Bill > SF2607

This bill modifies provisions related to prior authorization and utilization review in health care services, primarily focusing on how changes in clinical criteria and coverage terms are applied. Specifically, the bill updates rules for when a utilization review organization (an entity that reviews the medical necessity and appropriateness of health care services) can change its prior authorization criteria. Under the new provisions, if a health plan changes its coverage terms or clinical criteria during a plan year, those changes cannot be applied to enrollees who have already received prior authorization for a specific health care service using the previous criteria. The bill creates exceptions to this rule for situations involving potentially unsafe drugs or devices, services with recommended changes related to patient harm, or when a health plan replaces a brand name drug with a generic or equivalent drug at a lower cost. The bill also updates which provisions of Minnesota's utilization review chapter will apply to the state commissioner when delivering medical assistance services, effective January 1, 2026. These changes aim to provide more stability and predictability for patients and healthcare providers when health plans modify their authorization and coverage criteria.

Health and Social Services

https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF2607&ssn=0&y=2025