Prior Authorization

This page details the ongoing work of the MMA to limit the burden of prior authorization (PA), a requirement that physicians obtain approval from health insurers before providing select treatments.

Complete Guide to MN PA Law

Click here (coming soon) for a complete guide on Minnesota’s PA law, including a summary of the law, statutory citations, and instructions for filing complaints to regulators.

New PA Laws Effective January 1, 2026

Starting January 1, 2026, a sweeping set of new state laws, secured by the MMA, will limit the use of PA in state-regulated health insurance products. A summary of the new laws is provided below (click on each box to expand details).

Please note that these laws only apply to state regulated health insurance products (i.e., roughly 40% of the Minnesota market). A more detailed discussion of the limited applicability of state insurance regulations can be found in the “Complete Guide to MN PA Law” linked above (coming soon).

Before January 2026
State programs, including Medical Assistance and MinnesotaCare were excluded from state prior authorization (PA) regulations.

Starting January 2026
State public insurance programs are subject to state PA regulations.

Applicable Minnesota Statute
62M.01 CITATION, JURISDICTION, AND SCOPE

Before January 2026
State law prohibited PA for emergency services only.

Starting January 2026
State law prohibits PA for a longer list of services:

emergency services,
outpatient mental health treatment, excluding medications,
outpatient substance use disorder treatment, excluding medications,
antineoplastic cancer treatment consistent with National Comprehensive Cancer Network guidelines, excluding medications,
services that have an A or B rating from the United States Preventive Services Task Force or select preventive services described in federal law,
pediatric hospice services, and
treatment delivered through a neonatal abstinence program.

Applicable Minnesota Statute
62M.07 PRIOR AUTHORIZATION OF SERVICES

Before January 2026
All PA requests for medications defaulted to the standard review determination timeline (i.e., five business days, or seven days maximum, from health plan receipt of the request).

Starting January 2026
PA requests for medications for outpatient mental health, outpatient substance use disorder, and cancer treatment consistent with National Comprehensive Cancer Network guidelines default to the expedited review determination (i.e., "as expeditiously as the enrollee's medical condition requires, but no later than 48 hours and must include at least one business day after the initial request,” or three days maximum, from health plan receipt of the request).

Applicable Minnesota Statute
62M.07 PRIOR AUTHORIZATION OF SERVICES

Before January 2026
State law allowed health plans to use PA for the same treatment of the same chronic condition without limit.

Starting January 2026
A PA approval for treatment of a chronic condition does not expire unless the standard of treatment for the condition changes. “Chronic condition” is defined in statute as “a condition that is expected to last one year or more and: (1) requires ongoing medical attention to effectively manage the condition or prevent an adverse health event; or (2) limits one or more activities of daily living.”

Applicable Minnesota Statute
62M.07 PRIOR AUTHORIZATION OF SERVICES

Before January 2026
Health plans were permitted to deny coverage of services for which PA was required but not obtained, even if the services in question met PA criteria and would have been approved had a PA request been submitted.

Starting January 2026
State law prohibits health plans from denying coverage solely for the lack of PA if they would have otherwise covered the service.

Applicable Minnesota Statute
62A.59 COVERAGE OF SERVICE; PRIOR AUTHORIZATION

Before January 2026
State law did not explicitly prohibit health plans from denying coverage on the basis that PA was not obtained despite PA not being required up to the date of service.

Starting January 2026
State law dictates that if a health plan does not have an active PA requirement in effect for a service up to the date of service, the health plan cannot deny coverage for the service on the basis that PA was not obtained.

Applicable Minnesota Statute
62A.59 COVERAGE OF SERVICE; PRIOR AUTHORIZATION