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2019 United States Healthcare Legislation Update

2019 United States Healthcare Legislation Update

See below for a summary of legislation that passed in 2019 in state legislative sessions and in U.S. Congress.

Summaries of bills passed are updated on an ongoing basis.

**Updated July 15, 2019**

Assignment of Benefits and Billing Legislation

Arkansas — AR S 512 – Assignment of benefits to a Healthcare Provider
This act states that an enrollee of a healthcare plan may assign, through an assignment of benefits, their right to receive reimbursement for any healthcare service rendered by a healthcare provider regardless of whether the provider is in-network or out-of-network. The provider that receives the assignment of benefits shall them provide notice to the payor pf the assignment of benefits with a claim for payment for the services provided to the enrollee. If the provider is out-of-network, the notice must be accompanied by the complete copy of the assignment of benefits with the enrollee’s signature and date of execution. Payors who receive proper notice of the assignment of benefits and remit payment to the enrollee or fail to pay are liable for payment to the healthcare provider and remit payment to the provider for incorrect payment within 10 days of receiving notice from the provider. It was enacted April 5, 2019 and will go into effect by March 1, 2020, or as soon thereafter as the final rule is approved.

Colorado — CO H 1174 – Out of Network Health Care Services
This Act requires health insurance carriers, health care providers, and health care facilities to provide patients covered by health benefit plans with information concerning the provision of services by out of network providers, and in network and out of network facilities. It outlines the disclosure requirements, and the claims and payment process for the provision of out of network services. This Act goes into effect January 1, 2020.

Minnesota — MN S 131 – Health Care Facility Fee Disclosures
Requires facility fee disclosure prior to treatment for non-emergency services. This Act takes effect August 1, 2019.

Nevada — NV A 469 – Emergency Services Billing
This Act limits the amount a provider of health care may charge a person who has health insurance for certain medically necessary emergency services provided when the provider is out-of-network. Additionally, it requires an insurer to arrange for the transfer of a person who has health insurance to an in-network facility under certain circumstances. This Act goes into effect January 1, 2020.

New Mexico — NM S 337 – Surprise Billing Protection Act
New Mexico passed legislation that requires insurance to reimburse an out-of-network provider for emergency care necessary to evaluate and stabilize a patient and states that prior authorization is not required in emergency treatments. Cost-sharing must be limited to the same co-payments, co-insurance, or limitations of benefits to the same extent as if the treatment were by participating providers.

It also prevents balance billing of an individual at an in-network facility who receives treatment by an out-of-network provider when they do not have the option or ability to choose their provider or treatment by an out-of-network provider is medically necessary. Individuals who knowingly select an out-of-network provider may be held responsible for full charges.

Providers may not knowingly submit a surprise medical bill to an insured person and must post extensive information on their website. The bill also sets out reimbursement and overpayment procedures for surprise medical bills. This Act takes effect January 1, 2020.

Tennessee — TN H 1342 – Patient Billing Notices
This act states that individuals entitles to benefits under their healthcare policy have the right to assign their benefits to a healthcare policy and such rights must be clearly stated in the policy. Additionally, notice of an assignment must be in writing to the insurer in order to be effective, unless otherwise stated in the policy. Assignment of benefits to an out-of-network, facility-based physician may be disregarded unless the facility provides written notice to the insured or their representative, prior to treatment, that includes extensive required statements as detailed in the act.

Out-of-network facility-based physicians may have a right of indemnification or private cause of action against the facility for an insurer’s disregard of an assignment of benefits should they provide detailed notices to the patient.

Additionally, healthcare facilities are prohibited from collecting out-of-network charges from an insured in excess of cost-sharing amounts unless a detailed written notice is provided prior to treatment. Prior notice is not required when treatment is through an emergency department and the patient is unconscious or incapacitated, but must be provided following stabilization. This Act is effective as of April 30, 2019.

Tennessee — TN H 710 – Healthcare Billing Clarity Act
Hospitals may not include language in a billing statement that indicates or implies that a charge for specialty healthcare services (anesthesia, pathology, radiology, and emergency services) was rendered by a healthcare provider unless the charge contains sufficient information to identify the healthcare provider of the specialty service and the costs of supplies, equipment, or other services rendered to the patient by or at the hospital are excluded from the amount charged for specialty services or the billing statement includes language or a notice that the billed amounts so not include charges for healthcare providers that are not employed by the facility. This Act takes effect January 1, 2020.

