Coverage without cost-sharing requirement of immunization for routine use without a prescription, Minnesota Science-Based Vaccine Advisory Council establishment, and appropriation

A bill for an act

relating to health insurance; mandating coverage without cost-sharing of

immunizations for routine use without a prescription; establishing the Minnesota

Science-Based Vaccine Advisory Council; establishing advisory council duties;

requiring reports; appropriating money; amending Minnesota Statutes 2024, section

62Q.46, subdivision 1; proposing coding for new law in Minnesota Statutes, chapter

145.

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

Section 1.

Minnesota Statutes 2024, section 62Q.46, subdivision 1, is amended to read:

Subdivision 1.

Coverage for preventive items and services.

(a) "Preventive items and

services" has the meaning specified in the Affordable Care Act. Preventive items and services

includes:

(1) evidence-based items or services that have in effect a rating of A or B in the current

recommendations of the United States Preventive Services Task Force with respect to the

individual involved;

(2) immunizations for routine use in children, adolescents, and adults that have in effect
new text begin

with respect to the individual involved
new text end
a recommendation from
new text begin
:
new text end

new text begin

(i)
new text end
the Advisory Committee on Immunization Practices of the Centers for Disease Control

and Prevention with respect to the individual involved. For purposes of this
deleted text begin
clause
deleted text end
new text begin
item
new text end
, a

recommendation from the Advisory Committee on Immunization Practices of the Centers

for Disease Control and Prevention is considered in effect after the recommendation has

been adopted by the Director of the Centers for Disease Control and Prevention, and a

recommendation is considered to be for routine use if the recommendation is listed on the

Immunization Schedules of the Centers for Disease Control and Prevention;

new text begin

(ii) the American Academy of Pediatrics. For purposes of this item, a recommendation

from the American Academy of Pediatrics is considered in effect and for routine use if the

recommendation is listed on the American Academy of Pediatrics' Recommended Child

and Adolescent Immunization Schedule; or

new text end

new text begin

(iii) the Minnesota Science-Based Vaccine Advisory Council established under section

145.675;

new text end

(3) with respect to infants, children, and adolescents, evidence-informed preventive care

and screenings provided for in comprehensive guidelines supported by the Health Resources

and Services Administration;

(4) with respect to women, additional preventive care and screenings that are not listed

with a rating of A or B by the United States Preventive Services Task Force but that are

provided for in comprehensive guidelines supported by the Health Resources and Services

Administration;

(5) all contraceptive methods established in guidelines published by the United States

Food and Drug Administration;

(6) screenings for human immunodeficiency virus for:

(i) all individuals at least 15 years of age but less than 65 years of age; and

(ii) all other individuals with increased risk of human immunodeficiency virus infection

according to guidance from the Centers for Disease Control;

(7) all preexposure prophylaxis when used for the prevention or treatment of human

immunodeficiency virus, including but not limited to all preexposure prophylaxis, as defined

in any guidance by the United States Preventive Services Task Force or the Centers for

Disease Control, including the June 11, 2019, Preexposure Prophylaxis for the Prevention

of HIV Infection United States Preventive Services Task Force Recommendation Statement;

and

(8) all postexposure prophylaxis when used for the prevention or treatment of human

immunodeficiency virus, including but not limited to all postexposure prophylaxis as defined

in any guidance by the United States Preventive Services Task Force or the Centers for

Disease Control.

(b) A health plan company must provide coverage for preventive items and services at

a participating provider without imposing cost-sharing requirements, including a deductible,

coinsurance, or co-payment. Nothing in this section prohibits a health plan company that

has a network of providers from excluding coverage or imposing cost-sharing requirements

for preventive items or services that are delivered by an out-of-network provider.

(c) A health plan company is not required to provide coverage for any items or services

specified in any recommendation or guideline described in paragraph (a) if the

recommendation or guideline is no longer included as a preventive item or service as defined

in paragraph (a). Annually, a health plan company must determine whether any additional

items or services must be covered without cost-sharing requirements or whether any items

or services are no longer required to be covered.

(d) Nothing in this section prevents a health plan company from using reasonable medical

management techniques to determine the frequency, method, treatment, or setting for a

preventive item or service to the extent not specified in the recommendation or guideline.

