HF3743

Purpose

This bill aims to require health plans to cover preventive items and services, including immunizations for routine use, without cost-sharing. It also creates a Minnesota Science-Based Vaccine Advisory Council to advise on vaccine policy and lists funding to support these activities. It would amend state law to define what counts as preventive care and how coverage should work for these items.

Main goals

• Ensure immunizations and other preventive services are available to people without out-of-pocket costs.
• Align Minnesota’s preventive care coverage with national standards and schedules.
• Establish an expert advisory body to guide vaccine policy and implementation.
• Provide funding to implement the new requirements and council duties.

Scope of preventive items and services covered

• Preventive items and services are defined using the Affordable Care Act (ACA) framework and include vaccines with:
  • A or B ratings from the U.S. Preventive Services Task Force (USPSTF) for routine use, and
  • Recommendations from the CDC’s Advisory Committee on Immunization Practices (ACIP) as adopted by the CDC Director, and/or
  • Recommendations listed by the American Academy of Pediatrics (AAP) in its Immunization Schedules, or
  • Guidelines supported by the West Coast Health Alliance, and
  • Certain HIV-related preventive care guided by Health Resources and Services Administration (HRSA)-supported comprehensive guidelines.
• All contraceptive methods listed in FDA guidelines are covered.
• HIV testing for all individuals aged 15 to under 65, plus testing for others at increased risk per CDC guidance.
• All pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) related to HIV per applicable guidance (including USPSTF and CDC).
• Coverage for these items and services must be provided without cost-sharing (no deductible, coinsurance, or copayment) when delivered through a participating provider.

How coverage works

• Health plans must cover preventive items/services without cost-sharing when provided by in-network participating providers.
• Plans may exclude coverage or apply cost-sharing for preventive items/services delivered by out-of-network providers.
• Plans must annually review and update which items/services are covered without cost-sharing.
• Plans may use reasonable medical management techniques to determine frequency, method, or setting for preventive services if not specified in the guidelines.
• Prior authorization or step therapy for PrEP/PEP is generally not required, except that if the FDA has approved therapeutic equivalents of a drug/device/product, one or more equivalents may be covered without such requirements.
• The protections do not apply to grandfathered plans or to plans offered by the Minnesota Comprehensive Health Association (MCHA).

Administrative and funding provisions

• The bill would establish the Minnesota Science-Based Vaccine Advisory Council to guide vaccine policy and related duties.
• It would appropriate money to implement these changes (i.e., funding for administration and Council activities).

Notable limitations and exceptions

• Grandfathered health plans are not subject to these requirements.
• Plans offered by the Minnesota Comprehensive Health Association are not subject to these requirements.
• Out-of-network coverage for preventive items/services may be restricted by the plan.

What this bill seeks to accomplish

• Improve access to vaccines and preventive care by removing cost barriers.
• Create a formal, science-based mechanism to guide vaccine recommendations and policy in Minnesota.
• Update and align state insurance requirements with federal guidelines and reputable pediatric, public health, and HIV prevention standards.

Examples of covered items and services (high-level)

• Immunizations for routine use (as recommended by USPSTF, ACIP, AAP, or HRSA-supported guidelines).
• Contraceptive methods approved by FDA.
• HIV testing and HIV PrEP/PEP strategies.

Relevant Terms

preventive items and services; immunizations; routine use; cost-sharing; deductible; coinsurance; copayment; health plan; out-of-network; annual determination; medical management; prior authorization; step therapy; preexposure prophylaxis (PrEP); postexposure prophylaxis (PEP); human immunodeficiency virus (HIV); HIV testing; contraception; FDA guidelines; USPSTF; ACIP; Centers for Disease Control and Prevention (CDC); American Academy of Pediatrics (AAP); West Coast Health Alliance; Health Resources and Services Administration (HRSA); Minnesota Science-Based Vaccine Advisory Council; Minnesota Statutes section 62Q.46; grandfathered plans; Minnesota Comprehensive Health Association (MCHA).