Bill > HF2482

This bill modifies two key areas related to health care utilization review and prior authorization: First, it expands protections for patients receiving prior authorized services by ensuring that if a utilization review organization (an entity that reviews the medical necessity and appropriateness of health care services) changes its clinical criteria or coverage terms, those changes will not apply to patients who have already received prior authorization for a specific service during the current plan or calendar year. The bill creates specific exceptions to this rule, such as when a drug or device is deemed unsafe by the FDA, when independent research recommends changes due to patient harm, or when a generic or equivalent drug is added to a formulary at a lower cost. Second, the bill updates the applicability of utilization review provisions for the state commissioner when delivering services under medical assistance and MinnesotaCare programs, specifically adding certain sections of Minnesota Statutes related to utilization review that will take effect on January 1, 2026. These changes aim to provide more stability and predictability for patients and healthcare providers when navigating prior authorization processes and ensure that coverage changes do not unexpectedly disrupt ongoing medical treatments.

Health and Social Services, Labor and Employment

https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF2482&ssn=0&y=2025