(e) A health plan shall not require prior authorization or step therapy for preexposure

prophylaxis or postexposure prophylaxis, except that: if the United States Food and Drug

Administration has approved one or more therapeutic equivalents of a drug, device, or

product for the prevention of HIV, this paragraph does not require a health plan to cover

all of the therapeutically equivalent versions without prior authorization or step therapy, if

at least one therapeutically equivalent version is covered without prior authorization or step

therapy.

(f) This section does not apply to grandfathered plans.

(g) This section does not apply to plans offered by the Minnesota Comprehensive Health

Association.

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective July 1, 2026, for health plans offered,

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

new text end

Sec. 2.

new text begin

[145.675] MINNESOTA SCIENCE-BASED VACCINE ADVISORY

COUNCIL.

new text end

new text begin

Subdivision 1.

new text end

new text begin

Establishment.

new text end

new text begin

The commissioner of health must establish the Minnesota

Science-Based Vaccine Advisory Council.

new text end

new text begin

Subd. 2.

new text end

new text begin

Membership.

new text end

new text begin

(a) The advisory council must consist of at least 14 members

who are trusted scientists, clinicians, and public health leaders with knowledge of and

backgrounds in vaccines and immunization, including:

new text end

new text begin

(1) the commissioner of health or a designee;

new text end

new text begin

(2) one physician licensed and practicing in the state, appointed by the Minnesota Medical

Association;

new text end

new text begin

(3) one physician licensed and practicing in the state in the area of internal medicine,

appointed by the American College of Physicians, Minnesota Chapter;

new text end

new text begin

(4) one physician licensed and practicing in the state in the area of pediatrics, appointed

by the American Academy of Pediatrics, Minnesota Chapter;

new text end

new text begin

(5) one physician licensed and practicing in the state in the area of family medicine,

appointed by the Minnesota Academy of Family Physicians;

new text end

new text begin

(6) one physician licensed and practicing in the state in the area of obstetrics and

gynecology, appointed by the American College of Obstetricians and Gynecologists,

Minnesota Section;

new text end

new text begin

(7) one registered nurse or advanced practice registered nurse licensed and practicing

in the state, appointed by the Minnesota Nurses Association;

new text end

new text begin

(8) one pediatric nurse practitioner licensed and practicing in the state, appointed by the

National Association of Pediatric Nurse Practitioners, Minnesota Chapter;

new text end

new text begin

(9) one licensed school nurse practicing in the state in a public elementary or secondary

school, appointed by the School Nurse Organization of Minnesota;

new text end

new text begin

(10) one pharmacist licensed and practicing in the state with experience providing

immunization services to patients, appointed by the Minnesota Pharmacists Association;

new text end

new text begin

(11) one member of a Tribal Nation health department appointed by the Minnesota

Indian Affairs Council;

new text end

new text begin

(12) one representative specializing in infectious disease research, appointed by the

Infectious Disease Society of America;

new text end

new text begin

(13) one representative appointed by the Minnesota Council of Health Plans; and

new text end

new text begin

(14) one representative appointed by the director of the Center for Infectious Disease

Research and Policy at the University of Minnesota who is employed by or who is conducting

research for the center.

new text end

new text begin

(b) Each appointing authority must make appointments by September 1, 2026.

new text end

new text begin

(c) An appointing authority may designate an alternate member to attend and participate

in advisory council meetings in the appointed member's place, including replacing an

appointed member at the appointing authority's discretion. An appointing authority may

replace any member who steps down from the advisory committee or who, in the judgment

of the appointing authority, fails to attend a sufficient number of advisory council meetings.

new text end

new text begin

(d) The commissioner of health must develop an application process and required

documents that each appointing authority must collect and review prior to appointing an

applicant to the advisory council, including at minimum:

new text end

new text begin

(1) two letters of support for an applicant submitted by an individual with an established

professional relationship with the applicant and who is a trusted scientist, clinician, and

public health leader;

new text end

new text begin

(2) disclosure by the applicant and their immediate family members of any financial

interests that may be considered a conflict of interest if the applicant participates in the

advisory council as a member; and

new text end

new text begin

(3) evidence of completing a background study.

