SF 731

as introduced - 94th Legislature (2025 - 2026) Posted on 01/28/2025 11:05am

A bill for an act
relating to insurance; prohibiting prior authorization for services resulting in health
plan company liability of equal to or less than $100; amending Minnesota Statutes
2024, section 62M.07, subdivision 2.

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

Section 1.

Minnesota Statutes 2024, section 62M.07, subdivision 2, is amended to read:

Subd. 2.

Prior authorization of certain services prohibited.

No utilization review
organization, health plan company, or claims administrator may conduct or require prior
authorization of:

(1) emergency confinement or an emergency service. The enrollee or the enrollee's
authorized representative may be required to notify the health plan company, claims
administrator, or utilization review organization as soon as reasonably possible after the
beginning of the emergency confinement or emergency service;

(2) outpatient mental health treatment or outpatient substance use disorder treatment,
except for treatment which is a medication. Prior authorizations required for medications
used for outpatient mental health treatment or outpatient substance use disorder treatment
must be processed according to section 62M.05, subdivision 3b, for initial determinations,
and according to section 62M.06, subdivision 2, for appeals;

(3) antineoplastic cancer treatment that is consistent with guidelines of the National
Comprehensive Cancer Network, except for treatment which is a medication. Prior
authorizations required for medications used for antineoplastic cancer treatment must be
processed according to section 62M.05, subdivision 3b, for initial determinations, and
according to section 62M.06, subdivision 2, for appeals;

(4) services that currently have a rating of A or B from the United States Preventive
Services Task Force, immunizations recommended by the Advisory Committee on
Immunization Practices of the Centers for Disease Control and Prevention, or preventive
services and screenings provided to women as described in Code of Federal Regulations,
title 45, section 147.130;

(5) pediatric hospice services provided by a hospice provider licensed under sections
144A.75 to 144A.755; deleted text begin and
deleted text end

(6) treatment delivered through a neonatal abstinence program operated by pediatric
pain or palliative care subspecialists deleted text begin . deleted text end new text begin ; and
new text end

new text begin (7) any service, item, or treatment for which a health plan company's liability would be
equal to or less than $100 if the service, item, or treatment were approved.
new text end

Clauses (2) to deleted text begin (6) deleted text end new text begin (7) new text end are effective January 1, 2026, and apply to health benefit plans offered,
sold, issued, or renewed on or after that date.