State rapid start program established; operation of local rapid start programs to treat patients who are HIV-positive provided; prior authorization, cost sharing, and step therapy for antiretroviral therapy and HIV prevention services prohibited; and money appropriated.

A bill for an act

relating to health; establishing a state rapid start program; providing for the

operation of local rapid start programs to treat patients who are HIV-positive;

prohibiting prior authorization, cost sharing, and step therapy for antiretroviral

therapy and HIV prevention services; authorizing rulemaking; requiring reports;

appropriating money; proposing coding for new law in Minnesota Statutes, chapters

62Q; 145.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.
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SHORT TITLE.
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This act shall be known as the "Rapid Start HIV Treatment Act of 2026."

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Sec. 2.

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[62Q.1842] PROHIBITION ON PRIOR AUTHORIZATION, USE OF STEP

THERAPY, AND COST SHARING FOR ANTIRETROVIRAL THERAPY AND

HIV PREVENTION SERVICES.

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Subdivision 1.

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Definitions.

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(a) For purposes of this section, the following terms have

the meanings given.

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(b) "Antiretroviral therapy" has the meaning given in section 145.9235, subdivision 1.

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(c) "HIV prevention services" means ancillary or supportive services that are necessary

to:

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(1) ensure that a preexposure prophylaxis drug is prescribed or administered to an

individual who is HIV negative to prevent HIV transmission, provided the person has no

medical contraindications to the use of a preexposure prophylaxis drug; and

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(2) monitor an individual described in clause (1) to ensure the individual's safe and

effective ongoing use of a preexposure prophylaxis drug through office visits, laboratory

testing, testing for sexually transmitted infections, medication self-management and

adherence counseling, or any other health service specified as part of comprehensive HIV

prevention drug services by the United States Department of Health and Human Services,

the United States Centers for Disease Control and Prevention, or the United States Preventive

Services Task Force.

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(d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.

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Subd. 2.

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Prohibition on use of step therapy protocols and prior authorization.

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A

health plan that covers antiretroviral therapy must not limit or exclude coverage for

antiretroviral therapy by requiring prior authorization or requiring an enrollee to follow a

step therapy protocol. A health plan that covers HIV prevention services must not limit or

exclude coverage for these services by requiring prior authorization or requiring an enrollee

to follow a step therapy protocol.

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Subd. 3.

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Cost sharing prohibited.

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A health plan must not impose cost-sharing

requirements, including co-pays, deductibles, or coinsurance, for antiretroviral therapy or

HIV prevention services covered by the health plan.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, and applies to health

plans offered, sold, issued, or renewed on or after that date.

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Sec. 3.

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[145.9235] RAPID START HIV TREATMENT PROGRAMS.

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Subdivision 1.

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Definitions.

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(a) For purposes of this section, the following terms have

the meanings given, unless the context clearly indicates otherwise.

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(b) "1-3-7 framework" means the initiation of antiretroviral therapy ideally within one

day after a patient's diagnosis with HIV or reengagement in care, allowably within three

days after a patient's diagnosis or reengagement, and in all cases within seven business days

after a patient's diagnosis or reengagement.

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(c) "318 grantee" means an entity or program, typically a state or local health department,

public health organization, or academic institution, that receives federal funding from the

Centers for Disease Control and Prevention under section 318 of the Public Health Service

Act for sexually transmitted infection and sexually transmitted disease prevention programs.

A 318 grantee may also be a covered entity under the federal 340B Drug Pricing Program

and may purchase prescription drugs at reduced prices.

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(d) "AIDS Drug Assistance Program" or "ADAP" means the state program established

under Part B of the Ryan White HIV/AIDS Program to provide medications approved by

the Food and Drug Administration to treat income-eligible people living with HIV.

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(e) "Antiretroviral therapy" or "ART" means a therapy approved by the Food and Drug

Administration for the treatment or prevention of HIV, including a preexposure or

postexposure prophylaxis drug.

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(f) "Commissioner" means the commissioner of health.

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(g) "Presumptive eligibility for the ADAP" or "presumptive ADAP eligibility" means

eligibility determined according to subdivision 4.

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(h) "Rapid start" means a standard of medical care that prioritizes the immediate initiation

of ART for the treatment of HIV using the 1-3-7 framework.

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Subd. 2.

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State rapid start program established.

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(a) The commissioner must establish

a state rapid start program at the department to oversee the implementation and administration

of local rapid start programs under this section. The state rapid start program is responsible

for program development, contract management, training, evaluation, annual reporting on

program outcomes, and providing grants to local rapid start programs to cover a portion of

the cost of ART and access to ART, including during periods of presumptive ADAP

eligibility.

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(b) Personnel in the state rapid start program must develop and provide training and

ongoing clinical guidance on rapid start to primary care providers and infectious disease

specialists.

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(c) The commissioner may adopt rules to implement this section.

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Subd. 3.

