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.
"Rare disease or condition" means a disease or condition:
Affecting fewer than 200,000 persons in the United States and is chronic, serious, life-altering, or life-threatening
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
labeled as a rare disease or condition on the Genetic and Rare Diseases Information Center list created by the National Institutes of Health
Or for which an enrollee:
has received two or more clinical consultations from a primary care provider or specialty provider that are specific to the presenting complaint
has documentation in the enrollee's medical record of a developmental delay through standardized assessment, developmental regression, failure to thrive, or progressive multisystemic involvement
had laboratory or clinical testing that failed to provide a definitive diagnosis or resulted in conflicting diagnoses
- 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
Contact a HealthPartners Nurse Navigator with questions regarding HealthPartners members with a rare disease condition at 844-732-3544.