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
This bill proposes changes to the regulations on health insurance in Minnesota. It aims to ease the process of obtaining medical treatments by reducing the burden of prior authorization requirements for specific medical services and medications, particularly those related to cancer treatment.
Main Provisions
- Prohibition of Prior Authorization for Cancer Treatment: The bill prohibits health insurance plans from requiring prior authorization for antineoplastic cancer treatments that are consistent with established guidelines, except when these treatments involve medication. For medications, prior authorization must follow specific processing timelines for both initial determinations and appeals.
- Submission and Processing of Prior Authorization Requests: Before the deadline of January 1, 2027, health plans must implement an automated system using an application programming interface (API) that aligns with federal standards to streamline the prior authorization process for healthcare services. This system will facilitate proper documentation and streamline the communication between providers and insurers.
- No Denials Based on Timing: Prior authorization requests for services provided within seven days must be accepted. Insurers cannot deny requests or appeals merely because these were processed after the service was provided.
- Review of Existing Medication Prescriptions: Insurers must process authorizations for medications that have been previously approved or covered for a patient, ensuring continued access to prescribed treatments without requiring reauthorization each year.
Significant Changes to Existing Law
The bill introduces changes to Minnesota Statutes section 62M.07: - It adds a provision prohibiting prior authorization for certain cancer treatments and establishes a framework for expedited processing of authorizations for medications. - There is a requirement for health plan companies to enhance their administrative systems by implementing an API for managing authorization requests electronically, fostering more efficient and accessible healthcare service processing.
Relevant Terms
- Prior Authorization
- Antineoplastic Cancer Treatment
- Automated Processing System
- Application Programming Interface (API)
- Health Insurance
- Utilization Review
- Prescription Medications
- Healthcare Services
Bill text versions
- Introduction PDF file
Actions
| Date | Chamber | Where | Type | Name | Committee Name |
|---|---|---|---|---|---|
| April 06, 2025 | Senate | Floor | Action | Introduction and first reading | |
| April 06, 2025 | Senate | Floor | Action | Referred to | Commerce and Consumer Protection |
| April 09, 2025 | Senate | Floor | Action | Author added |
Citations
[
{
"analysis": {
"added": [
"Prohibiting prior authorization for antineoplastic cancer treatment medications conforming to National Comprehensive Cancer Network guidelines."
],
"removed": [],
"summary": "Amendments to the regulations regarding prior authorization of emergency and outpatient services under section 62M.07, subdivision 2.",
"modified": [
"Clarifying the processing requirements for prior authorizations related to outpatient mental health treatments."
]
},
"citation": "62M.07",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [
"Requirement for an application programming interface (API) to automate prior authorization processes."
],
"removed": [],
"summary": "Adjustments to the submission process for prior authorization requests under section 62M.07, subdivision 4.",
"modified": [
"Mandate for submission of prior authorization requests via multiple communication methods 24/7."
]
},
"citation": "62M.07",
"subdivision": "subdivision 4"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Referenced for initial determination procedures related to prior authorization of specific treatments and medications.",
"modified": []
},
"citation": "62M.05",
"subdivision": "subdivision 3b"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Referenced for appeal procedures related to prior authorization of specific treatments and medications.",
"modified": []
},
"citation": "62M.06",
"subdivision": "subdivision 2"
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Related to licensing of hospice providers, referenced in broader context of health services exemptions.",
"modified": []
},
"citation": "144A.75 to 144A.755",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Referenced in relation to compliance requirements for submission requests of prescription drugs and medications.",
"modified": []
},
"citation": "62J.497",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Federal standards referenced for preventive health services and immunizations.",
"modified": []
},
"citation": "45 CFR 147.130",
"subdivision": ""
},
{
"analysis": {
"added": [],
"removed": [],
"summary": "Federal regulations referenced for technical standards applicable to electronic health interface requirements.",
"modified": []
},
"citation": "45 CFR 170.215(a)1",
"subdivision": ""
}
]