SF731 (Legislative Session 94 (2025-2026))

Prior authorization prohibition for services resulting in health plan company liability equal to or less than $100

AI Generated Summary

This bill, identified as SF No 731, seeks to amend existing insurance laws in Minnesota. Its main goal is to prohibit the need for prior authorization—a pre-approval from a health insurance company before a service can be provided by a medical professional—for specific health services under certain conditions. The proposed changes include:

  1. Eliminating the requirement for prior authorization for emergency medical services and some types of confinement, although notification to the insurance company after such services commence would still be required.
  2. Removing prior authorization requirements for outpatient mental health and substance use disorder treatments, except when medications are involved. Medications would still require prior authorization per existing statutes for initial decisions and appeals.
  3. Excluding antineoplastic (cancer treatment) medications from prior authorization as long as the treatment follows the guidelines of the National Comprehensive Cancer Network.
  4. Removing prior authorization for services that receive an A or B rating from the U.S. Preventive Services Task Force, recommended immunizations by the CDC's Advisory Committee on Immunization Practices, and preventive services and screenings for women as specified in federal regulations.
  5. Ending prior authorization for pediatric hospice services provided by licensed hospice providers and treatments delivered through neonatal abstinence programs by certain subspecialists.
  6. Prohibiting prior authorization for any service, item, or treatment where the health plan’s liability (cost) is $100 or less.

The act is set to take effect on January 1, 2026, and will apply to health benefit plans offered, sold, issued, or renewed on or after that date. This legislation aims to streamline certain healthcare processes, potentially easing barriers to accessing emergency, preventive, and critical care for patients.

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
January 26, 2025HouseFloorActionIntroduction and first reading
January 26, 2025SenateFloorActionIntroduction and first reading
January 26, 2025HouseFloorActionReferred toCommerce and Consumer Protection
January 26, 2025SenateFloorActionReferred toCommerce and Consumer Protection

Citations

 
[
  {
    "analysis": {
      "added": [
        "A new clause exempting certain services from prior authorization if liability is $100 or less."
      ],
      "removed": [],
      "summary": "This bill amends the criteria for prior authorization of services under section 62M.07.",
      "modified": [
        "Clarifies processing of prior authorizations for outpatient mental health and substance use disorder treatments and antineoplastic cancer treatments."
      ]
    },
    "citation": "62M.07",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "References to processing for certain medications under section 62M.05.",
      "modified": [
        "Specifies initial determination procedures for certain medication treatments."
      ]
    },
    "citation": "62M.05",
    "subdivision": "subdivision 3b"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "References to appeal procedures for certain medications under section 62M.06.",
      "modified": [
        "Specifies appeal procedures for certain medication treatments."
      ]
    },
    "citation": "62M.06",
    "subdivision": "subdivision 2"
  },
  {
    "analysis": {
      "added": [],
      "removed": [],
      "summary": "Reference to licensing requirements for pediatric hospice services.",
      "modified": [
        "Acknowledges licensing standards for pediatric hospice services."
      ]
    },
    "citation": "144A.75 to 144A.755",
    "subdivision": ""
  }
]