and Prevention, or the United States Preventive
Services Task Force.
new text end

new text begin (d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.
new text end

new text begin Subd. 2. new text end

new text begin Prohibition on use of step therapy protocols and prior authorization. new text end

new text begin A
health plan that covers antiretroviral therapy must not limit or exclude coverage for
antiretroviral therapy by requiring prior authorization or requiring an enrollee to follow a
step therapy protocol. A health plan that covers HIV prevention services must not limit or
exclude coverage for these services by requiring prior authorization or requiring an enrollee
to follow a step therapy protocol.
new text end

new text begin Subd. 3. new text end

new text begin Cost sharing prohibited. new text end

new text begin A health plan must not impose cost-sharing
requirements, including co-pays, deductibles, or coinsurance, for antiretroviral therapy or
HIV prevention services covered by the health plan.
new text end

new text begin EFFECTIVE DATE. new text end

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

Sec. 3.

new text begin [145.9235] RAPID START HIV TREATMENT PROGRAMS.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) For purposes of this section, the following terms have
the meanings given, unless the context clearly indicates otherwise.
new text end

new text begin (b) "1-3-7 framework" means the initiation of antiretroviral therapy ideally within one
day after a patient's diagnosis with HIV or reengagement in care, allowably within three
days after a patient's diagnosis or reengagement, and in all cases within seven business days
after a patient's diagnosis or reengagement.
new text end

new text begin (c) "318 grantee" means an entity or program, typically a state or local health department,
public health organization, or academic institution, that receives federal funding from the
Centers for Disease Control and Prevention under section 318 of the Public Health Service
Act for sexually transmitted infection and sexually transmitted disease prevention programs.
A 318 grantee may also be a covered entity under the federal 340B Drug Pricing Program
and may purchase prescription drugs at reduced prices.
new text end

new text begin (d) "AIDS Drug Assistance Program" or "ADAP" means the state program established
under Part B of the Ryan White HIV/AIDS Program to provide medications approved by
the Food and Drug Administration to treat income-eligible people living with HIV.
new text end

new text begin (e) "Antiretroviral therapy" or "ART" means a therapy approved by the Food and Drug
Administration for the treatment or prevention of HIV, including a preexposure or
postexposure prophylaxis drug.
new text end

new text begin (f) "Commissioner" means the commissioner of health.
new text end

new text begin (g) "Presumptive eligibility for the ADAP" or "presumptive ADAP eligibility" means
eligibility determined according to subdivision 4.
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new text begin (h) "Rapid start" means a standard of medical care that prioritizes the immediate initiation
of ART for the treatment of HIV using the 1-3-7 framework.
new text end

new text begin Subd. 2. new text end

new text begin State rapid start program established. new text end

new text begin (a) The commissioner must establish
a state rapid start program at the department to oversee the implementation and administration
of local rapid start programs under this section. The state rapid start program is responsible
for program development, contract management, training, evaluation, annual reporting on
program outcomes, and providing grants to local rapid start programs to cover a portion of
the cost of ART and access to ART, including during periods of presumptive ADAP
eligibility.
new text end

new text begin (b) Personnel in the state rapid start program must develop and provide training and
ongoing clinical guidance on rapid start to primary care providers and infectious disease
specialists.
new text end

new text begin (c) The commissioner may adopt rules to implement this section.
new text end

new text begin Subd. 3. new text end

new text begin Local rapid start programs. new text end

new text begin (a) The commissioner, through the state rapid
start program, must establish and maintain local rapid start programs at designated HIV
testing and clinical care sites.
new text end

new text begin (b) A local rapid start program maintained under this section must:
new text end

new text begin (1) implement a standard of medical care that prioritizes the immediate initiation of
antiretroviral therapy according to the 1-3-7 framework for the treatment of HIV to reduce
HIV levels as quickly as possible. Under the 1-3-7 framework, initiation within one day
after HIV diagnosis or reengagement in care is highly preferred, within three days after
diagnosis or reengagement is considered good practice, and within seven business days
after diagnosis or reengagement is considered sufficient;
new text end

new text begin (2) provide direct care or care coordination that ensures:
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new text begin (i) immediate access to extended clinical appointments;
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new text begin (ii) prescribing or dispensing of ART within the 1-3-7 framework; and
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new text begin (iii) access to comprehensive support services, including but not limited to health
education, transportation, housing assistance, nutrition, and psychosocial supports;
new text end

