1.1Senator Boldon moved to amend
S.F. No. 3967 as follows (...):
1.2Delete everything after the enacting clause and insert:
1.3 "Section 1. Minnesota Statutes 2024, section 62Q.545, is amended to read:
1.462Q.545 COVERAGE OF HOME CARE NURSING.
1.5 Subdivision 1. Home care nursing services mandated coverage. (a) Home care nursing
1.6services, as provided under section
256B.0625, subdivision 7, with the exception of section
1.7256B.0654, subdivision 4, shall be covered under a health plan for persons who are
1.8concurrently covered by both the health plan and enrolled in medical assistance under
1.9chapter 256B.
1.10(b) For purposes of this section, a period of home care nursing services may be subject
1.11to the co-payment, coinsurance, deductible, or other enrollee cost-sharing requirements
that
1.12apply under the health plan. Cost-sharing requirements for home care nursing services
must
1.13not place a greater financial burden on the insured or enrollee than those requirements
1.14applied by the health plan to other similar services or benefits. Nothing in this
section is
1.15intended to prevent a health plan company from requiring prior authorization by the
health
1.16plan company for such services as required by section
256B.0625, subdivision 7, or use of
1.17contracted providers under the applicable provisions of the health plan.
1.18(c) Notwithstanding section 62J.26, a health plan must not impose any quantity limitation
1.19on the coverage under this section.
1.20 Subd. 2. Legislative findings and purpose. The mandated coverage on home care
1.21nursing services in subdivision 1 has been intended, since its enactment in 2010,
to require
1.22health plans to cover all prescribed, medically necessary home care nursing services.
Pursuant
1.23to Code of Federal Regulations, title 45, section 155.170, a benefit required by state
action
1.24taking place before December 31, 2011, is considered an EHB, such that the state is
not
1.25required to make payments to defray the cost of benefits. To minimize unnecessary
state
1.26payments, including costs to the medical assistance program for potential coverage
of
1.27recipients of home care nursing services, the commissioner must not make payments
to
1.28defray the cost of benefits under this section and must facilitate the provision of
1.29comprehensive coverage of home care nursing services in the private insurance market.
1.30 Subd. 3. Use of terminology. (a) Notwithstanding section 62J.26, a health plan must
1.31refer to all services meeting the definition of home care nursing services in paragraph
(b)
1.32as home care nursing services in the health plan's policy, certificate, contract,
or other
2.1evidence of coverage and related documents, including but not limited to utilization
review
2.2policies, claims forms, instructions, and communications to enrollees and providers.
2.3(b) For purposes of this subdivision, "home care nursing services" means ongoing,
2.4individual, and continuous nursing services that are:
2.5(1) ordered by a physician, advanced practice registered nurse, or physician assistant;
2.6(2) provided by a registered nurse or licensed practical nurse acting within the provider's
2.7scope of practice;
2.8(3) medically necessary to maintain, stabilize, or restore the recipient's health
due to
2.9medical complexity or the need for sustained skilled nursing assessment, intervention,
or
2.10monitoring; and
2.11(4) required for a duration or frequency that cannot be safely or effectively met
through
2.12intermittent, episodic, or visit-based nursing services.
2.13EFFECTIVE DATE.Subdivisions 1 and 2 are effective retroactively from January 1,
2.142026, and apply to policies issued, offered, or renewed and causes of action accruing
on or
2.15after that date. Subdivision 3 is effective August 1, 2026."
2.16Amend the title accordingly
2.17The motion prevailed. #did not prevail. So the amendment was #not adopted.