SF3716

Purpose

• Require health plans to cover Pap tests (Pap smears) and two additional diagnostic services if a healthcare provider determines they are medically necessary after the Pap test.
• Ensure access to follow-up care without cost barriers and clarify how the new coverage interacts with existing program rules and federal law.

Key Provisions

• Coverage obligation: All health plans must cover Pap tests plus two additional diagnostic services following a Pap test when medically necessary.
• No cost-sharing: Health plans may not require any deductible, copayment, coinsurance, or other cost-sharing for this coverage.
• No review/referral hurdles: Plans cannot impose utilization review, referral requirements, or delays that would block or slow coverage for the Pap test and related diagnostics.
• No quantity limits: No limits on the amount of coverage for the required Pap test and diagnostic services.
• Application rules: If applying the new coverage would affect the enrollee’s eligibility for a health savings account (HSA) under the federal Internal Revenue Code or for a catastrophic health plan, the new coverage applies only after the enrollee meets the plan’s deductible.
• Reimbursement framework: The state Commerce Commissioner must reimburse health plans for the coverage required by this bill, following federal standards (45 CFR 155.170). Reimbursement is limited to coverage that would not have been provided by the plan without these requirements.
• Exclusions from reimbursement: Treatments, services, supplies, and equipment that were already covered by the health plan as of January 1, 2026 are not eligible for reimbursement under this provision.
• Reporting requirement: Health plans must report quantified costs attributable to the added benefit in a format set by the Commerce Commissioner.
• Use of current plan coverage as baseline: The plan’s coverage as of January 1, 2026 must be used as the baseline to determine whether additional coverage would not have been provided without the new requirements.
• Federal alignment: Reimbursement and oversight are to be in line with 45 CFR 155.170.

Funding and Administration

• Appropriation from general fund: Beginning in fiscal year 2028, an amount necessary to pay defrayment of the added coverage (and the commissioner's admin costs) is annually appropriated to the Commerce Commissioner.
• Administrative costs: The appropriation must cover the commissioner's administrative costs related to administering the defrayal payments.

Implementation and Legal Alignment

• Amends Minnesota law: Adds a new subdivision under 62Q (new law) and modifies Minnesota Statutes 2024 section 256B.0625 (the Medical Assistance program) to reflect this coverage requirement.
• Effective coverage date: The new coverage framework references a baseline date of January 1, 2026, for determining which existing plan coverages are eligible for reimbursement and for establishing the baseline of coverage.

Practical Impact and Considerations

• For consumers: Pap tests and the following two diagnostic services should be covered with no out-of-pocket costs when medically necessary, improving access to preventive care and follow-up.
• For health plans: Must adjust benefits to remove cost-sharing, remove certain barriers to follow-up care, and report costs to the Commerce Commissioner for potential state reimbursement.
• Administration: The Commerce Department will handle reimbursement to plans for the incremental costs caused by this requirement, subject to federal rules and annual state funding.

Significant Changes to Existing Law

• Introduces a new required coverage standard for Pap tests and two diagnostic services with no cost-sharing, plus a framework for state reimbursement of incremental costs.
• Changes how coverage is evaluated for HSA eligibility and catastrophic plan eligibility in the context of this mandate.
• Establishes reporting, baseline comparison, and appropriation mechanisms to support the new coverage requirement.

Relevant Terms - Pap tests / Pap smears - Diagnostic services - Cost-sharing (deductible, copayment, coinsurance) - Utilization review - Referral requirements - Delay period - Quantity limitations - Health Savings Account (HSA) - Internal Revenue Code § 223 - Catastrophic health plan - United States Code § 42 § 18022e - Commissioner of commerce - Reimbursement - Code of Federal Regulations, Title 45, § 155.170 - Minnesota Medical Assistance (Mn. Stat. 256B.0625) - Minnesota Statutes Chapter 62Q (new law) - General fund appropriation - Fiscal year (FY) 2028 onward

Relevant Terms