SF4940

Purpose

The bill aims to improve treatment options for people with dementia by requiring health plan companies to cover dementia treatments and related testing, and by adjusting how step therapy is used for medical assistance.

Main Provisions

• Coverage of FDA-approved dementia treatments:
  • A health plan company must provide coverage for every type of medical service and prescription medication approved by the FDA that is used to treat or slow the progression of dementia.
• Coverage of diagnostic testing:
  • Coverage must include diagnostic testing to determine the appropriateness or effectiveness of a medical service or prescription medication for dementia.
• Prohibition of step therapy for dementia coverage:
  • Health plans are prohibited from using a step therapy protocol when providing the dementia coverage described above (as defined in 62Q.184 subdivision 1).
• Changes to medical assistance (MA) step therapy:
  • The bill modifies step therapy requirements for the Medical Assistance program.
• Legislative codification:
  • The changes involve amending Minnesota Statutes 2024 section 256B.0625 subdivision 13f and proposing coding for a new law in Minnesota Statutes chapter 62Q.

Scope and Applicability

• Applies to health plan companies offering coverage in Minnesota for dementia-related medical services and medications.
• Applies to diagnostic testing connected with dementia treatment.
• Applies to the Medical Assistance program (MA) regarding step therapy rules.

Practical Impact

• People with dementia could access a broader range of FDA-approved treatments without needing to go through step therapy, potentially speeding access to therapies.
• Diagnostic testing for assessing treatment appropriateness/effectiveness would be covered.
• Medical Assistance (Medicaid program) rules around step therapy for dementia may be adjusted, affecting low-income individuals relying on MA.

Significant Changes to Existing Law

• Adds explicit coverage requirements for dementia treatments and diagnostic testing under health plans.
• Explicitly prohibits step therapy for dementia coverage.
• Alters MA step therapy requirements.
• Adds new codification in Minnesota Statutes Chapter 62Q and updates to 256B.0625 subdivision 13f.

Relevant Terms dementia; FDA-approved; coverage; health plan company; medical services; prescription medications; diagnostic testing; diagnostic testing to determine appropriateness or effectiveness; step therapy protocol; 62Q.184 subdivision 1; Medical Assistance (MA); Minnesota Statutes 256B.0625 subdivision 13f; Minnesota Statutes chapter 62Q; dementia treatments; slow the progression of dementia.