This bill amends Minnesota Statutes to enhance medical assistance coverage for individuals with primary third-party payers. It requires that medical assistance covers any drug on the formulary of the recipient's primary third-party payer for which the payer has made partial payment, regardless of whether the drug is excluded from the medical assistance formulary or preferred drug list. Additionally, it specifies that prior authorization is not required for these drugs, ensuring that coverage is provided without regard to the payment amount initially covered by the primary third-party payer.

Furthermore, the bill mandates that medical assistance must cover in-network services even if a primary third-party payer deems them out-of-network or requiring a referral, as long as they do not require a referral under medical assistance guidelines. This change aims to streamline access to necessary medical services and medications for recipients, ensuring they receive comprehensive care without unnecessary barriers related to third-party insurance coverage.

Statutes affected:
Introduction: 256B.0625, 256B.37