Health Omnibus Bill Goes to Floor with Prior Authorization Reform Section

May 9, 2024

The House Ways and Means Committee referred the health omnibus bill to the House floor for a vote on May 6. As this went to press, the legislation was awaiting a final vote. (Editor's note: The bill passed 69-58 on May 9.)

The legislation (HF 4571, Liebling, DFL – Rochester) includes the MMA’s prior authorization reform language. The bill: 

1. Applies current prior authorization laws to medical assistance (MA) and MinnesotaCare. 

2. Prohibits prior authorization for oral buprenorphine, preventative services, pediatric hospice care, and for pediatric neonatal abstinence programs. 

3. Prohibits prior authorization for non-medication treatments for cancer, outpatient mental health and substance-use disorder. The bill allows prior authorization for medications to treat these conditions but shortens the decision timeline to 48 hours from five days. 

4. Limits prior authorization for chronic conditions to one-time only unless the standard of treatment changes. 

5. Directs health plans to submit a formalized annual report to the Department of Health on how often they use prior authorization, how often they approve and how often they deny. 

6. Requires health plans to utilize an automated process that is consistent with the new federal requirements that identifies whether a prior authorization is required and what documentation is needed. 

7. Prohibits a health plan from retrospectively denying coverage of a service for which a prior authorization was not required 

8. Prohibits a health plan from denying coverage solely on the basis of lack of a prior authorization if they would have otherwise covered the service. 

The Senate companion bill includes language applying current prior authorization laws to MA and MinnesotaCare. A conference committee will be formed in the coming days to sort out the differences between the two bills and develop identical language. Once identical language is finalized, the bill will go back to the House and Senate for a final vote before being sent to the governor for his signature.