Health plans required to cover infertility treatment and standard fertility preservation services, medical assistance and MinnesotaCare required to cover infertility treatment and standard fertility preservation services, and money appropriated.

A bill for an act

relating to health; requiring health plans to cover infertility treatment and standard

fertility preservation services; requiring medical assistance and MinnesotaCare to

cover infertility treatment and standard fertility preservation services; appropriating

money; amending Minnesota Statutes 2024, sections 62Q.679; 256B.0625, by

adding a subdivision; Minnesota Statutes 2025 Supplement, section 256B.0625,

subdivision 13; proposing coding for new law in Minnesota Statutes, chapter 62Q.

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

Section 1.

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[62Q.60] COVERAGE OF INFERTILITY TREATMENT.

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Subdivision 1.

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Scope.

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This section applies to all health plans that provide maternity

benefits to Minnesota residents.

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Subd. 2.

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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) "Diagnosis of and treatment for infertility" means procedures and medications:

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(1) used to diagnose or treat infertility; and

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(2) consistent with established, published, or approved medical practices or professional

guidelines from the American College of Obstetricians and Gynecologists or the American

Society for Reproductive Medicine.

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(c) "Infertility" means a disease, condition, or status characterized by:

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(1) the failure of a person with a uterus to establish a pregnancy or to carry a pregnancy

to live birth after the following duration of unprotected sexual intercourse, regardless of

whether a pregnancy resulted in miscarriage during that time:

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(i) for a person under the age of 35, 12 months' duration; or

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(ii) for a person 35 years of age or older, six months' duration;

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(2) a person's inability to reproduce without medical intervention either as a single

individual or with the person's partner; or

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(3) a licensed health care provider's determination that a patient is infertile based on the

patient's medical, sexual, and reproductive history; age; physical findings; or diagnostic

testing.

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(d) "Standard fertility preservation services" means procedures that are consistent with

the established medical practices or professional guidelines published by the American

Society for Reproductive Medicine or the American Society of Clinical Oncology for a

person who has a medical condition or is expected to undergo medication therapy, surgery,

radiation, chemotherapy, or other medical treatment that is recognized by medical

professionals to cause a risk of impairment to fertility.

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Subd. 3.

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Required coverage.

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(a) Health plans must provide comprehensive coverage

for:

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(1) the diagnosis of and treatment for infertility; and

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(2) standard fertility preservation services.

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(b) Coverage under this section must include unlimited embryo transfers, but may impose

a limit of four completed oocyte retrievals. Single embryo transfer must be used when

medically appropriate and recommended by the treating health care provider.

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(c) Coverage for surgical reversal of elective sterilization is not required under this

section.

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Subd. 4.

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Cost-sharing requirements.

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A health plan must not impose any cost-sharing

requirement on the coverage under this section that is greater than the cost-sharing

requirement imposed on maternity coverage under the plan, including but not limited to the

following requirements:

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(1) co-payment;

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(2) deductible; or

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(3) coinsurance.

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Subd. 5.

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Exclusions and limitations.

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(a) A health plan must not impose any benefit

maximum, waiting period, utilization review, referral requirement, or any other limitation

on the coverage under this section, except as provided in subdivision 3, paragraphs (b) and

(c), that is not generally applicable to maternity coverage under the health plan.

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(b) The prohibition under this subdivision includes but is not limited to any exclusion,

limitation, or other restriction on:

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(1) fertility medications that are different from those imposed on other prescription

medications; and

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(2) any fertility services based on an enrollee's participation in fertility services provided

by or to a third party.

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Subd. 6.

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Reimbursement.

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(a) The commissioner of commerce must reimburse health

plan companies for coverage under this section. Reimbursement is available only for coverage

that would not have been provided by the health plan without the requirements of this

section. Treatments and services covered by the health plan as of January 1, 2026, are

ineligible for payment under this subdivision by the commissioner of commerce.

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(b) Health plan companies must report to the commissioner of commerce quantified

costs attributable to the additional benefit under this section in a format developed by the

commissioner. A health plan's coverage as of January 1, 2026, must be used by the health

plan company as the basis for determining whether coverage would not have been provided

by the health plan for purposes of this subdivision.

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(c) The commissioner of commerce must evaluate submissions and make payments to

health plan companies as provided in Code of Federal Regulations, title 45, section 155.170.

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Subd. 7.

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Appropriation.

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Beginning in fiscal year 2028, an amount necessary to make

payments to health plan companies to defray the cost of providing coverage under this

section is annually appropriated from the general fund to the commissioner of commerce.

The amount appropriated under this subdivision must include the administrative costs

incurred by the commissioner to make the defrayal payments.

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EFFECTIVE DATE.

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

plans issued or renewed on or after that date.

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Sec. 2.

Minnesota Statutes 2024, section 62Q.679, is amended to read:

62Q.679 RELIGIOUS OBJECTIONS.

Subdivision 1.

Definitions.

(a) The definitions in this subdivision apply to this section.

