Health plans would cover home nursing for some Medical Assistance members

A health plan must cover home care nursing services for a person who is also enrolled in Medical Assistance. The person must be covered by the health plan and enrolled in Medical Assistance at the same time. The covered services are those provided under section 256B.0625, subdivision 7, except for section 256B.0654, subdivision 4. Plans may require prior authorization and use contracted providers. Cost sharing may apply, but it must not place a greater financial burden on the person than cost sharing for similar services. This provision would apply to policies issued, offered, or renewed, and claims arising, on or after January 1, 2026.

A health plan must not set a quantity limit on coverage under this section. The rule applies to home care nursing coverage under this section. This rule applies despite section 62J.26. This provision would apply to policies issued, offered, or renewed, and claims arising, on or after January 1, 2026.

The health commissioner must not pay to offset the cost of these benefits and must help make comprehensive home care nursing coverage available through private insurance. These directions concern home care nursing benefits under this section. The text includes potential costs to Medical Assistance among the costs that must not be offset. This provision would apply to policies issued, offered, or renewed, and claims arising, on or after January 1, 2026.

A health plan must use the name home care nursing services for qualifying services in coverage documents and related communications. The naming rule covers services meeting the definition in subdivision 3, including services described in a plan's review policies, claim forms, instructions, and communications to enrollees and providers. The services must be ongoing, individual nursing ordered by a physician, advanced practice registered nurse, or physician assistant and provided by a registered or licensed practical nurse. The care must be medically necessary due to medical complexity or a need for sustained skilled assessment, treatment, or monitoring, and its duration or frequency cannot be safely or effectively met through occasional or visit-based nursing. This provision would take effect August 1, 2026.