Health Care Provider Updates – 2024 Minnesota Legislative Session

In addition to the medical debt reforms we previously discussed, the Minnesota Legislature enacted a number of changes during the 2024 legislative session that impact health care providers. Many of these changes were included in the omnibus tax bill (HF 5247/SF 5234) that passed in the final hours of session. The overview below highlights some of these health care-related legislative changes, including the following:  

• Changes to the Minnesota Health Records Act

• New Licensure Compacts

• Changes to Health Care Professional Licensure and Regulation

• Scope of Practice Expansions for Pharmacists and Physician Assistants

• New Coverage Mandates

• Prior Authorization Reforms

• Creation of the Office of Emergency Medical Services

• 340B Covered Entity Registration and Reporting

• Substance Use Disorder Treatment Services Location Updates

Changes to the Minnesota Health Records Act

In response to the Minnesota Supreme Court’s 2023 decision in Schneider v. Children’s Health Care, the Legislature amended the Minnesota Health Records Act (“MHRA”) to restrict the circumstances under which a health care provider can release a patient’s health records without the patient’s written consent. In Schneider, the Court held that MHRA language requiring a “specific authorization in law” to release health records encompasses applicable federal law, including permitted disclosures under the federal Health Insurance Portability and Accountability Act (“HIPAA”). This case resolved ambiguity around the scope of permitted disclosures under the MHRA, enabling providers to rely on HIPAA’s broader disclosure provisions when releasing patient health records without a patient’s consent.

As part of the omnibus tax bill, the Legislature amended the MHRA language above to require a “specific authorization in Minnesota law” to release patient health records without consent. This change effectively eliminates the flexibility created by Schneider and requires providers to obtain a patient’s written consent for disclosure even in those situations where disclosure would otherwise be permitted under HIPAA. The legislation also added language to the MHRA expressly requiring it to be construed in a more stringent manner than HIPAA. Health care providers that altered their policies and practices to align with the holding in Schneider will need to revisit their policies and practices to bring them into compliance with the revised MHRA language.

New Licensure Compacts

The omnibus tax bill established Minnesota’s membership in several professional licensure compacts, including those for physician assistants, occupational therapists, physical therapists, licensed professional counselors, audiologists, speech-language pathologists, licensed social workers, dentists, and dental hygienists.

Licensure compacts allow licensed health care professionals who reside and hold licensure in a member state to practice their profession in another member state after following an expedited licensure process. These compacts streamline licensing and allow professionals to more easily practice across state lines via traditional in-person methods or via telehealth.

Minnesota already participates in other licensure contacts, including the Interstate Medical Licensure Compact, which the state joined in 2015. Minnesota, however, has not joined the Nurse Licensure Compact (“NLC”), despite previous legislative attempts to establish membership in the NLC along with 42 other NLC member states.

Changes to Health Care Professional Licensure and Regulation  

The Legislature enacted various changes to health care professional licensure and regulation requirements, including the following:

• Establishment of licensing requirements for behavior analysts;

• Establishment of registration requirements for transfer care specialists (who are authorized to remove and transport dead bodies from the place of death to a licensed funeral establishment);

• Modification of social worker licensure requirements; and

• Establishment of guest licensure for marriage and family therapists.

Scope of Practice Expansions for Pharmacists and Physician Assistants

The omnibus tax bill removed the heightened collaboration requirements for physician assistants (“PAs”) that previously allowed PAs to provide ongoing psychiatric treatment to children with emotional disturbance and adults with serious mental illness only in collaboration with a physician and as further defined in a practice agreement that provided for physician consultation and referral to psychiatry. PAs will now be able to provide this type of ongoing psychiatric treatment as part of their scope of practice under the general practice agreement requirements.  

The bill also expanded pharmacist scope of practice as follows:

• Effective July 1, 2024, pharmacists may order lab tests as part of participating in clinical interpretations and monitoring drug therapy, including collecting specimens, interpreting results, notifying patients of results, and referring patients to other health care providers for follow-up care and initiating, modifying, or discontinuing drug therapy pursuant to a protocol or collaborative practice agreement. Pharmacists may also delegate performance of these tests to pharmacy technicians and pharmacy interns.

