Purpose

• Require health plans to cover Pap tests and two additional diagnostic services after a Pap test if a health care provider determines they are medically necessary. The goal is to ensure cervical cancer screening follow-up is fully covered without cost to the patient and to modify related coverage in the medical assistance program.

Main Provisions

• Required coverage

  • All health plans must cover Pap tests and two additional diagnostic services after the Pap test if a provider deems them medically necessary based on the Pap results. This includes services, treatments, supplies, and equipment connected to those follow-up steps.

• Cost-sharing restrictions

  • Health plans must not impose any cost-sharing for this coverage. This means no deductibles, copayments, or coinsurance for the Pap test or the two diagnostic services.

• Review, referral, and access rules

  • No restrictions on utilization review, referrals, or delays related to this coverage. Plans cannot place review or referral barriers or delay periods on these services.

• Quantity limits

  • No quantity limitations on the covered Pap tests or the two diagnostic follow-up services.

• Application regarding deductibles and eligibility

  • If applying the no-cost-sharing rule before the enrollee meets their deductible would jeopardize health savings account (HSA) eligibility (per 26 USC 223) or catastrophic coverage eligibility (per 42 USC 18022e), then the no-cost-sharing rule applies only after the enrollee has met their deductible.

• Reimbursement by the state

  • The state (specifically the commissioner of commerce) must reimburse health plans for this added coverage as allowed by federal rules (CFR Title 45, Part 155.170). Reimbursement is limited to coverage that would not have been provided by the plan without these requirements. Existing treatments and services covered as of January 1, 2026 are ineligible for these payments.

• Plan reporting and oversight

  • Health plans must report quantified cost information related to the additional benefit in a commissioner-approved format. The commissioner will assess submissions and issue payments per the federal rule cited above.

• Funding and appropriation

  • Starting in fiscal year 2028, an annual appropriation from the general fund to the commissioner of commerce will cover the payments to health plans to defray the cost of providing this coverage, including administrative costs.

• Relation to Medical Assistance program

  • The bill also contemplates amending the Medical Assistance program coverage language to reflect the changes in Pap test and follow-up diagnostic coverage.

Significant Changes to Existing Law

• Mandates coverage for Pap tests and two subsequent diagnostic services with no cost-sharing by health plans, subject to the medical necessity standard.
• Prohibits certain access barriers (no utilization review, no referral requirements, no delays) for the covered services.
• Introduces a state reimbursement mechanism to fund portions of the added coverage, with specific federal rule-based conditions and exclusions.
• Establishes a funding stream from the general fund to Minnesota’s Commissioner of Commerce starting in FY 2028 to support defrayal payments to health plans.
• Links coverage rules to federal tax-advantaged-accounts (HSA) and catastrophic coverage eligibility in specific circumstances.

Implementation Notes

• The changes reference federal standards and rules (e.g., CFR 45.155.170, 26 USC 223, 42 USC 18022e) and require health plans to report costs in a commissioner-defined format.
• The Jan 1, 2026 baseline appears to govern which treatments/services are ineligible for certain reimbursements, emphasizing the need to consider current plan benefits when applying the new funding.

Practical Impact

• For patients: reduced or eliminated out-of-pocket costs for Pap testing and necessary follow-up diagnostics; fewer barriers to timely screening and diagnosis.
• For health plans: need to cover the specified services without cost-sharing and to report cost data to the state for reimbursement.
• For the state: new funding obligations beginning in FY 2028 to support these reimbursements, with administrative costs included.

Relevant clarifications may be needed from the legislature or the Department of Commerce on how the application clause interacts with specific HSA rules for individual enrollees.

Relevant Terms - Pap test / Pap smear - diagnostic services - medical necessity - health plans / health plan companies - utilization review - referral - deductible - copayment - coinsurance - health savings account (HSA) - catastrophic health plan - United States Code (26 USC 223) - United States Code (42 USC 18022e) - Commissioner of Commerce - Code of Federal Regulations (CFR) Title 45, §155.170 - general fund appropriation - Medical Assistance / Minnesota Statutes 256B.0625