(b) "Closely held for-profit entity" means an entity that is not a nonprofit entity, has

more than 50 percent of the value of its ownership interest owned directly or indirectly by

five or fewer owners, and has no publicly traded ownership interest. For purposes of this

paragraph:

(1) ownership interests owned by a corporation, partnership, limited liability company,

estate, trust, or similar entity are considered owned by that entity's shareholders, partners,

members, or beneficiaries in proportion to their interest held in the corporation, partnership,

limited liability company, estate, trust, or similar entity;

(2) ownership interests owned by a nonprofit entity are considered owned by a single

owner;

(3) ownership interests owned by all individuals in a family are considered held by a

single owner. For purposes of this clause, "family" means brothers and sisters, including

half-brothers and half-sisters, a spouse, ancestors, and lineal descendants; and

(4) if an individual or entity holds an option, warrant, or similar right to purchase an

ownership interest, the individual or entity is considered to be the owner of those ownership

interests.

(c) "Eligible organization" means an organization that opposes covering some or all

health benefits under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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on account of

religious objections and that is:

(1) organized as a nonprofit entity and holds itself out to be religious; or

(2) organized and operates as a closely held for-profit entity, and the organization's

owners or highest governing body has adopted, under the organization's applicable rules of

governance and consistent with state law, a resolution or similar action establishing that the

organization objects to covering some or all health benefits under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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on account of the owners' sincerely held religious beliefs.

(d) "Exempt organization" means an organization that is organized and operates as a

nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal

Revenue Code of 1986, as amended.

Subd. 2.

Exemption.

(a) An exempt organization is not required to provide coverage

under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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if the exempt organization has

religious objections to the coverage. An exempt organization that chooses to not provide

coverage pursuant to this paragraph must notify employees as part of the hiring process and

must notify all employees at least 30 days before:

(1) an employee enrolls in the health plan; or

(2) the effective date of the health plan, whichever occurs first.

(b) If the exempt organization provides partial coverage under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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, the notice required under paragraph (a) must provide a list of the

portions of such coverage which the organization refuses to cover.

Subd. 3.

Accommodation for eligible organizations.

(a) A health plan established or

maintained by an eligible organization complies with the coverage requirements of section

62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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, with respect to the health benefits identified in

the notice under this paragraph, if the eligible organization provides notice to any health

plan company with which the eligible organization contracts that it is an eligible organization

and that the eligible organization has a religious objection to coverage for all or a subset of

the health benefits under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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.

(b) The notice from an eligible organization to a health plan company under paragraph

(a) must include: (1) the name of the eligible organization; (2) a statement that it objects to

coverage for some or all of the health benefits under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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,

or 62Q.60
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, including a list of the health benefits to which the eligible organization objects,

if applicable; and (3) the health plan name. The notice must be executed by a person

authorized to provide notice on behalf of the eligible organization.

(c) An eligible organization must provide a copy of the notice under paragraph (a) to

prospective employees as part of the hiring process and to all employees at least 30 days

before:

(1) an employee enrolls in the health plan; or

(2) the effective date of the health plan, whichever occurs first.

(d) A health plan company that receives a copy of the notice under paragraph (a) with

respect to a health plan established or maintained by an eligible organization must, for all

future enrollments in the health plan:

(1) expressly exclude coverage for those health benefits identified in the notice under

paragraph (a) from the health plan; and

(2) provide separate payments for any health benefits required to be covered under

section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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for enrollees as long as the enrollee

remains enrolled in the health plan.

(e) The health plan company must not impose any cost-sharing requirements, including

co-pays, deductibles, or coinsurance, or directly or indirectly impose any premium, fee, or

other charge for the health benefits under section
62Q.522
on the enrollee. The health plan

company must not directly or indirectly impose any premium, fee, or other charge for the

health benefits under section
62Q.522
,
62Q.524
,
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or
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62Q.585
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, or 62Q.60
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on the eligible

organization or health plan.

(f) On January 1, 2025, and every year thereafter a health plan company must notify the

commissioner, in a manner determined by the commissioner, of the number of eligible

organizations granted an accommodation under this subdivision.

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EFFECTIVE DATE.

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This section is effective January 1, 2027.

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Sec. 3.

Minnesota Statutes 2025 Supplement, section 256B.0625, subdivision 13, is

amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs
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, except for fertility drugs when

specifically used to enhance fertility, if
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prescribed by a licensed practitioner and dispensed

by a licensed pharmacist, by a physician enrolled in the medical assistance program as a

dispensing physician, or by a physician, a physician assistant, or an advanced practice

registered nurse employed by or under contract with a community health board as defined

in section
145A.02, subdivision 5
, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply unless

authorized by the commissioner or as provided in paragraph (h) or the drug appears on the

90-day supply list published by the commissioner. The 90-day supply list shall be published

by the commissioner on the department's website. The commissioner may add to, delete

from, and otherwise modify the 90-day supply list after providing public notice and the

opportunity for a 15-day public comment period. The 90-day supply list may include

cost-effective generic drugs and shall not include controlled substances.

