1st Engrossment - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am
A bill for an act
relating to insurance; requiring coverage for amino-acid-based elemental
formulas; amending Minnesota Statutes 2006, sections 62A.26; 256B.0625, by
adding a subdivision.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2006, section 62A.26, is amended to read:
This section applies to all policies of accident
and health insurancenew text begin regulated under this chapternew text end , health maintenance contracts regulated
under chapter 62D, health benefit certificates offered through a fraternal benefit society
regulated under chapter 64B, and deleted text begin groupdeleted text end subscriber contracts offered by nonprofit health
service plan corporations regulated under chapter 62C, but does not apply to policies
designed primarily to provide coverage payable on a per diem, fixed indemnity or
nonexpense incurred basis, or policies that provide only accident coverage.
Every policy, plan, certificate, or contract referred to in subdivision
1 deleted text begin issued or renewed after August 1, 1985,deleted text end must provide coverage for special dietary
new text begin formulas essential to the treatment of inborn errors of metabolism, including new text end treatment
for phenylketonuria when recommended by a physician.
new text begin
(a) Every policy, plan, certificate, or contract referred to in subdivision
1 must provide coverage for amino-acid-based elemental formulas when ordered by a
physician for diagnosed cases of cystic fibrosis; amino acid, organic acid, and fatty
acid metabolic and malabsorption disorders; IgE mediated allergies to food proteins;
food protein-induced enterocolitis syndrome; eosinophilic esophagitis; eosinophilic
gastroenteritis; and eosinophilic colitis, when those conditions are diagnosed by an
allergist, gastroenterologist, or pediatrician. Coverage of amino-acid-based elemental
formulas for enrollees diagnosed with an IgE mediated condition is limited to enrollees
age five years and under.
new text end
new text begin
(b) A policy, plan, certificate, or contract described in paragraph (a) may require
that an enrollee obtain prior authorization for the coverage described in this subdivision.
When requesting coverage, ordering physicians may be required to submit documentation
of diagnosis, expected course of treatment, and duration of use of amino-acid-based
elemental formulas. Coverage may be provided for up to 90 days when requested by a
physician while actively seeking diagnosis. Documentation of symptoms and referral
for diagnosis may be required.
new text end
new text begin
(c) No special deductible, co-payment, waiting period, or other special restriction for
the coverage specified in this subdivision may be imposed if not imposed under the policy,
plan, certificate, or contract for nonpreventive treatment or prescription drugs in general.
new text end
new text begin
This section is effective for policies, plans, certificates, and
contracts issued on or after August 1, 2007.
new text end
Minnesota Statutes 2006, section 256B.0625, is amended by adding a
subdivision to read:
new text begin
Medical assistance covers
amino-acid-based elemental formulas on the same terms and conditions required of
policies, plans, and certificates under section 62A.26.
new text end