Continuity of care to be improved with changes to prior authorization requirements

A new law modifies statutes on health care services utilization and prior authorization requirements to modify timelines for determinations and appeals, provide for continuity of care and improve public access to information.

Sponsored by Rep. Kelly Morrison (DFL-Deephaven) and Sen. Julie Rosen (R-Vernon Center), the law is – except where otherwise noted – effective Jan. 1, 2021, and applies to health plans offered, sold, issued or renewed on or after that date.

Under the law, if a person switches health plan companies, their new provider will be required to comply with previous prior authorizations for health care services for the first 60 days after enrollment while a new utilization review is conducted. The enrollee, or a medical professional acting on their behalf, will be required to submit documentation to access this.

If a utilization review organization changes its coverage terms or clinical criteria during a plan year, those changes will not apply until the next year for any enrollee who received prior authorization for a health care service that would be affected, with some exceptions.

The law will also require utilization review organizations to submit their current requirements and restrictions for prior authorization determinations to the health plan companies for which they conduct reviews.

The health plan companies, in turn, will be required to post this information on their public websites in easy-to-understand language. Any changes to the prior authorization requirements will also need to be posted online.

In addition, health plan companies will be required to post certain data on their public websites, including the number of prior authorization requests for which an authorization was issued and the reasons for prior authorization denial. This will need to be available online by April 1, 2022, and updated by each following April 1.

The law will also:

• shorten the length of time available for determinations to be made regarding utilization review;

• require a report from the Department of Health, including data on prior authorization requests, by April 1, 2021;

• prohibit the revocation, limitation or restriction of a prior authorization that has been authorized except when there is evidence of fraud, misinformation or a conflict with state or federal law;

• require that new requirements or restrictions will need to be provided to any impacted Minnesota-based, in-network attending health care professionals at least 45 days before those changes will go into effect; and

• clarify and define terms and make a range of conforming changes.

This chapter of law will not apply to managed care plans or county-based purchasing plans providing coverage to state public health care program enrollees under Medical Assistance or MinnesotaCare.

HF3398/SF3204*/CH114

SF3204* / HF3398 / CH114