Texas – TX S 1264 – Consumer Protections Against Billing
Revises provisions relating to consumer protections against medical and health care billing by out of network providers; provides the procedure for an injunction for balance billing; provides for enforcement by regulatory agencies; provides for balance billing prohibition notices; expands the mandatory coverage of emergency care. Effective September 1, 2019.

Virginia — VA H 2538 – Balance Billing
In facilities where a person receives elective treatment, the facility must post a notice that health care services provided by a provider group will be billed separately from the facility and that some services may not be provided by an in-network provider. Additionally, the facility must inform the insured person or their representative the names of the provider groups providing treatment at the facility, that the insured should contact their insurer to determine if the providers are in-network, that the covered person may be financially responsible for services should the provider be out-of-network, and any cost-sharing requirements. This Act goes into effect July 1, 2019.

Washington — WA H 1065 – Health Care Services
This Act protects consumers from charges for out-of-network health care services. It adds mental health and substance use disorders to the definition of emergency medical conditions and defines balance bill, in-network and out-of-network. This Act goes into effect January 1, 2020, provided funding approved by June 30, 2019.

Child Health Care Coverage Legislation

Michigan – MI H 4304 – Child Health Care Coverage
Provides for the provisions and enforcement of support, health care, and parenting time orders with respect to divorce, separate maintenance, paternity, child custody and support, and spousal support; prescribes the powers and duties of the circuit court and friend of the court; prescribes certain duties of certain employers and other sources of income; provides for penalties and remedies. Effective June 20, 2019.

New York – NY A 8053 – Child Health Insurance Plan
Amends the Public Health Law; extends the expiration date for the Child Health Insurance Plan. Effective July 3, 2019.

Health Insurance Legislation

Arizona — AZ H 2494 – Health Care Service Contracts
The Act provides that a contract between a health insurer and a health care provider that is issued, amended, or renewed on or after a certain date to provide health care services to the health insurer’s enrollees, may not restrict the method of payment from the health insurer to the health care provider in which the only acceptable payment method is a credit card payment or an electronic funds transfer payment. Will take effect on the 91st day after session adjournment.

Colorado — CO H 1004 – Affordable Health Coverage
This act proposes implementing a competitive state option for affordable health care coverage. It requests that the state seek authorization to use existing federal money for the proposed state option and requires the state to complete studies to determine the feasibility and requirements to implement a state plan. It was enacted on May 17, 2019.

Delaware – DE H 193 – Health Insurance Individual Health Insurance
Creates the Health Insurance Individual Market Stabilization Reinsurance Program and Fund. Effective June 20, 2019.

Maine — ME S 10 – Consumer Protections for Health Coverage
The Act ensures that consumer protections related to health insurance coverage included in the federal Patient Protection and Affordable Care Act are codified in state law. It clarifies that individual and group health plans may not impose any pre-existing condition exclusion on an enrollee and permits a carrier to restrict enrollment in individual health plans to open enrollment and special enrollment periods established in rule. This Act is effective March 19, 2019.

Michigan – MI H 4397 – Personal Protection Insurance
Amends insurance laws; requires insurers that offer automobile insurance to file premium rates or personal protection insurance coverage for automobile insurance policies effective after a specified date; relates to transportation network companies. Effective June 11, 2019.

Michigan – MI S 1 – No Fault Auto Insurance
Makes miscellaneous changes to the Insurance Code related to no fault automobile insurance coverage and benefits. Effective June 1, 2019.

Mississippi — MS H 628 – Health Insurance Late Payment Penalties
The act requires accident and health insurance policies to include additional provisions that penalize the late payment of claims by an insurer to a healthcare provider or insured party. This Act takes effect July 1, 2019.

Nevada — NV A 170 – Health Insurance Coverage
This Act requires an insurer to provide certain information relating to accessing health care services to the Office of Consumer Health Assistance, the Governors Consumer Health Advocate to submit a report of such information to the Legislature, an insurer to offer a health benefit plan regardless of health status, and an Advocate to take certain actions to assist consumers in accessing health care services. It incorporates ACA protections on a state level. This Act goes into effect January 1, 2020.

