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HF2482 (Legislative Session 94 (2025-2026))

Health care utilization review provisions and prior authorization clinical criteria applicability modified.

Related bill: SF2607

AI Generated Summary

Purpose of the Bill

The purpose of this legislation is to modify how changes to prior authorization clinical criteria and utilization review processes are applied in Minnesota's health care system. This aims to ensure consistency and transparency for patients who have already received authorization for certain health services or drugs under specific coverage terms.

Main Provisions

  • Delayed Implementation of Changes: If a utilization review organization changes the terms of coverage or clinical criteria for health care services or drugs during a plan year, these new terms will not take effect until the following plan year. This is to protect patients who have already received prior authorization.

  • Exceptions to Delayed Implementation: Immediate changes can still occur if:

    • A drug or device is deemed unsafe by the FDA.
    • A drug or device is withdrawn by the FDA or manufacturer.
    • An independent, evidence-based standard issues a warning or guideline change due to patient harm.

  • Modification to Drug Formulary: Organizations can remove a brand name drug from their formulary or change its cost if they add a therapeutically equivalent generic drug at a lower cost, with a 60-day prior notice to prescribers, pharmacists, and affected enrollees.

  • Application to Public Health Programs: Beginning January 1, 2026, certain utilization review regulations from chapter 62M will apply to the commissioner when providing services under public programs like Medicaid (chapters 256B and 256L).

Significant Changes

  • Codifies the timeline for when changes in utilization review processes or criteria become applicable, aligning patient expectations and coverage stability.
  • Introduces specific timelines and conditions under which changes can bypass the delayed implementation, focusing on urgent safety issues or regulatory mandates.
  • Expands the applicability of certain utilization review statutes to public health services starting in 2026.

Relevant Terms

  • Prior Authorization
  • Utilization Review
  • Clinical Criteria
  • Health Benefit Plans
  • FDA Regulations
  • Formulary
  • Generic Drugs
  • Patient Harm
  • Medicaid

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 16, 2025HouseFloorActionIntroduction and first reading, referred toHuman Services Finance and Policy
March 19, 2025HouseFloorActionMotion to recall and re-refer, motion prevailedHealth Finance and Policy

Citations

 
[
  {
    "analysis": {
      "added": [
        "Clarifies exceptions when changes do not apply, such as FDA safety withdrawals or evidence-based patient harm warnings."
      ],
      "removed": [],
      "summary": "This bill modifies the applicability of prior authorization clinical criteria changes under section 62M.17, subdivision 2.",
      "modified": [
        "Specifies effective dates for different conditions under which prior authorization criteria changes can bypass the standard non-applicability rule."
      ]
    },
    "citation": "62M.17",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "This bill modifies applicability of utilization review provisions under section 256B.0625, subdivision 25c.",
      "modified": [
        "Updates the sections and subdivisions of chapter 62M that are applicable to the commissioner when delivering services under chapters 256B and 256L."
      ]
    },
    "citation": "256B.0625",
    "subdivision": "subdivision 25c"
  }
]

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