MN HF384

Health plan companies cannot restrict enrollees' choice of provider for diagnosis, monitoring, and treatment of rare diseases or conditions.

"Rare disease or condition" includes diseases affecting fewer than 200,000 persons that are chronic, serious, life-altering, or life-threatening; diseases with FDA-designated treatment drugs; diseases listed by the National Institutes of Health; or conditions meeting specific diagnostic criteria including two or more clinical consultations and failed or conflicting test results.

Cost-sharing requirements and benefit limitations for rare disease treatment must not place greater financial burden or be more restrictive than requirements for in-network medical treatment.

Health plan companies must provide written information to enrollees and train customer service representatives on the requirements, with an exemption for medications obtained from retail pharmacies.

Health plan requirements apply to medical assistance coverage under Minnesota Statutes section 256B.0625, effective January 1, 2024, for health plans offered, issued, or renewed on or after that date.