New Jersey – NJ A 5499 – Health Benefit Plan State Based Exchange
Authorizes the Department of Banking and Insurance to establish a state-based exchange for certain health benefits plans; requires the Department of Health Services to apply for federal funds for integration of Medicaid eligibility platform and exchange. Enacted June 28, 2019.

New Mexico — NM H 436 – Health Insurance Law
Amends the Insurance Code, the Small Group Rate and Renewability Act, the Health Insurance Portability Act, the Health Maintenance Organization Law, and the Nonprofit Health Care Plan Law to align provisions relating to the accessibility of health care coverage to federal law. This includes preventing discrimination based on pre-existing conditions. Requires the Superintendent of Insurance to seek federal health coverage access and affordability waiver authorization and funding. This Act is effective June 14, 2019.

New Mexico — NM H 285 – Short-Term and Limited Benefit Plan Act
Enacts the short-term health plan and excepted benefit act to establish guidelines relating to short-term health and excepted benefit coverage. Bans the sale and issuance of unlicensed and unapproved health benefits plans. Amends sections of the New Mexico insurance code, the health maintenance organization law and the nonprofit health care plan law to establish direct-service ratio applicability for short-term plans. This Act is effective June 14, 2019.

Rhode Island – RI S 1038 – Insurer Payments on Access to Health Care Study
Creates a Special Legislative Commission to Study the Impact of Insurer Payments on Access to Health Care. Enacted June 28, 2019.

Vermont – VT H 524 – Health Insurance and the Individual Mandate
Relates to health insurance and the individual mandate; clarifies who is exempt from the requirement to maintain minimum essential coverage, including certain religious, immigrant, or incarcerated individuals. Effective June 17, 2019, July 1, 2019 and January 1, 2020.

Healthcare Liens Legislation

Arkansas — AR S 542 – Medical and Hospital Service Liens
This bill adds orthotists, prosthestists, and perdorthists as parties that can file a lien. It was enacted April 11, 2019 and will be effective as of July 24, 2019.

Mississippi — MS S 2012 – Lien for Burn Care
Creates a lien for causes of action accruing to an injured party for uncompensated traumatic burn care. Is to go into effect on July 1, 2019. It will replace an earlier statute for liens related to burn care that will expire on the same day.

South Dakota — SD S 70 – Hospital Lien Law
This act amended the hospital lien law. It require hospitals that receive notification of a third party payor of healthcare benefits for an injured person to submit to the payor for payment any reasonable and necessary charges for treatment, care and maintenance before filing a hospital lien. If the hospital received notice of a third party payor after filing the lien, they shall then submit a request for payment to the payor. Should the payor fail or refuse the pay, the hospital may file a lien or enforce their existing lien. Additionally, liens may be filed by a person, association, limited liability company, corporation, county, or other institution, including a Municipal corporation, maintaining a hospital licensed under the laws of the state that furnish care. This act is to go into effect July 1, 2019.

Utah — UT S 51 – Hospital Lien Law
Requires that hospitals execute and file, at the expense of the hospital, a release of the lien and mail it to the injured patient, their heirs, or representative upon receipt of the payment of the lien or the portion recoverable under the lien. This Act is effective May 14, 2019.

Medicaid Programs Legislation

California – CA S 78 – Health
Makes various changes related to health. Allows certain health information sharing relating to lead screening for children enrolled in MediCal. Requires certain reporting by health facilities. Creates the Minimum Essential Coverage Individual Mandate to require individuals to maintain minimum essential coverage. Creates Individual Market Assistance to provide healthcare coverage assistance. Provides for certain vocational rehabilitation programs. Enacted June 27, 2019.

California – CA S 104 – MediCal Eligibility
Extends eligibility for full scope MediCal benefits to individuals between certain ages who are otherwise eligible for those benefits but for their immigration status. Effective July 9, 2019, with additional later implementation dates for programs.

Connecticut – CT H 7165 – Medicaid Coverage for Donor Breast Milk
Provides Medicaid reimbursement for donor breast milk deemed medically necessary. Effective July 1, 2019.