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical

ingredient" is defined as a substance that is represented for use in a drug and when used in

the manufacturing, processing, or packaging of a drug becomes an active ingredient of the

drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle

for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and

excipients which are included in the medical assistance formulary. Medical assistance covers

selected active pharmaceutical ingredients and excipients used in compounded prescriptions

when the compounded combination is specifically approved by the commissioner or when

a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths

as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded

prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by

a licensed practitioner or by a licensed pharmacist who meets standards established by the

commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family

planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults

with documented vitamin deficiencies, vitamins for children under the age of seven and

pregnant or nursing women, and any other over-the-counter drug identified by the

commissioner, in consultation with the Formulary Committee, as necessary, appropriate,

and cost-effective for the treatment of certain specified chronic diseases, conditions, or

disorders, and this determination shall not be subject to the requirements of chapter 14. A

pharmacist may prescribe over-the-counter medications as provided under this paragraph

for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter

drugs under this paragraph, licensed pharmacists must consult with the recipient to determine

necessity, provide drug counseling, review drug therapy for potential adverse interactions,

and make referrals as needed to other health care professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable

under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and

Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible

for drug coverage as defined in the Medicare Prescription Drug, Improvement, and

Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these

individuals, medical assistance may cover drugs from the drug classes listed in United States

Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to

13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall

not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing

Program and dispensed by 340B covered entities and ambulatory pharmacies under common

ownership of the 340B covered entity. Medical assistance does not cover drugs acquired

through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal

contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section

151.37, subdivision 14
; nicotine replacement medications prescribed and dispensed by a

licensed pharmacist in accordance with section
151.37, subdivision 15
; and opiate antagonists

used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed

pharmacist in accordance with section
151.37, subdivision 16
.

(h) Medical assistance coverage for a prescription contraceptive must provide a 12-month

supply for any prescription contraceptive if a 12-month supply is prescribed by the

prescribing health care provider. The prescribing health care provider must determine the

appropriate duration for which to prescribe the prescription contraceptives, up to 12 months.

For purposes of this paragraph, "prescription contraceptive" means any drug or device that

requires a prescription and is approved by the Food and Drug Administration to prevent

pregnancy. Prescription contraceptive does not include an emergency contraceptive drug

approved to prevent pregnancy when administered after sexual contact. For purposes of this

paragraph, "health plan" has the meaning provided in section
62Q.01, subdivision 3
.

(i) Notwithstanding a removal of a drug from the drug formulary under subdivision 13d,

except as provided in paragraphs (j) and (k), medical assistance covers a drug, with respect

to an enrollee who was previously prescribed the drug during the calendar year when the

drug was on the formulary, at the same level until January 1 of the calendar year following

the year in which the commissioner removed the drug from the formulary.

(j) Paragraph (i) does not apply if the commissioner changes the drug formulary:

(1) for a drug that has been deemed unsafe by the United States Food and Drug

Administration (FDA);

(2) for a drug that has been withdrawn by the FDA or the drug manufacturer; or

(3) when an independent source of research, clinical guidelines, or evidence-based

standards has issued drug-specific warnings or recommended changes with respect to a

drug's use for reasons related to previously unknown and imminent patient harm.

(k) Paragraph (i) does not apply when the commissioner removes a brand name drug

from the formulary if the commissioner adds to the formulary a generic or multisource brand

name drug rated as therapeutically equivalent according to the FDA Orange Book, or a

biologic drug rated as interchangeable according to the FDA Purple Book, at the same or

lower cost to the enrollee.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, or upon federal approval,

whichever is later. The commissioner of human services shall notify the revisor of statutes

when federal approval is obtained.

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Sec. 4.

Minnesota Statutes 2024, section 256B.0625, is amended by adding a subdivision

to read:

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Subd. 77.

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Infertility treatment.

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(a) Medical assistance covers:

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(1) diagnosis of and treatment for infertility; and

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(2) standard fertility preservation services.

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(b) Medical assistance must meet the same requirements that would otherwise apply to

a health plan that provides maternity benefits to Minnesota residents under section 62Q.60,

except that medical assistance is not required to comply with any provision of section 62Q.60

if compliance with the provision would:

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(1) prevent the state from receiving federal financial participation for the coverage under

this subdivision; or

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(2) result in a lower level of coverage or reduced access to coverage for medical assistance

enrollees.

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EFFECTIVE DATE.

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This section is effective January 1, 2027, or upon federal approval,

whichever is later. The commissioner of human services shall notify the revisor of statutes

when federal approval is obtained.

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Sec. 5.
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APPROPRIATIONS; INFERTILITY TREATMENT COVERAGE.
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Subdivision 1.

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Medical assistance.

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$....... in fiscal year 2027 is appropriated from the

general fund to the commissioner of human services for medical assistance coverage of

infertility treatment and fertility preservation services under Minnesota Statutes, section

256B.0625, subdivision 77. The base for this appropriation is $....... in fiscal year 2028 and

$....... in fiscal year 2029.

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Subd. 2.

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MinnesotaCare.

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$....... in fiscal year 2027 is appropriated from the health care

access fund to the commissioner of human services for MinnesotaCare coverage of infertility

treatment and fertility preservation services under Minnesota Statutes, sections 256L.03,

subdivision 1, and 256B.0625, subdivision 77. The base for this appropriation is $....... in

fiscal year 2028 and $....... in fiscal year 2029.

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