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 only at the beginning of the next plan year or calendar year for fee-for-service providers, ensuring that enrollees who have already received prior authorization are not adversely affected by mid-year changes. 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 removes the reference to section 62M.18 from the applicability provisions, streamlining the regulations that govern utilization review processes. Overall, these changes aim to enhance the stability and predictability of health care service coverage for enrollees while maintaining necessary safeguards for patient safety.

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