Connecticut – CT S 1052 – Medicaid Coverage of Telehealth Services
Expands Medicaid coverage of telehealth services; requires the Commissioner of Social Services to expand Medicaid coverage of telehealth services state wide whenever such coverage meets federal Medicaid requirements for efficiency, economy and quality of care. Effective July 1, 2019.

Florida
Florida has reached the initial threshold for Medicaid expansion in the state. Political committee Florida Decides Healthcare, Inc. has submitted a petition complete with the required signatures to trigger a Supreme Court review. The Supreme Court will determine if the proposed ballot wording for Medicaid expansion meets legal standards. If approved by the court, the committee will then be required to submit a total of 766,200 signatures to get the Medicaid expansion measure, which will extend coverage to individuals with incomes below 138% FPL, on the ballot in November 2020.

Georgia — GA S 106 – Submission of Waiver Requests and Proposals
Authorizes the Department of Community Health to submit a Section 1115 waiver request, which may include an increase in the income threshold; authorizes the Governor to submit a innovation waiver (Section 1332) proposal with respect to health insurance coverage or health insurance products. Was passed March 27, 2019.

Hawaii – HI H 1453 – Emergency Ambulance Services
Authorizes the Department of Health to establish fees for transportation to medical facilities and for provision of emergency medical services; authorizes transportation by ambulance to medical facilities other than hospital emergency departments; requires Medicaid and private insurance coverage of ambulance services; authorizes Medicaid programs, and requires private insurers, to provide coverage for statewide community paramedicine services rendered by emergency medical technicians or paramedics. Effective June 25, 2019.

Idaho — ID S 1204 – Medicaid Waiver Provisions
Idaho is developing waiver requests for Medicaid expansion that include requirements approved by Idaho voters through the passage of Proposition 2 in 2018. The proposed “Coverage Choice Waiver” seeks to implement 10 provisions:

  • All patients must undergo a substance abuse assessment.
  • Medicaid coverage for Institutions for Mental Disease (IMD).
  • An exchange opt-in that will allow eligibility for individuals who earn from 100 to 138% FPL to continue to be eligible to purchase subsidized private insurance coverage through the Your
  • Health Idaho insurance exchange rather than switching to Medicaid.
  • Work requirements of at least 20 hours of work, volunteering, or training a week. Failure to comply would result in loss of coverage for 2 months or until they come back into compliance.
  • If work requirements and sanctions are not able to be implemented (per pending lawsuits in Kentucky and Arkansas), the state would require individuals who do not comply with the work requirements to cover the maximum allowable copays on their Medicaid care for 6 months or until they comply with the work requirements.
  • If federal matching for the program drops below 90-10, the Legislature would be required to reconsider expansion.
  • The legislature is required to review expansion in 2023 to determine if it should be continued.
  • No expansion recipient may receive family planning services from a provider other than their assigned primary care doctor without the doctor granting them a waiver.
  • That no applications for federal waivers may delay the implementation of expansion, which goes into effect January 1, 2020.
  • The legislature must create a task force to study Medicaid expansion and its costs. The task force is set to hold its first meeting June 17th.
  • Public hearings on the waiver are scheduled for June 24th and 27th.

Illinois — IL S 1321 – Child Care Assistance Program

The Illinois House and Senate unanimously passed legislation that aims to implement a bipartisan Medicare reform package. Specifically, it addresses the state’s Medicaid managed care program, under which the state pays private insurers a set rate per member per month for services. Hospitals have complained that the insurers are denying claims for administrative reasons and causing significant delays in providing reimbursement. In order to resolve this issue, Senate Bill 1321 requires insurers to pay and complete claims within 30 days or face a penalty. Additionally, it requires the Illinois Department of Healthcare and Family Services to create and maintain a provider complaint portal where unsettled disputes with insurers may be submitted.

The state will use a dispute resolution process where the Department will act as the final decision maker for payment disputes.

The Bill also requires the state to review the Medicaid re-determination process to ensure that coverage of enrollees is still appropriate.

The bill is now awaiting approval from the Governor. It will take effect upon signature. The full bill can be found here»

Iowa — IA H 625 – Medicaid Integration
This act integrates Medicaid and the Healthy and Well Kids in Iowa program eligibility payment and administrative functions under the Department of Human Services. This Act goes into effect July 1, 2019.