new text end

new text begin

Subd. 3.

new text end

new text begin

Terms.

new text end

new text begin

Members appointed under subdivision 2, clauses (2) to (14), serve a

four-year term.

new text end

new text begin

Subd. 4.

new text end

new text begin

Organization and meetings.

new text end

new text begin

(a) The advisory council must select a chair from

the advisory council's membership. The chair serves as chair for a two-year term. The

advisory council must meet at least four times per year, and more frequently at the call of

the chair or at the request of a majority of advisory council members. The advisory council

must provide opportunities for public input at meetings, including oral public testimony.

new text end

new text begin

(b) Members of the advisory council receive no compensation for their service but shall

be reimbursed as provided in section 15.059 for expenses incurred as a result of their duties

as members of the advisory council.

new text end

new text begin

(c) Advisory council meetings are subject to the Open Meeting Law under chapter 13D.

new text end

new text begin

Subd. 5.

new text end

new text begin

Duties and powers.

new text end

new text begin

(a) The advisory council must:

new text end

new text begin

(1) develop and publish recommended schedules of vaccines in the state for adults,

infants, children, and adolescents on an annual basis;

new text end

new text begin

(2) recommend to the commissioner modifications, if any, to the specific immunizations

required for enrollment in elementary or secondary schools or child care facilities under

section 121A.15 and Minnesota Rules, chapter 4604; and

new text end

new text begin

(3) recommend to the commissioner modifications, if any, to the specific immunizations

required for enrollment in postsecondary institutions under section 135A.14 and Minnesota

Rules, chapter 4604.

new text end

new text begin

(b) In developing science-based vaccine and immunization recommendations, the advisory

council must consider current peer-reviewed scientific studies and sound public health

policy.

new text end

new text begin

(c) If the advisory council chair determines that the commissioner does not adequately

consider the advisory council's recommendations when considering updates to the required

immunization schedules, the chair may call for an override vote. If two-thirds of the advisory

council vote to override the existing state vaccine schedules, the advisory council may

republish the advisory council's own recommendations to serve as the state vaccine schedules.

The advisory council's recommendations must serve as the state vaccine schedules for no

less than six months.

new text end

new text begin

Subd. 6.

new text end

new text begin

Administration.

new text end

new text begin

The commissioner must provide meeting space and

administrative services for the advisory council.

new text end

new text begin

Subd. 7.

new text end

new text begin

Reports.

new text end

new text begin

The council must submit a report by July 1, in each even-numbered

year, to the chairs and ranking minority members of the legislative committees with primary

jurisdiction over health policy. The report must describe the committee's work to fulfill the

duties prescribed in subdivision 5.

new text end

new text begin

Subd. 8.

new text end

new text begin

Expiration.

new text end

new text begin

This section expires July 1, 2036.

new text end

Sec. 3.
new text begin
MINNESOTA SCIENCE-BASED VACCINE ADVISORY COUNCIL; FIRST

APPOINTMENTS AND FIRST MEETING.
new text end

new text begin

Subdivision 1.

new text end

new text begin

First appointments.

new text end

new text begin

The first members appointed to the Minnesota

Science-Based Vaccine Advisory Council under Minnesota Statutes, section 145.675,

subdivision 2, clauses (2) to (8), serve a term of two years.

new text end

new text begin

Subd. 2.

new text end

new text begin

First meeting.

new text end

new text begin

The commissioner of health must convene the first meeting of

the Minnesota Science-Based Vaccine Advisory Council by January 1, 2027. At the first

meeting, the advisory council must select a chair from among its members.

new text end

Sec. 4.
new text begin
APPROPRIATION; MINNESOTA SCIENCE-BASED VACCINE ADVISORY

COUNCIL.
new text end

new text begin

(a) $....... in fiscal year 2027 is appropriated from the general fund to the commissioner

of health for the Minnesota Science-Based Vaccine Advisory Council under Minnesota

Statutes, section 145.675.

new text end

new text begin

(b) The general fund base for this appropriation is $....... in fiscal year 2028 and $.......

in fiscal year 2029.

new text end

new text begin

EFFECTIVE DATE.

new text end

new text begin

This section is effective July 1, 2026.

new text end