MN Rare Disease Mandate
Effective January 1, 2024, HealthPartners will comply with the MN Rare Disease Mandate [Minn. Stat. § 62Q.451] ensuring that no health plan company may restrict the choice of an enrollee as to where the enrollee receives services from a licensed health care provider related to the diagnosis, monitoring and treatment of a rare disease or condition. Please note that the requirements of the statute do not apply to most self-insured plans.
For patients who meet the rare disease mandate conditions:
Please submit this information online to confirm eligibility, application of appropriate benefits, and payments for providers not participating in the enrollee’s plan network for covered services.
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"Rare disease or condition" means a disease or condition:
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Affecting fewer than 200,000 persons in the United States and is chronic, serious, life-altering, or life-threatening
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Affecting more than 200,000 persons in the United States and a drug for treatment has been designated as a drug for a rare disease or condition pursuant to United States Code, title 21, section 360bb FDA Orphan Drugs List
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labeled as a rare disease or condition on the Genetic and Rare Diseases Information Center list created by the National Institutes of Health
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Or for which an enrollee:
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has received two or more clinical consultations from a primary care provider or specialty provider that are specific to the presenting complaint
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has documentation in the enrollee's medical record of a developmental delay through standardized assessment, developmental regression, failure to thrive, or progressive multisystemic involvement
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had laboratory or clinical testing that failed to provide a definitive diagnosis or resulted in conflicting diagnoses
Additional resources:
- Fast Facts January 2024 edition
- HealthPartners MN Rare Diseases or Conditions policy
- Review the MN Rare Disease Mandate
- NIH list of rare diseases and conditions
- Orphan Drugs|HRSA
Questions?
Contact a HealthPartners Nurse Navigator with questions regarding HealthPartners members with a rare disease condition at 844-732-3544.