Louisiana — LA HCR 43 – Medicaid
Urges the Secretary of the Department of Health to reconsider the department’s policy of excluding the majority of Medicaid enrollees from quarterly income verification. Passed with immediate effect May 1, 2019.

Louisiana – LA H 199 – TEFRA Option Medicaid Waiver Program
Establishes the Tax Equity and Fiscal Responsibility Act, or TEFRA, option Medicaid waiver program through which children with disabilities can access Medicaid funded services regardless of their parents’ income. Effective August 1, 2019.

Louisiana – LA H 211 – Medicaid
Provides relative to Medicaid coverage of certain behavioral health services; limits the number of reimbursable service hours per day for providers of certain behavioral health services; requires inclusion of certain information on claims for payment for behavioral health services. Effective August 1, 2019.

Louisiana – LA H 424 – Medicaid Program
Revises provisions relating to the Medicaid program; provides for denials of provider claims and prior authorization requests by Medicaid managed care organizations; requires Medicaid managed care organizations and the Department of Health to take certain actions pursuant to the denial of prior authorization requests by healthcare providers; requires publication of information related to prior authorization requirements on certain websites. Effective August 1, 2019.

Maine
On June 17, 2019, Governor Janet Mill signed a two-year budget that delegated $125 million for Medicaid expansion. Expansion had been approved by state voters in November 2017, but then Governor Paul LePage fought its installment through the courts up until Mills took office. The budget becomes effective July 2019.

Maryland — MD H 814 – Easy Enrollment Health Insurance
The Act established the Easy Enrollment Health Insurance Program, which allows the state to use tax return forms to identify uninsured residents and refer them to no-cost or low-cost health insurance. Those that qualify for Medicaid will be enrolled automatically. This Act goes into effect June 1, 2019.

Montana — MT H 658 – Healthcare Laws and Medicaid Revisions
This act extends the Medicaid Expansion Program by revising the termination date of the state Health and Economic Livelihood Partnership Act. It establishes community engagement requirements for Help Act participants, revises Medicaid eligibility verification procedures, establishes the Help Act Employer Grant Program, enacts a fee on health service corporations, applies the insurance Premium tax to the state fund, establishes a fee on hospital outpatient revenue and provides appropriations. Partially effective upon passage on May 9, 2019, part on July 1, 2019, and part January 1, 2020.

New Hampshire
On June 20, 2019, a House-Senate conference committee amended legislation to grant Health and Human Services Commissioner Jeffrey Meyers broad power to exempt individuals from the state’s Medicaid work requirements. The bill must now be approved by the House and Senate before it can be signed into law. The move was made after state officials were unable to contact approximately 20,000 Medicaid enrollees who may be required to comply with the work requirements or lose their insurance. The requirements went into effect June 1st and require anyone covered by Granite Advantage, New Hampshire’s extended Medicaid program, to complete 100 hours of work or approved community engagement activities a month. Individuals have until July 7th to report the hours worked or reasons for an exemption.

New Mexico — NM S 41 – Medicaid Providers Due Process
The act preserves access to Medicaid services, provides due process to Medicaid providers and subcontractors, provides for hearing officers, establishes procedures to resolve overpayment disputes, and provides for judicial review of a credible allegation of fraud determination. This Act goes into effect January 1, 2020.

North Carolina – NC H 656 – Medicaid Transformation
Modifies the laws pertaining to Medicaid and State Health Choice Managed Care Programs as needed for the implementation of the Medicaid transformation; establishes regulation and requirements for dis-enrollment from prepaid health plans; revises provisions relating to the appeals process. Effective in part, July 1, 2019, July 4, 2019 and October 1, 2019.

New Hampshire – NH S 290 – State Granite Advantage Health Care Program
Makes various changes to the State Granite Advantage Health Care Program; clarifies which beneficiaries may be subject to the work and community engagement requirement; reduces the number of hours for the work and community engagement requirement; adds exemptions for certain persons from the requirement; adds circumstances for the elimination of the requirement. Effective July 8, 2019.