• Effective July 1, 2024, pharmacists may initiate, order, and administer (i) influenza and COVID vaccines to all individuals ages three and older, and (ii) all other FDA-approved vaccines to patients six and older. Pharmacists may also delegate vaccine administration to pharmacy technicians or pharmacy interns who meet certain requirements.

• Effective January 1, 2026, pharmacists who meet certain training and education requirements may prescribe, dispense, and administer drugs to prevent the acquisition of HIV, and may order, conduct, and interpret laboratory tests necessary for therapies that use such drugs, subject to protocols developed by the Board of Pharmacy.

New Coverage Mandates

The omnibus tax bill created several new coverage mandates that go into effect January 1, 2025. These mandates require health plans and medical assistance in Minnesota to provide coverage for the following services and supplies:

• Abortion and abortion-related services;

• Gender-affirming care;

• Orthotic and prosthetic devices and related supplies and services;  

• Rapid whole genome sequencing;

• Post-birth transfers of mothers and newborns between medical facilities;

• Hair prostheses related to cancer treatment;

• Amino acid-based formula; and

• Intermittent urinary catheters.

There are exemptions from the abortion and gender-affirming care coverage mandates for organizations with religious objections if they meet certain requirements and notify employees of non-coverage at least 30 days before enrollment.

Prior Authorization Reforms

The omnibus tax bill made various changes to prior authorization requirements that go into effect January 1, 2026. Specifically, health plans will be prohibited from (i) retrospectively denying or limiting coverage of a health care service for which prior authorization was not required, unless the service was provided based on fraud or misinformation, and (ii) denying or limiting coverage of a health care service an enrollee has already received solely on the basis of lack of prior authorization if the service would otherwise have been covered had prior authorization been obtained.

Additionally, the bill expanded the list of services for which prior authorization is prohibited to include the following:

• Non-medication outpatient mental health and substance use disorder treatment;

• Non-medication antineoplastic cancer treatment;

• Preventative health services and immunizations;

• Pediatric hospice services; and

• Neonatal abstinence treatment.

The legislation also establishes that authorizations for treatment of a chronic health condition cannot expire unless the standard of care for the condition changes.

Lastly, effective January 1, 2027, health plans must automate prior authorizations for all claims, except those for prescriptions and other medications. The system must allow providers to check if prior authorization is necessary and, if so, help the provider through submission of the prior authorization request.

Creation of Office of Emergency Medical Services

In response to concerns about the viability of Minnesota’s emergency ambulance services, the Legislature passed HF 4738/SF 4835, which replaces the Emergency Medical Services Regulatory Board with the Office of Emergency Medical Services. Effective January 1, 2025, the Office of Emergency Medical Services will have full responsibility for emergency medical services in Minnesota. While the Emergency Medical Services Regulatory Board was independent, the Office of Emergency Medical Services will be directed by a political appointee who will have control over licensure and regulation of ambulance services in Minnesota. The bill also establishes multiple advisory councils to review regulations and make recommendations to the Office of Emergency Medical Services.

340B Covered Entity Registration and Reporting

The omnibus tax bill expanded certain obligations that apply to 340B covered entities, which were enacted in 2023. Current law requires 340B covered entities to report to the Commissioner of Health certain information regarding transactions completed by the covered entity or on its behalf related to its 340B program participation. Effective April 1, 2024, covered entities are also required to annually register with the Department of Health and to aggregate reported data in a manner that prevents identification of an individual entity. The new legislation also establishes penalties for failing to report, including fines in the amount of up to $500 per day for each day data are late.

Location of Substance Use Disorder Treatment Services

The omnibus tax bill amended requirements regarding the locations where a substance use disorder treatment license holder can provide treatment services, whether in-person or via telehealth. The legislation mandates that license holders provide all treatment services at one of their licensed locations or at one of the approved alternatives, which include (i) a client’s home or place of residence, (ii) approved satellite locations within schools, jails, or nursing homes, (iii) other suitable satellite locations approved by the Department of Human Services (“DHS”) (up to two satellite locations per license), and (iv) via telehealth to clients individually or as a group, if certain criteria are met. Providers who elect to provide services at any of the alternative locations or via telehealth are subject to additional DHS oversight and documentation requirements.

Contact us to discuss how you or your organization can prepare to comply with these new laws.