HF 1758

as introduced - 94th Legislature (2025 - 2026) Posted on 03/05/2025 12:31pm

A bill for an act
relating to insurance; requiring health plans to cover infertility treatment and
standard fertility preservation services; requiring medical assistance and
MinnesotaCare to cover infertility treatment and standard fertility preservation
services; appropriating money; amending Minnesota Statutes 2024, section
256B.0625, subdivision 13, by adding a subdivision; 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.60] COVERAGE OF INFERTILITY TREATMENT.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin This section applies to all health plans that provide maternity
benefits to Minnesota residents.
new text end

new text begin Subd. 2. new text end

new text begin Definitions. new text end

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

new text begin (b) "Diagnosis of and treatment for infertility" means procedures and medications:
new text end

new text begin (1) to diagnose or treat infertility; and
new text end

new text begin (2) consistent with established, published, or approved medical practices or professional
guidelines from the American College of Obstetricians and Gynecologists or the American
Society for Reproductive Medicine.
new text end

new text begin (c) "Infertility" means a disease, condition, or status characterized by:
new text end

new text begin (1) the failure of a person with a uterus to establish a pregnancy or to carry a pregnancy
to live birth after the following duration of unprotected sexual intercourse, regardless of
whether a pregnancy resulted in miscarriage during such time:
new text end

new text begin (i) for a person under the age of 35, 12 months duration; or
new text end

new text begin (ii) for a person 35 years of age or older, six months duration;
new text end

new text begin (2) a person's inability to reproduce without medical intervention either as a single
individual or with the person's partner; or
new text end

new text begin (3) a licensed health care provider's determination that a patient is infertile based on the
patient's medical, sexual, and reproductive history; age; physical findings; or diagnostic
testing.
new text end

new text begin (d) "Standard fertility preservation services" means procedures that are consistent with
the established medical practices or professional guidelines published by the American
Society for Reproductive Medicine or the American Society of Clinical Oncology for a
person who has a medical condition or is expected to undergo medication therapy, surgery,
radiation, chemotherapy, or other medical treatment that is recognized by medical
professionals to cause a risk of impairment to fertility.
new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin (a) Health plans must provide comprehensive coverage
for:
new text end

new text begin (1) diagnosis of and treatment for infertility; and
new text end

new text begin (2) standard fertility preservation services.
new text end

new text begin (b) Coverage under this section must include unlimited embryo transfers, but may impose
a limit of four completed oocyte retrievals. Single embryo transfer must be used when
medically appropriate and recommended by the treating health care provider.
new text end

new text begin (c) Coverage for surgical reversal of elective sterilization is not required under this
section.
new text end

new text begin Subd. 4. new text end

new text begin Cost-sharing requirements. new text end

new text begin A health plan must not impose on the coverage
under this section any cost-sharing requirement that is greater than the cost-sharing
requirement imposed on maternity coverage under the plan, including but not limited to the
following requirements:
new text end

new text begin (1) co-payment;
new text end

new text begin (2) deductible; or
new text end

new text begin (3) coinsurance.
new text end

new text begin Subd. 5. new text end

new text begin Exclusions and limitations. new text end

new text begin (a) A health plan must not impose any benefit
maximum, waiting period, utilization review, referral requirement, or any other limitation
on the coverage under this section, except as provided in subdivision 3, paragraphs (b) and
(c), that is not generally applicable to maternity coverage under the health plan.
new text end

new text begin (b) The prohibition under this subdivision includes but is not limited to any exclusion,
limitation, or other restriction on:
new text end

new text begin (1) fertility medications that are different from those imposed on other prescription
medications; and
new text end

new text begin (2) any fertility services based on an enrollee's participation in fertility services provided
by or to a third party.
new text end

new text begin Subd. 6. 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 under this section. Reimbursement is available only for coverage
that would not have been provided by the health plan without the requirements of this
section. Treatments and services covered by the health plan as of January 1, 2025, 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 additional benefit under this section in a format developed by the
commissioner. A health plan's coverage as of January 1, 2025, must be used by the health
plan company as the basis for determining whether coverage would not have been provided
by the health plan for purposes of this subdivision.
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

new text begin Subd. 7. new text end

new text begin Appropriation. new text end

new text begin Each fiscal year, an amount necessary to make payments to
health plan companies to defray the cost of providing coverage under this section is
appropriated to the commissioner of commerce.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, and applies to all health
plans issued or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2024, section 256B.0625, subdivision 13, is amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, deleted text begin except for fertility drugs when
specifically used to enhance fertility, deleted text end 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, a physician assistant, or an advanced practice
registered nurse 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 commissioner or as provided in paragraph (h) or the drug appears on the
90-day supply list published by the commissioner. The 90-day supply list shall be published
by the commissioner on the department's website. The commissioner may add to, delete
from, and otherwise modify the 90-day supply list after providing public notice and the
opportunity for a 15-day public comment period. The 90-day supply list may include
cost-effective generic drugs and shall not include controlled substances.

(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.

(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.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.

(h) Medical assistance coverage for a prescription contraceptive must provide a 12-month
supply for any prescription contraceptive if a 12-month supply is prescribed by the
prescribing health care provider. The prescribing health care provider must determine the
appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.
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 begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 3.

Minnesota Statutes 2024, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 77. new text end

new text begin Infertility treatment. new text end

new text begin (a) Medical assistance covers:
new text end

new text begin (1) diagnosis of and treatment for infertility; and
new text end

new text begin (2) standard fertility preservation services.
new text end

new text begin (b) Medical assistance must meet the same requirements that would otherwise apply to
a health plan that provides maternity benefits to Minnesota residents under section 62Q.60,
except that medical assistance is not required to comply with any provision of section 62Q.60
if compliance with the provision would:
new text end

new text begin (1) prevent the state from receiving federal financial participation for the coverage under
this subdivision; or
new text end

new text begin (2) result in a lower level of coverage or reduced access to coverage for medical assistance
enrollees.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end

Sec. 4. new text begin APPROPRIATIONS; INFERTILITY TREATMENT COVERAGE.
new text end

new text begin Subdivision 1. new text end

new text begin Medical assistance. new text end

new text begin $....... in fiscal year 2026 and $....... in fiscal year
2027 are appropriated from the general fund to the commissioner of human services for
medical assistance coverage of infertility treatment and fertility preservation services under
Minnesota Statutes, section 256B.0625, subdivision 77. The base for this appropriation is
$....... in fiscal year 2028.
new text end

new text begin Subd. 2. new text end

new text begin MinnesotaCare. new text end

new text begin $....... in fiscal year 2026 and $....... in fiscal year 2027 are
appropriated from the health care access fund to the commissioner of human services for
MinnesotaCare coverage of infertility treatment and fertility preservation services under
Minnesota Statutes, section 256L.03, subdivision 1. The base for this appropriation is $.......
in fiscal year 2028.
new text end

new text begin Subd. 3. new text end

new text begin Defrayal of costs. new text end

new text begin $....... in fiscal year 2027 is appropriated from the general
fund to the commissioner of commerce for the estimated amount of defrayal costs for
mandated coverage of infertility treatment and fertility preservation services. The base for
this appropriation is $....... in fiscal year 2028.
new text end

new text begin Subd. 4. new text end

new text begin Administrative costs. new text end

new text begin $....... in fiscal year 2027 is appropriated from the general
fund to the commissioner of commerce for administrative costs to implement mandated
coverage of infertility treatment and fertility preservation services. The base for this
appropriation is $....... in fiscal year 2028.
new text end