Nevada – NV S 198 – Medicaid Eligibility
Revises provisions relating to Medicaid; requires the Division of Welfare and Supportive Services to analyze and report certain information concerning the eligibility of children for Medicaid. Effective June 12, 2019.

Nevada – NV S 174 – Autism Spectrum Disorders Services
Makes various changes relating to services provided to persons with autism spectrum disorders; requires the Legislative Auditor to conduct an audit of the Medicaid program concerning the delivery of such services. Effective June 7, 2019.

Oklahoma
On June 18, 2019, the Oklahoma Supreme Court rejected an effort to prevent a public vote on Medicaid expansion in the state. The Oklahoma Council of Public Affairs, a conservative think tank, brought a lawsuit claiming that the description of Medicaid expansion measures that appears on petition signature sheets was misleading and insufficient. The court ruled against them, ruling that the description was sufficient and that the petition would be allowed to move forward. Supporters now must get 178,000 signatures to get the Medicaid expansion measure on the 2020 ballot.

Texas – TX H 72 – Medicaid Benefits for Adopted Children
Relates to the continuation of Medicaid benefits provided to certain children adopted from the conservatorship of the Department of Family and Protective Services. Effective September 1, 2019.

Texas – TX H 4533 – Medicaid
Relates to the administration and operation of Medicaid, including Medicaid managed care and the delivery of Medicaid acute care services and long-term services and supports to certain persons; provides for the standardization and modernization of Medicaid reporting and services. Effective September 1, 2019.

Utah — UT S 96 – Medicaid Expansion Adjustments
Utah has proposed a partial Medicaid expansion to replace the full Medicaid expansion approved by voters in November 2018. Senate Bill 96 outlines the proposal, which has been incorporated into a Section 1115 Waiver called the “Per Capital Plan Cap.” The partial expansion will cover adults up to 100% FPL and intends to limit eligibility to 12 months of continuous coverage. Additionally, the plan seeks to cap how much federal funding will be allowed for each Medicaid enrollee. The waiver proposal is open for public comment from May 31, 2019 to June 30, 2019, during which time several public hearings will be held.

Wisconsin

On June 4, the Wisconsin Legislature’s budget committee approved an increased spending of $200 million for Medicaid over the next two years. However, they did not approve Governor Tony Evers’ plan for Medicaid expansion, which was estimated to cost an additional $187.5 million. The approved plan allocates increased funding for nursing homes, personal care workers, direct care givers and aids to children and families. It will also increase payments to hospitals and fund 25 to 30 mental health workers. Wisconsin is one of 14 states that have not accepted Medicaid expansion money from the Federal government, and the only state that did a partial expansion to cover people up to 100% FPL without federal funding.

Wyoming — WY H 194 – Air Ambulance Coverage
Requires that air ambulance transport services will be covered under Medicaid and authorizes the submission of Medicaid state plan amendments and the necessary waivers to implement the coverage. It will apply to air coverage provided on or after April 1, 2020.

Medicare Programs Legislation

Indiana – IN S 392 – Medicare Supplement Policies

Prohibits preexisting condition exclusions in state employee health plans, accident and sickness insurance policies, and health maintenance organization contracts; requires insurers that makes a Medicare supplement policy available to an individual eligible for Medicare based on age to make at least one Plan A Medicare supplement policy available to an individual eligible for Medicare based on disability; specifies enrollment and insurance producer compensation requirements that apply to the Plan A policy. Effective July 1, 2019.

Mental Health Legislation

Alaska – AK H 40 – Mental Health Budget
Makes appropriations for the operating and capital expenses of the state’s integrated comprehensive mental health program. Enacted June 28, 3019.

Hawaii – HI S 567 – Mental Health Treatment
Appropriates out of the general revenue for legal assistance with petitions for assisted community treatment and related court proceedings. Effective July 1, 2019.

Nevada – NV A 66 – Crisis Stabilization Centers
Authorizes the holder of a license to operate a psychiatric hospital that meets certain requirements to obtain an endorsement as a crisis stabilization center; provides for the licensure and regulation of providers of nonemergency secure behavioral health transport services; requires certain health maintenance organizations and managed care organizations to negotiate with such hospitals to become in network providers. Effective January 1, 2020.

