HF 5474

as introduced - 93rd Legislature (2023 - 2024) Posted on 05/15/2024 10:13am

A bill for an act
relating to health insurance; requiring health plans to cover the management and
treatment of obesity; requiring a report; amending Minnesota Statutes 2022, section
256B.0625, 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.474] OBESITY MANAGEMENT AND TREATMENT.
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 terms defined in this
subdivision have the meanings given.
new text end

new text begin (b) "Intensive behavioral or lifestyle therapy" means an evidence-based, intensive,
multicomponent behavioral or lifestyle modification intervention that supports healthy
weight management.
new text end

new text begin (c) "FDA-approved antiobesity medication" means any medication approved by the
United States Food and Drug Administration (FDA) with an indication for chronic weight
management in patients with an obesity diagnosis.
new text end

new text begin (d) "Metabolic and bariatric surgery" means any surgical intervention included in the
most current American Society for Metabolic and Bariatric Surgery and International
Federation for the Surgery of Obesity and Metabolic Disorders Guidelines on Indications
for Metabolic and Bariatric Surgery.
new text end

new text begin Subd. 2. new text end

new text begin Management and treatment of obesity; coverage required. new text end

new text begin (a) A health plan
must include coverage to diagnose and treat obesity, including but not limited to:
new text end

new text begin (1) intensive behavioral or lifestyle therapy;
new text end

new text begin (2) metabolic and bariatric surgery; and
new text end

new text begin (3) FDA-approved antiobesity medication.
new text end

new text begin (b) Coverage criteria for FDA-approved antiobesity medications must not be more
restrictive than the FDA-approved indications for antiobesity treatments.
new text end

new text begin (c) Coverage under this section must not be different or separate from coverage for any
other illness, condition, or disorder for purposes of cost-sharing, including but not limited
to determining deductibles, co-payment and coinsurance factors, and benefit year maximums
for deductibles, co-payment, and coinsurance.
new text end

new text begin (d) This section does not prohibit a health plan from applying utilization management
to determine the medical necessity for obesity treatment if medical necessity determinations
are made in the same manner as determinations are made to treat any other illness, condition,
or disorder covered by the health plan.
new text end

new text begin (e) Intensive behavioral or lifestyle therapy may include interventions certified by or
recognized by the Centers for Disease Control and Prevention or recommended by current
clinical standards of care. The services may be provided in office, virtual, or
community-based settings to support patient access and needs.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end

Sec. 2.

Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:

new text begin Subd. 72. new text end

new text begin Management and treatment of obesity. new text end

new text begin (a) Medical assistance covers obesity
management and treatment in the same manner as required under section 62Q.474.
new text end

new text begin (b) The department must report to the public annually on efforts to reduce and manage
obesity. The report must include prevalence and diagnosis rates, utilization of obesity
intervention services, and health improvements, including diabetes prevention, diabetes
management, and cardiovascular health.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2025.
new text end