SF1998

Purpose

To require health plan companies to cover dementia treatment and related diagnostics, and to remove barriers that use step therapy for dementia care. It also makes related changes to Minnesota medical assistance rules and adds coding for the new law in a separate statute chapter.

Main Provisions

• Coverage of FDA-approved dementia treatments: Health plan companies must cover every type of medical service and prescription medication that the United States Food and Drug Administration has approved for treating or slowing the progression of dementia.
• Coverage of diagnostic testing: Health plan companies must cover diagnostic tests that determine the appropriateness or effectiveness of a dementia treatment or medication.
• Prohibition of step therapy: Health plan companies are prohibited from using step therapy protocols when providing the dementia coverage described above (as defined in a referenced section of the law).

Amendments to Law

• Medical Assistance: The bill amends Minnesota Statutes 2024 section 256B.0625, subdivision 13f, to reflect the new dementia coverage requirements for medical assistance programs.
• New statutory chapter: It also provides coding for the new dementia coverage provisions in Minnesota Statutes chapter 62Q.

Impact and Scope

• Access and consistency: Dementia patients would have more consistent access to FDA-approved treatments and the necessary diagnostic tests, reducing barriers created by step therapy.
• Who is affected: Applies to health plan companies and to the Medical Assistance program, with changes codified in the state’s statutes.

Terminology Emphasis

Key terms from the bill include dementia, FDA-approved, medical services, prescription medications, diagnostic testing, step therapy, health plan, Medical Assistance (MA), Minnesota Statutes 256B.0625, subdivision 13f, and Minnesota Statutes chapter 62Q.

Relevant Terms dementia FDA FDA-approved medical services prescription medications diagnostic testing step therapy health plan Medical Assistance (MA) Minnesota Statutes 256B.0625 Minnesota Statutes chapter 62Q