April 3, 2025
According to an MMA analysis of publicly posted Minnesota health plan data, the number of prior authorization (PA) requests in Minnesota has more than doubled over the past two years - from 227,549 in 2022 to 460,243 in 2024.
The analysis finds that 70% of this increase is attributable to Blue Cross Blue Shield of Minnesota products, and 24% of this increase is attributable to Medica products.
The analysis also finds that in 2024:
87% of initial PA requests were approved,
Only 19% of PA denials were appealed by providers/patients,
Of appealed requests, 84% were approved,
Overall, 89% of PA requests were ultimately approved (i.e., either initially or upon appeal).
The analysis is based on data required by a 2020 Minnesota law that requires Minnesota health plans to publicly post annual PA data on their websites.
Starting January 1, 2026, a new set of PA regulations championed by the MMA will take effect. Most notably, state-regulated health plans will be prohibited from requiring PA for:
treatment of a chronic health condition that has received PA under the current insurance provider, unless the standard of care has changed. "Chronic health condition" means a) expected to last at least one year and b) requires ongoing medical management to prevent adverse health events or limits at least one activity of daily living,
outpatient mental health and substance use treatment services, excluding medications,
antineoplastic cancer treatment consistent with guidelines of the National Comprehensive Cancer Network, excluding medications,
services with an A or B rating from the US Preventive Services Task Force,
immunizations recommended by the Advisory Committee on Immunization Practices,
preventive services for women as described in Code of Federal Regulations Title 45, Section 147.130,
pediatric hospice services, and
services delivered through a neonatal abstinence program operated by pediatric pain or palliative care specialists.
For more information, contact Adrian Uphoff, health policy analyst.
July 16, 2025
On July 8, the MMA submitted a formal comment in opposition to a Centers for Medicare and Medicaid Services (CMS) proposed rule that would dramatically restrict states’ ability to impose Medicaid provider taxes on insurance companies.
July 16, 2025
Minnesota Attorney General Keith Ellison met with the MMA Board of Trustees at its July 14 meeting and offered to regularly engage with the group to discuss the state’s healthcare issues.
July 16, 2025
The Drug Enforcement Administration (DEA) is warning its registrants of new fraud schemes in which scammers impersonate DEA personnel and notify them that they are under investigation, presumably to obtain personal information.