This bill amends Minnesota Statutes to modify the applicability of prior authorization clinical criteria changes and utilization review provisions in the context of human services. Specifically, it introduces new language that allows for changes in coverage terms or clinical criteria for health care services to take effect in the next plan year or calendar year for fee-for-service providers, rather than immediately. This provision is designed to protect enrollees who have already received prior authorization under the previous criteria. Additionally, the bill outlines exceptions to this rule, such as when a drug or device is deemed unsafe by the FDA or when independent research recommends changes due to patient harm.

Furthermore, the bill specifies that starting January 1, 2026, certain provisions of chapter 62M will apply to the commissioner when delivering services under chapters 256B and 256L, including the amended section 62M.17, subdivision 2. The bill also clarifies that if a utilization review organization changes coverage terms for a service based on new evidence of imminent patient harm, the previous authorization rules will not apply. Overall, these changes aim to enhance patient safety while providing a structured approach to the implementation of clinical criteria changes.

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