Prior authorization prohibition for services resulting in health plan company liability equal to or less than $100
SF731 amends Minnesota’s prior-authorization law to expand the list of health care services that insurers, utilization review organizations, and claims administrators may not subject to prior authorization. In addition to existing prohibitions for emergency services, outpatient mental health and substance use disorder treatment, certain cancer treatment, preventive services, pediatric hospice services, and neonatal abstinence program treatment, the bill adds a new category: any service, item, or treatment for which the health plan’s liability would be $100 or less if approved.
The bill is aimed at reducing administrative barriers for low-cost care by preventing insurers from requiring prior authorization when the financial exposure to the plan is minimal. The new prohibition would apply to health benefit plans offered, sold, issued, or renewed on or after January 1, 2026. The bill amends Minnesota Statutes section 62M.07, subdivision 2, which governs services exempt from prior authorization requirements.
If enacted, SF731 would narrow the circumstances in which prior authorization may be used under Minnesota insurance law, directly affecting health plan companies, claims administrators, and utilization review organizations. It would create a statutory prohibition on prior authorization for low-cost services with plan liability of $100 or less, while leaving existing exemptions in place for emergency care, certain behavioral health services, cancer treatment, preventive care, pediatric hospice, and neonatal abstinence treatment. The change would apply prospectively to health benefit plans renewed or issued on or after January 1, 2026.
Based on the bill text and available context, the measure appears generally consumer- and patient-friendly, with a focus on reducing delays and administrative burden in accessing care. The authorship by a bipartisan group suggests some cross-party interest in limiting prior authorization for low-cost services. No committee transcripts or recorded votes were provided, so there is no documented opposition or support beyond the bill’s structure and sponsorship.
The main policy issue is whether insurers should be barred from using prior authorization for services that would cost the plan $100 or less, even if they might otherwise want to review medical necessity or utilization. Supporters are likely to view the change as a way to streamline access and reduce paperwork for routine or inexpensive care. Potential opponents, typically insurers or utilization management advocates, may argue that a dollar-threshold rule is too blunt, could limit cost-control tools, and may not account for clinical variation or cumulative spending across many low-cost claims.