Bill > SF3123

This bill establishes a five-year pilot program for the state employee group insurance program that will test a new approach to reviewing healthcare services. From January 1, 2026, to December 31, 2030, the commissioner of management and budget will administer a program where health plans use retrospective utilization review (evaluating healthcare services after they've been provided) instead of prior authorization (getting approval before a service). The program aims to compare the effectiveness, costs, and benefits of this approach. Health carriers will conduct quality and payment audits to assess the program's impact on employee access to medically necessary care and healthcare provider payments. If a health service is determined to be unnecessary through this review, the health carrier may decline payment, and healthcare providers cannot bill the employee for that service. The commissioner can terminate the program if it negatively impacts employee access to care or increases costs. The commissioners of management and budget and health will evaluate the program's impacts and issue annual reports to legislative committees, with recommendations on whether to continue or expand the pilot program. Key terms like "medically necessary care" and "prior authorization" are specifically defined in the bill to ensure clear implementation.

Government Affairs

https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF3123&ssn=0&y=2025