Bill > HF2555

This bill establishes a five-year utilization review pilot program for the state employee group insurance program that will run from January 1, 2026, to December 31, 2030. The program aims to compare the effectiveness of retrospective utilization review (evaluating healthcare services after they are provided) with prior authorization (getting approval before receiving services). Under the pilot program, health plans must use retrospective utilization review and may optionally use prior authorization when evaluating the necessity and appropriateness of healthcare services for state employees. Health carriers will be required to conduct quality and payment audits to assess the program's impact on employee access to medically necessary care and healthcare costs. If a health carrier makes an adverse determination about a service, they can decline payment to the healthcare provider, and the provider cannot bill the employee for that service. The commissioner of management and budget can terminate the program if it significantly negatively impacts employee access to care or state healthcare costs, but must provide notice to legislative committees. The commissioners of management and budget and health will evaluate the program's impacts and issue annual reports from 2027 to 2031, including recommendations on whether to continue or expand the pilot program to other populations.

Government Affairs

https://www.revisor.mn.gov/bills/bill.php?b=House&f=HF2555&ssn=0&y=2025