A bill for an act
relating to insurance; requiring equal coverage of services provided by a pharmacist;
setting medical assistance and MinnesotaCare requirements for coverage and
payment of pharmacy services; amending Minnesota Statutes 2022, sections
62A.15, subdivision 4, by adding a subdivision; 256B.0625, by adding a
subdivision; 256L.03, by adding a subdivision; proposing coding for new law in
Minnesota Statutes, chapter 62D.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Minnesota Statutes 2022, section 62A.15, is amended by adding a subdivision
to read:
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All benefits provided by a policy or contract referred to in
subdivision 1 relating to expenses incurred for medical treatment or services provided by
a licensed physician must include services provided by a licensed pharmacist, according to
the requirements of section 151.01, to the extent a licensed pharmacist's services are within
the pharmacist's scope of practice.
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This section is effective January 1, 2025, and applies to policies
or contracts offered, issued, or renewed on or after that date.
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Minnesota Statutes 2022, section 62A.15, subdivision 4, is amended to read:
(a) No carrier referred to in subdivision 1 may, in the
payment of claims to employees in this state, deny benefits payable for services covered by
the policy or contract if the services are lawfully performed by a licensed chiropractor, a
licensed optometrist, a registered nurse meeting the requirements of subdivision 3a, a licensed
physician assistant, deleted text begin ordeleted text end a licensed acupuncture practitionernew text begin , or a licensed pharmacistnew text end .
(b) When carriers referred to in subdivision 1 make claim determinations concerning
the appropriateness, quality, or utilization of chiropractic health care for Minnesotans, any
of these determinations that are made by health care professionals must be made by, or
under the direction of, or subject to the review of licensed doctors of chiropractic.
(c) When a carrier referred to in subdivision 1 makes a denial of payment claim
determination concerning the appropriateness, quality, or utilization of acupuncture services
for individuals in this state performed by a licensed acupuncture practitioner, a denial of
payment claim determination that is made by a health professional must be made by, under
the direction of, or subject to the review of a licensed acupuncture practitioner.
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This section is effective January 1, 2025, and applies to policies
or contracts offered, issued, or renewed on or after that date.
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All benefits provided by a health maintenance contract
relating to expenses incurred for medical treatment or services provided by a licensed
physician must include services provided by a licensed pharmacist to the extent a licensed
pharmacist's services are within the pharmacist's scope of practice.
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When paying claims for enrollees in Minnesota, a health
maintenance organization must not deny payment for medical services covered by an
enrollee's health maintenance contract if the services are lawfully performed by a licensed
pharmacist.
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This section does not apply to or affect
the coverage or reimbursement for medication therapy management services under section
62Q.675 or 256B.0625, subdivisions 5 and 28a.
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This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
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Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
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(a) Medical assistance
coverage for services provided by a licensed physician must include coverage for services
provided by a licensed pharmacist to the extent a licensed pharmacist's services are within
the scope of practice. This requirement applies to services provided (1) under fee-for-service
medical assistance, and (2) by a managed care plan under section 256B.69 or a county-based
purchasing plan under section 256B.692.
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(b) The commissioner, and managed care and county-based purchasing plans when
providing services under sections 256B.69 and 256B.692, must reimburse a participating
pharmacist or pharmacy for a service that is also within a physician's scope of practice at
an amount no lower than the standard payment rate that would be applied when reimbursing
a physician for the service.
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This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
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Minnesota Statutes 2022, section 256L.03, is amended by adding a subdivision to
read:
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MinnesotaCare coverage and
payment for pharmacy services must comply with the requirements for medical assistance
specified under section 256B.0625, subdivision 13k.
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This section is effective January 1, 2025, or upon federal approval,
whichever is later. The commissioner of human services must notify the revisor of statutes
when federal approval is obtained.
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The commissioner of commerce shall consult with health plan companies, pharmacies,
and pharmacy benefit managers to develop guidance to implement coverage for the pharmacy
services required by sections 1 to 3.
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