new text begin (3) closely communicate and coordinate with HIV testing programs to facilitate timely
connection to care; and
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new text begin (4) operate in a nondiscriminatory manner and provide equitable access to services for
all individuals, regardless of race, ethnicity, gender identity, sexual orientation, mode of
exposure to HIV, immigration status, or ability to pay for treatment.
new text end

new text begin Subd. 4. new text end

new text begin Presumptive eligibility for ADAP. new text end

new text begin The commissioner of human services must
develop and communicate to local rapid start programs a process to determine a patient's
presumptive eligibility for the ADAP. Under this process, an individual is presumptively
eligible for the ADAP if the individual orally attests to meeting the income and residency
requirements for the ADAP and provides evidence of HIV infection in the form of either
(1) a test result from a reactive HIV test approved by the Food and Drug Administration,
or (2) a clinical diagnosis. A local rapid start program must make a determination on an
individual's presumptive eligibility within one business day after the individual's application.
An individual's period of presumptive eligibility shall last for at least 30 days from the date
of determination and may be extended at the discretion of the local rapid start program.
new text end

new text begin Subd. 5. new text end

new text begin Funding and reimbursement. new text end

new text begin Local rapid start programs shall be funded with
state funds, federal funds, and other available funding sources and must use funds in the
following order of priority:
new text end

new text begin (1) medical assistance, MinnesotaCare, and private insurance coverage;
new text end

new text begin (2) funding for 318 grantees to support services for uninsured and underinsured
individuals;
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new text begin (3) resources from the Ryan White HIV/AIDS Program and the ADAP to provide
supplemental coverage; and
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new text begin (4) grants distributed by the commissioner to cover a portion of the cost of ART and
ensure access to ART without patient cost sharing or delays due to prior authorization,
including during periods of presumptive ADAP eligibility.
new text end

new text begin Subd. 6. new text end

new text begin Data collection and reporting. new text end

new text begin Local rapid start programs must collect and
maintain detailed data on program enrollment, ART initiation time frames, demographic
information of patients served by the program, and health outcomes for patients served by
the program. A local rapid start program must at least collect and maintain data on:
new text end

new text begin (1) the number of patients referred to the program who have evidence of HIV infection
and who are newly diagnosed or reengaged in care;
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new text begin (2) the number of offers made by program staff to newly diagnosed or reengaged HIV
positive patients to enroll in the program;
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new text begin (3) the number of newly diagnosed or reengaged HIV-positive patients enrolled in the
program and the number who decline to enroll;
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new text begin (4) for patients who decline to enroll in the program, their reasons for not enrolling;
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new text begin (5) for patients enrolled in the program:
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new text begin (i) the length of time from first evidence of a new HIV-positive diagnosis or reengagement
in care to the initiation of ART; and
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new text begin (ii) the length of time from the initiation of ART to the achievement of an undetectable
viral load;
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new text begin (6) the demographics of patients enrolled in the program, including race, ethnicity, age,
sex, gender identity, sexual orientation, modes of exposure to HIV, disability status, primary
or preferred language, housing status, and insurance status; and
new text end

new text begin (7) the proportion of patients enrolled in the program who belong to demographic
categories identified by local epidemiological data to have challenges engaging with and
being retained in HIV care and who achieve undetectable viral loads within three months
after diagnosis or reengagement.
new text end

new text begin Subd. 7. new text end

new text begin Reports to public and legislature. new text end

new text begin (a) By October 1, 2027, and each October
1 thereafter, the commissioner must submit to the legislature and make available to the
public a comprehensive report on the activities of local rapid start programs. Each report
must at least include information on:
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new text begin (1) the number of local rapid start programs that were in operation in the most recent
reporting period;
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new text begin (2) the number of patients enrolled in local rapid start programs to date and the proportion
of these patients who initiated antiretroviral therapy one day, three days, or seven days
following an HIV diagnosis or reengagement in care;
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new text begin (3) challenges identified with program implementation and operations and proposed
responses to challenges; and
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new text begin (4) rates of rapid start by patients seen by providers who diagnose HIV.
new text end

new text begin (b) Section 144.05, subdivision 7, does not apply to reports under this subdivision.
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Sec. 4. new text begin APPROPRIATION; RAPID START PROGRAMS.
new text end

new text begin $....... in fiscal year 2027 is appropriated from the general fund to the commissioner of
health for purposes of Minnesota Statutes, section 145.9235.
new text end