Skip to main content Skip to office menu Skip to footer
Minnesota Legislature

Office of the Revisor of Statutes

HF 963

as introduced - 91st Legislature (2019 - 2020) Posted on 03/11/2019 04:43pm

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - as introduced

Line numbers 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8
1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 2.21 2.22 2.23 2.24 2.25 2.26 2.27 2.28 2.29 2.30 2.31 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15
5.16 5.17
5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32
6.1 6.2
6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 7.34
8.1 8.2

A bill for an act
relating to health insurance; establishing supply requirements for prescription
contraceptives; requiring health plans to cover contraceptive methods, sterilization,
and related medical services, patient education, and counseling; establishing
accommodations for eligible organizations; amending Minnesota Statutes 2018,
section 256B.0625, subdivision 13; proposing coding for new law in Minnesota
Statutes, chapter 62Q.

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

Section 1.

new text begin [62Q.521] COVERAGE OF CONTRACEPTIVE METHODS AND
SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Closely held for-profit entity" means an entity that:
new text end

new text begin (1) is not a nonprofit entity;
new text end

new text begin (2) has more than 50 percent of the value of its ownership interest owned directly or
indirectly by five or fewer individuals, or has an ownership structure that is substantially
similar; and
new text end

new text begin (3) has no publicly traded ownership interest, having any class of common equity
securities required to be registered under United States Code, title 15, section 781.
new text end

new text begin For purposes of this paragraph:
new text end

new text begin (i) ownership interests owned by a corporation, partnership, estate, or trust are considered
owned proportionately by that entity's shareholders, partners, or beneficiaries;
new text end

new text begin (ii) ownership interests owned by a nonprofit entity are considered owned by a single
owner;
new text end

new text begin (iii) ownership interests owned by an individual are considered owned, directly or
indirectly, by or for the individual's family. For purposes of this item, "family" means
brothers and sisters, including half-brothers and half-sisters, a spouse, ancestors, and lineal
descendants; and
new text end

new text begin (iv) if an individual or entity holds an option to purchase an ownership interest, the
individual or entity is considered to be the owner of those ownership interests.
new text end

new text begin (c) "Contraceptive method" means a drug, device, or other product approved by the Food
and Drug Administration to prevent unintended pregnancy.
new text end

new text begin (d) "Contraceptive service" means consultation, examination, procedures, and medical
services related to the prevention of unintended pregnancy. This includes but is not limited
to voluntary sterilization procedures, patient education, counseling on contraceptives, and
follow-up services related to contraceptive methods or services, management of side effects,
counseling for continued adherence, and device insertion or removal.
new text end

new text begin (e) "Eligible organization" means an organization that opposes providing coverage for
some or all contraceptive methods or services on account of religious objections and that
is:
new text end

new text begin (1) organized as a nonprofit entity and holds itself as a religious organization; or
new text end

new text begin (2) organized and operates as a closely held for-profit entity, and the organization's
highest governing body has adopted, under the organization's applicable rules of governance
and consistent with state law, a resolution or similar action establishing that it objects to
covering some or all contraceptive methods or services on account of the owners' sincerely
held religious beliefs.
new text end

new text begin (f) "Medical necessity" includes but is not limited to considerations such as severity of
side effects, difference in permanence and reversability of a contraceptive method or service,
and ability to adhere to the appropriate use of the contraceptive method or service, as
determined by the attending provider.
new text end

new text begin (g) "Religious organization" means an organization that is organized and operates as a
nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
Revenue Code of 1986, as amended.
new text end

new text begin (h) "Therapeutic equivalent version" means a drug, device, or product that can be expected
to have the same clinical effect and safety profile when administered to a patient under the
conditions specified in the labeling, and that:
new text end

new text begin (1) is approved as safe and effective;
new text end

new text begin (2) is a pharmaceutical equivalent, (i) containing identical amounts of the same active
drug ingredient in the same dosage form and route of administration, and (ii) meeting
compendial or other applicable standards of strength, quality, purity, and identity;
new text end

new text begin (3) is bioequivalent in that:
new text end

new text begin (i) the drug, device, or product does not present a known or potential bioequivalence
problem and meet an acceptable in vitro standard; or
new text end

new text begin (ii) if the drug, device, or product does present a known or potential bioequivalence
problem, it is shown to meet an appropriate bioequivalence standard;
new text end

new text begin (4) is adequately labeled; and
new text end

new text begin (5) is manufactured in compliance with current manufacturing practice regulations.
new text end

new text begin Subd. 2. new text end

new text begin Required coverage; cost sharing prohibited. new text end

new text begin (a) A health plan must provide
coverage for contraceptive methods and services.
new text end

new text begin (b) A health plan company must not impose cost-sharing requirements, including co-pays,
deductibles, or co-insurance, for contraceptive methods or services.
new text end

new text begin (c) Notwithstanding paragraph (b), a health plan that is a high-deductible health plan in
conjunction with a health savings account must include cost-sharing for contraceptive
methods and services at the minimum level necessary to preserve the enrollee's ability to
make tax exempt contributions and withdrawals from the health savings account, as provided
by section 223 of the Internal Revenue Code of 1986, as amended.
new text end

new text begin (d) A health plan company must not impose any referral requirements, restrictions, or
delays for contraceptive methods or services.
new text end

new text begin (e) A health plan must include at least one of each type of Food and Drug Administration
approved contraceptive method in its formulary. If more than one therapeutic equivalent
version of a contraceptive method is approved, a health plan must include at least one
therapeutic equivalent version in its formulary, but is not required to include all therapeutic
equivalent versions.
new text end

