SF205

SF205 (Legislative Session 94 (2025-2026))

Antineoplastic cancer treatment prior authorization prohibition

AI Generated Summary

Senate File No. 205 is a Minnesota legislative bill introduced to prevent health plans and other similar organizations from requiring prior authorization for certain medical treatments and services. Specifically, the bill would make it illegal to require prior authorization for:

Emergency medical confinement or services, although the policyholder or their representative must notify the health insurer as soon after the incident as possible.
Outpatient mental health and substance use disorder treatments, avoiding prior authorizations unless medication is involved (specific processes outlined for authorizations related to medications).
Antineoplastic (cancer) treatments that adhere to the National Comprehensive Cancer Network guidelines, with exceptions related to medications (specific processes are also outlined).
Medical services that have top preventive ratings by the United States Preventive Services Task Force, recommended immunizations by the CDC, and specific preventive services for women.
Pediatric hospice services provided by licensed hospice providers.
Treatments delivered by neonatal abstinence programs headed by pediatric pain or palliative care specialists.

The prohibitions on prior authorization are set to take effect from January 1, 2026, and would apply to all health plans offered, sold, issued, or renewed from that date forward. This legislation aims to streamline access to crucial medical services and reduce the administrative burdens and delays often associated with prior authorization in healthcare.

Bill text versions

Introduction PDF file
1st Engrossment PDF file

Actions

Date	Chamber	Where	Type	Name	Committee Name
January 15, 2025	Senate	Floor	Action	Introduction and first reading
January 15, 2025	Senate	Floor	Action	Referred to	Commerce and Consumer Protection
March 09, 2025	Senate	Floor	Action	Comm report: To pass as amended and re-refer to	Health and Human Services

Citations

[
  {
    "analysis": {
      "added": [
        "Prohibits prior authorization for antineoplastic cancer treatments consistent with guidelines."
      ],
      "removed": [
        "Previous specifications not included in the current amendment details."
      ],
      "summary": "The bill amends prior authorization rules for certain health services under section 62M.07, subdivision 2.",
      "modified": [
        "Clarification on conditions under which cancer treatment medications require prior authorization."
      ]
    },
    "citation": "62M.07, subdivision 2"
  },
  {
    "analysis": {
      "added": [
        "None directly added by this bill."
      ],
      "removed": [
        "None directly removed by this bill."
      ],
      "summary": "References the processing of prior authorizations for medications.",
      "modified": [
        "Aligns the processing of cancer treatment medication authorizations with existing initial determination procedures."
      ]
    },
    "citation": "62M.05, subdivision 3b"
  },
  {
    "analysis": {
      "added": [
        "None directly added by this bill."
      ],
      "removed": [
        "None directly removed by this bill."
      ],
      "summary": "References appeals process related to prior authorizations.",
      "modified": [
        "Ensures appeals for cancer medication authorizations adhere to existing standards."
      ]
    },
    "citation": "62M.06, subdivision 2"
  },
  {
    "analysis": {
      "added": [
        "Includes pediatric hospice services within the amendment scope."
      ],
      "removed": [
        "None directly removed by this bill."
      ],
      "summary": "References licensing statutes for hospice providers under sections 144A.75 to 144A.755.",
      "modified": [
        "Establishes that pediatric hospice services don't require prior authorization within specified health plans."
      ]
    },
    "citation": "144A.75 to 144A.755"
  },
  {
    "analysis": {
      "added": [
        "Specifies that services with specific federal compliance do not require prior authorization."
      ],
      "removed": [
        "Does not remove any regulation specifics."
      ],
      "summary": "Federal regulation related to preventive services and screenings for women.",
      "modified": [
        "Aligns preventive services with relevant federal laws and guidelines."
      ]
    },
    "citation": "Code of Federal Regulations title 45, section 147.130"
  }
]