The bill modifies the applicability of prior authorization clinical criteria changes and utilization review provisions in Minnesota's human services laws. Specifically, it amends Minnesota Statutes 2024, section 62M.17, subdivision 2, to clarify that changes in coverage terms or clinical criteria for health care services will not take effect until the next plan year or calendar year for fee-for-service providers, unless certain conditions are met. These conditions include instances where a drug or device is deemed unsafe by the FDA or when independent research recommends changes due to patient harm. Additionally, the bill introduces a provision that allows for immediate changes in coverage terms if there is a risk of previously unknown and imminent patient harm, effective January 1, 2026.

Furthermore, the bill amends Minnesota Statutes 2024, section 256B.0625, subdivision 25c, to specify that certain provisions of chapter 62M will apply to the commissioner when delivering services under chapters 256B and 256L, effective January 1, 2026. Notably, it includes the insertion of section 62M.17, subdivision 2, while deleting section 62M.18 from the applicability list. This legislative change aims to enhance patient safety and ensure that health care providers and enrollees are adequately informed about changes in coverage and clinical criteria.

Statutes affected:
Introduction: 62M.17, 256B.0625