new text begin (f) For each health plan, a health plan company must list the contraceptive methods and
services that are covered without cost-sharing in a manner that is easily accessible to
enrollees, health care providers, and representatives of health care providers. The list for
each health plan must be promptly updated to reflect changes to the coverage.
new text end

new text begin (g) If an enrollee's attending provider recommends a particular contraceptive method or
service based on a determination of medical necessity for that enrollee, the health plan must
cover that contraceptive method or service without cost-sharing. The health plan company
issuing the health plan must defer to the attending provider's determination that the particular
contraceptive method or service is medically necessary for the enrollee.
new text end

new text begin Subd. 3. new text end

new text begin Religious employers; exempt new text end

new text begin (a) A religious employer is not required to cover
contraceptive methods or services if the employer has religious objections to the coverage.
A religious employer that chooses to not provide coverage for contraceptive methods and
services must notify employees as part of the hiring process and total employees at least 30
days before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (b) If the religious employer provides coverage for some contraceptive methods or
services, the notice must provide a list of the contraceptive methods or services the employer
refuses to cover.
new text end

new text begin Subd. 4. new text end

new text begin Accommodation for eligible organizations. new text end

new text begin (a) A health plan established or
maintained by an eligible organization complies with the requirements of subdivision 2 to
provide coverage of contraceptive methods and services if the eligible organization provides
notice to any health plan company the eligible organization contracts with that it is an eligible
organization and that the eligible organization has a religious objection to coverage for all
or a subset of contraceptive methods or services.
new text end

new text begin (b) The notice from an eligible organization to a health plan company under paragraph
(a) must include the name of the eligible organization, a statement that it objects to coverage
for some or all of contraceptive methods or services, including a list of the contraceptive
methods or services the eligible organization objects to, if applicable, and the health plan
name. The notice must be executed by a person authorized to provide notice on behalf of
the eligible organization.
new text end

new text begin (c) An eligible organization must provide a copy of the notice under paragraph (b) to
prospective employees as part of the hiring process and total employees at least 30 days
before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (d) A health plan company that receives a copy of the notice under paragraph (a) with
respect to a health plan established or maintained by an eligible organization must:
new text end

new text begin (1) expressly exclude coverage for some or all contraceptive methods or services from
the health plan; and
new text end

new text begin (2) provide separate payments for any contraceptive methods or services required to be
covered under subdivision 2 for enrollees as long as the enrollee remains enrolled in the
health plan.
new text end

new text begin (e) The health plan company must not impose any cost-sharing requirements, including
co-pays, deductibles, or co-insurance, or directly or indirectly impose any premium, fee, or
other charge for contraceptive services or methods on the eligible organization, health plan,
or enrollee.
new text end

new text begin (f) On January 1, 2021, and every year thereafter a health plan company must notify the
commissioner, in a manner to be determined by the commissioner, regarding the number
of eligible organizations granted an accommodation under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 2.

new text begin [62Q.522] COVERAGE FOR PRESCRIPTION CONTRACEPTIVES;
SUPPLY REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin Except as otherwise provided in section 62Q.521,
subdivision 3, all health plans that provide prescription coverage must comply with the
requirements of this section.
new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "prescription contraceptive" means
any drug or device that requires a prescription and is approved by the Food and Drug
Administration to prevent pregnancy. Prescription contraceptive does not include an
emergency contraceptive drug that prevents pregnancy when administered after sexual
contact.
new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin (a) Health plan coverage for a prescription contraceptive
must provide a 12-month supply for any prescription contraceptive, regardless of whether
the enrollee was covered by the health plan at the time of the first dispensing.
new text end

new text begin (b) The prescribing health care provider must determine the appropriate number of
months to prescribe the prescription contraceptives for, up to 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2021, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2018, section 256B.0625, subdivision 13, is amended to read:


Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5
, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissionernew text begin or as provided in paragraph (g)new text end.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the formulary committee, as necessary, appropriate, and
cost-effective for the treatment of certain specified chronic diseases, conditions, or disorders,
and this determination shall not be subject to the requirements of chapter 14. A pharmacist
may prescribe over-the-counter medications as provided under this paragraph for purposes
of receiving reimbursement under Medicaid. When prescribing over-the-counter drugs under
this paragraph, licensed pharmacists must consult with the recipient to determine necessity,
provide drug counseling, review drug therapy for potential adverse interactions, and make
referrals as needed to other health care professionals. Over-the-counter medications must
be dispensed in a quantity that is the lowest of: (1) the number of dosage units contained in
the manufacturer's original package; (2) the number of dosage units required to complete
the patient's course of therapy; or (3) if applicable, the number of dosage units dispensed
from a system using retrospective billing, as provided under subdivision 13e, paragraph
(b).

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

new text begin (g) Medical assistance coverage for a prescription contraceptive must provide a 12-month
supply for any prescription contraceptive, regardless of whether the enrollee was covered
by medical assistance or the health plan at the time of the first dispensing. The prescribing
health care provider must determine the appropriate number of months to prescribe the
prescription contraceptives for, up to 12 months.
new text end

new text begin For purposes of this paragraph, "prescription contraceptive" means any drug or device that
requires a prescription and is approved by the Food and Drug Administration to prevent
pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
approved to prevent pregnancy when administered after sexual contact. For purposes of this
paragraph, "health plan" has the meaning provided in section 62Q.01, subdivision 3.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section applies to medical assistance and MinnesotaCare
coverage effective January 1, 2021.
new text end