Minnesota SF 143: Vaccination and immunization exemption procedures modification

Bill Text

1.1 A bill for an act​
1.2 relating to human services; clarifying medical assistance coverage of prescription​
1.3 drugs in cases of cost-effective health insurance coverage; amending Minnesota​
1.4 Statutes 2024, section 256B.0625, subdivisions 15, 25b.​
1.5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:​
1.6 Section 1. Minnesota Statutes 2024, section 256B.0625, subdivision 15, is amended to​
1.7 read:​
1.8 Subd. 15.Health plan premiums and co-payments.(a) Medical assistance covers​
1.9 health care prepayment plan premiums, insurance premiums, and co-payments if determined​
1.10 to be cost-effective by the commissioner. For purposes of obtaining Medicare Part A and​
1.11 Part B, and co-payments, expenditures may be made even if federal funding is not available.​
1.12 If the commissioner determines that coverage of health care prepayment plan premiums,​
1.13 insurance premiums, and co-payments is cost-effective for an individual with prescription​
1.14 drug coverage provided by a commercial insurer, medical assistance must:​
1.15 (1) cover cost-sharing for prescription drugs in the quantity approved by the commercial​
1.16 insurer, even if the approved quantity exceeds a 34-day supply, without requiring the​
1.17 prescriber to obtain approval by the commissioner or from the agency provider help desk;​
1.18 and​
1.19 (2) cover cost-sharing for prescription drugs approved by the commercial insurer, whether​
1.20 or not the drug is on the preferred drug list established under subdivision 13g, without​
1.21 requiring prior approval when the enrollee is subject to a deductible for prescription drug​
1.22 coverage provided by the commercial insurer.​
1​Section 1.​
25-01511 as introduced​12/20/24 REVISOR AGW/BM​
SENATE​
STATE OF MINNESOTA​
S.F. No. 143​NINETY-FOURTH SESSION​
(SENATE AUTHORS: BOLDON)​
OFFICIAL STATUS​D-PG​DATE​
Introduction and first reading​82​01/16/2025​
Referred to Health and Human Services​

2.1 (b) Effective for all premiums due on or after June 30, 1997, medical assistance does​
2.2 not cover premiums that a recipient is required to pay under a qualified or Medicare​
2.3 supplement plan issued by the Minnesota Comprehensive Health Association. Medical​
2.4 assistance shall continue to cover premiums for recipients who are covered under a plan​
2.5 issued by the Minnesota Comprehensive Health Association on June 30, 1997, for a period​
2.6 of six months following receipt of the notice of termination or until December 31, 1997,​
2.7 whichever is later.​
2.8 EFFECTIVE DATE.This section is effective January 1, 2026.​
2.9 Sec. 2. Minnesota Statutes 2024, section 256B.0625, subdivision 25b, is amended to read:​
2.10 Subd. 25b.Authorization with third-party liability.(a) Except as otherwise allowed​
2.11 under this subdivision or required under federal or state regulations, the commissioner must​
2.12 not consider a request for authorization of a service when the recipient has coverage from​
2.13 a third-party payer unless the provider requesting authorization has made a good faith effort​
2.14 to receive payment or authorization from the third-party payer. A good faith effort is​
2.15 established by supplying with the authorization request to the commissioner the following:​
2.16 (1) a determination of payment for the service from the third-party payer, a determination​
2.17 of authorization for the service from the third-party payer, or a verification of noncoverage​
2.18 of the service by the third-party payer; and​
2.19 (2) the information or records required by the department to document the reason for​
2.20 the determination or to validate noncoverage from the third-party payer.​
2.21 (b) A provider requesting authorization for services covered by Medicare is not required​
2.22 to bill Medicare before requesting authorization from the commissioner if the provider has​
2.23 reason to believe that a service covered by Medicare is not eligible for payment. The provider​
2.24 must document that, because of recent claim experiences with Medicare or because of​
2.25 written communication from Medicare, coverage is not available for the service.​
2.26 (c) Authorization is not required:​
2.27 (1) if a third-party payer has made payment that is equal to or greater than 60 percent​
2.28 of the maximum payment amount for the service allowed under medical assistance; or​
2.29 (2) in cases of cost-effective prescription drug coverage when the prescription drug is​
2.30 approved by the commercial insurer, whether or not the drug is on the preferred drug list​
2.31 established under subdivision 13g, and the enrollee is subject to a deductible for prescription​
2.32 drug coverage provided by the commercial insurer.​
2​Sec. 2.​
25-01511 as introduced​12/20/24 REVISOR AGW/BM​

3.1 EFFECTIVE DATE.This section is effective January 1, 2026.​
3​Sec. 2.​
25-01511 as introduced​12/20/24 REVISOR AGW/BM​