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SF3306 (Legislative Session 94 (2025-2026))

Prior authorization on medications prescribed for antineoplastic cancer treatment prohibition; prior authorization denials based on timing of the provided health care service prohibition; expedited prior authorization review for prescriptions that have previously been authorized or covered requirement

AI Generated Summary

Purpose of the Bill

The bill aims to streamline and simplify the prior authorization process for specific health services and medications under health insurance plans in Minnesota. It specifically addresses requirements related to antineoplastic cancer treatments, expediting prior authorization for ongoing prescriptions, and implementing technological solutions to improve the process.

Main Provisions

  • Prohibition of Prior Authorization for Certain Treatments: The bill prohibits prior authorization for emergency services, outpatient mental health and substance use disorder treatments, and pediatric hospice care, among others. For antineoplastic cancer treatments specifically, prior authorization is prohibited if the treatment aligns with the National Comprehensive Cancer Network guidelines.

  • Expedited Process for Previously Authorized Medications: The bill requires expedited review for medications that have been previously authorized or covered for a patient, ensuring that any continued medication is reviewed promptly.

  • Technological Integration: By January 1, 2027, health plans and utilization review organizations must have an application programming interface (API) to automate the prior authorization process for non-drug services, using specific interoperability standards.

Significant Changes to Existing Law

  • Prior Authorization Submission Requirements: Providers must be able to submit prior authorization requests through various channels (phone, fax, voicemail, electronic) 24/7. Only non-dental services are impacted by this change.

  • Automated Systems Requirement: The bill mandates automated systems (API) to process prior authorization requests for health services, enhancing efficiency in handling such requests and ensuring quick determination and communication with healthcare providers.

  • Protection Against Timing-Based Denials: Utilization review organizations cannot deny a prior authorization request or appeal based on the timing of the submission if it is within seven days after the service.

Relevant Terms

  • Prior Authorization
  • Antineoplastic Cancer Treatment
  • National Comprehensive Cancer Network (NCCN)
  • Utilization Review
  • Health Insurance
  • Interoperability
  • Application Programming Interface (API)

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 06, 2025SenateFloorActionIntroduction and first reading
April 06, 2025SenateFloorActionReferred toCommerce and Consumer Protection

Citations

 
[
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Amendments to health insurance law regarding prior authorization of specific services under section 62M.07 subdivision 2.",
      "modified": [
        "Clarifications on the prohibition of prior authorization for certain emergency services and treatments."
      ]
    },
    "citation": "62M.07",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "References to the process of initial determinations for prior authorization in health services.",
      "modified": [
        "Specifies that prior authorizations for medications for specific treatments must follow this process."
      ]
    },
    "citation": "62M.05",
    "subdivision": "subdivision 3b"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "References the process for appeals related to prior authorization in health services.",
      "modified": [
        "Specifies that appeals for prior authorizations must follow this process."
      ]
    },
    "citation": "62M.06",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [
        "Requirements for a prior authorization API effective January 1, 2027."
      ],
      "removed": [],
      "summary": "Amendments to health insurance law regarding the submission of prior authorization requests under section 62M.07 subdivision 4.",
      "modified": [
        "Modifies the rules for submitting prior authorization requests."
      ]
    },
    "citation": "62M.07",
    "subdivision": "subdivision 4"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Requirements for submission requests for prescription drugs and medications are referenced.",
      "modified": [
        "Specifies compliance with section 62J.497 for prescription drugs."
      ]
    },
    "citation": "62J.497",
    "subdivision": ""
  }
]

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