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Local rapid start programs.

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(a) The commissioner, through the state rapid

start program, must establish and maintain local rapid start programs at designated HIV

testing and clinical care sites.

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(b) A local rapid start program maintained under this section must:

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(1) implement a standard of medical care that prioritizes the immediate initiation of

antiretroviral therapy according to the 1-3-7 framework for the treatment of HIV to reduce

HIV levels as quickly as possible. Under the 1-3-7 framework, initiation within one day

after HIV diagnosis or reengagement in care is highly preferred, within three days after

diagnosis or reengagement is considered good practice, and within seven business days

after diagnosis or reengagement is considered sufficient;

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(2) provide direct care or care coordination that ensures:

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(i) immediate access to extended clinical appointments;

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(ii) prescribing or dispensing of ART within the 1-3-7 framework; and

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(iii) access to comprehensive support services, including but not limited to health

education, transportation, housing assistance, nutrition, and psychosocial supports;

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(3) closely communicate and coordinate with HIV testing programs to facilitate timely

connection to care; and

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(4) operate in a nondiscriminatory manner and provide equitable access to services for

all individuals, regardless of race, ethnicity, gender identity, sexual orientation, mode of

exposure to HIV, immigration status, or ability to pay for treatment.

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Subd. 4.

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Presumptive eligibility for ADAP.

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The commissioner of human services must

develop and communicate to local rapid start programs a process to determine a patient's

presumptive eligibility for the ADAP. Under this process, an individual is presumptively

eligible for the ADAP if the individual orally attests to meeting the income and residency

requirements for the ADAP and provides evidence of HIV infection in the form of either

(1) a test result from a reactive HIV test approved by the Food and Drug Administration,

or (2) a clinical diagnosis. A local rapid start program must make a determination on an

individual's presumptive eligibility within one business day after the individual's application.

An individual's period of presumptive eligibility shall last for at least 30 days from the date

of determination and may be extended at the discretion of the local rapid start program.

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Subd. 5.

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Funding and reimbursement.

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Local rapid start programs shall be funded with

state funds, federal funds, and other available funding sources and must use funds in the

following order of priority:

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(1) medical assistance, MinnesotaCare, and private insurance coverage;

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(2) funding for 318 grantees to support services for uninsured and underinsured

individuals;

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(3) resources from the Ryan White HIV/AIDS Program and the ADAP to provide

supplemental coverage; and

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(4) grants distributed by the commissioner to cover a portion of the cost of ART and

ensure access to ART without patient cost sharing or delays due to prior authorization,

including during periods of presumptive ADAP eligibility.

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Subd. 6.

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Data collection and reporting.

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Local rapid start programs must collect and

maintain detailed data on program enrollment, ART initiation time frames, demographic

information of patients served by the program, and health outcomes for patients served by

the program. A local rapid start program must at least collect and maintain data on:

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(1) the number of patients referred to the program who have evidence of HIV infection

and who are newly diagnosed or reengaged in care;

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(2) the number of offers made by program staff to newly diagnosed or reengaged HIV

positive patients to enroll in the program;

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(3) the number of newly diagnosed or reengaged HIV-positive patients enrolled in the

program and the number who decline to enroll;

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(4) for patients who decline to enroll in the program, their reasons for not enrolling;

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(5) for patients enrolled in the program:

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(i) the length of time from first evidence of a new HIV-positive diagnosis or reengagement

in care to the initiation of ART; and

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(ii) the length of time from the initiation of ART to the achievement of an undetectable

viral load;

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(6) the demographics of patients enrolled in the program, including race, ethnicity, age,

sex, gender identity, sexual orientation, modes of exposure to HIV, disability status, primary

or preferred language, housing status, and insurance status; and

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(7) the proportion of patients enrolled in the program who belong to demographic

categories identified by local epidemiological data to have challenges engaging with and

being retained in HIV care and who achieve undetectable viral loads within three months

after diagnosis or reengagement.

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Subd. 7.

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Reports to public and legislature.

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(a) By October 1, 2027, and each October

1 thereafter, the commissioner must submit to the legislature and make available to the

public a comprehensive report on the activities of local rapid start programs. Each report

must at least include information on:

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(1) the number of local rapid start programs that were in operation in the most recent

reporting period;

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(2) the number of patients enrolled in local rapid start programs to date and the proportion

of these patients who initiated antiretroviral therapy one day, three days, or seven days

following an HIV diagnosis or reengagement in care;

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(3) challenges identified with program implementation and operations and proposed

responses to challenges; and

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(4) rates of rapid start by patients seen by providers who diagnose HIV.

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(b) Section 144.05, subdivision 7, does not apply to reports under this subdivision.

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Sec. 4.
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APPROPRIATION; RAPID START PROGRAMS.
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$....... in fiscal year 2027 is appropriated from the general fund to the commissioner of

health for purposes of Minnesota Statutes, section 145.9235.

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