Prior Authorization Legislation

New Mexico — NM S 188 – Health Insurance Prior Authorization Act
Enacts the Prior Authorization Act and requires the Office of the Superintendent of Insurance to standardize and streamline the prior authorization process for nonemergency medical care and related benefits. Additionally, imposes requirements on health insurers and their pharmacy benefits managers with respect to prior authorization and requires the Office of Superintendent of Insurance and health insurers to report data on prior authorization. This Act goes into effect on June 14, 2019, with later implementation of some requirements.

Indiana — IN H 1546 – Health Care Medicaid Authorization
The Act specifies that the prior authorization for health care services statute applies to the risk based managed care Medicaid program and requires that a Medicaid managed care organization use a standardized prior authorization form prescribed by the office of the secretary of family and social services. The Act goes into effect July, 1, 2019 and compliance with the Act’s requirements must occur after December 31, 2020.

Providers Legislation

Hawaii – HI H 1270 – Hospital Sustainability Program
Extends the sunset date of the Hospital Sustainability Program; clarifies exemptions from the hospital sustainability fee and increases the allowable aggregate fees to be charged; appropriates funds out of the Hospital Sustainability Special Fund for upcoming fiscal years. Effective in part June 27, 2019, and part July 1, 2019.

Texas – TX H 2041 – Freestanding Emergency Medical Care Facility Regulation
Relates to the regulation of freestanding emergency medical care facilities; requires facilities to disclose fees and accepted health benefit plans. Effective September 1, 2019.

Texas – TX S 2286 – Health Care Provider Participation Programs
Provides for the creation and operations of health care provider participation programs in certain counties with a hospital district bordering Oklahoma. Effective June 10, 2019.

Telehealth Legislation

Florida – FL H 23 – Standards of Telehealth Practices
Relates to telehealth; establishes standards of practice for telehealth providers; authorizes telehealth providers to use telehealth to perform patient evaluations and to prescribe certain controlled substances; provides that a non-physician telehealth provider using telehealth and acting within his or her relevant scope of practice is not deemed to be practicing medicine without a license; provides record keeping requirements; provides for out of state providers. Effective in part July 1, 2019, part January 1, 2020, and part July 1, 2020.

Hawaii – HI S 1246 – Telehealth Care Access
Establishes goals for the adoption and proliferation of telehealth to increase health care access; establishes the Strategic Telehealth Advisory Council and a permanent full time State Telehealth Coordinator position; establishes the Telehealth Administrative Simplification Working Group; appropriates funds. Effective July 1, 2019.

Federal Laws

US HR 259 — Medicaid Recipients Spousal Impoverishment Protection
The U.S. House of Representatives passed legislation that extends the Medicaid Money Follows the Person Rebalancing Demonstration and extends protection for Medicaid recipients of home and community-based services against spousal impoverishment. Additionally, it reduces the Federal Medical Assistance percentage after 2020 for states without an asset verification program. It was enacted on January 24, 2019.

US HR 1839 — Medicaid Recipients Protection
Extends protection for Medicaid recipients of home and community-based services against spousal impoverishment; establishes a State Medicaid option to provide coordinated care to children with complex medical conditions through health homes; prevents the misclassification of drugs for purposes of the Medicaid drug rebate program. It was enacted on April 18, 2019.

Other Legislation

Colorado — CO H 1001 – Hospital Transparency Measures
Concerns hospital transparency measures required to analyze the efficacy of hospital delivery system reform incentive payments; relates to hospital expenditure reports detailing uncompensated hospital costs and the different categories of expenditures, by major payer group, made by hospitals in the state; requires hospitals in the state to make certain information available to the Department of Health. Goes into effect 90 days after final adjournment (approximately August 2, 2019).

Delaware – DE SR 11 – Medical Assistance Division Resolution
Encourages the Division of Medicaid and Medical Assistance and the Department of Correction to facilitate continuous health coverage for individuals with opioid use disorder, other substance use disorders, or high health needs upon release. Enacted June 27, 2019.

Florida – FL H 7 – Direct Health Care Agreements
Relates to direct health care agreements; expands the scope of direct primary care agreements; provides definitions; conforms provisions to changes made by the act. Effective July 1, 2019.

Louisiana – LA H 434 – State Medical Assistance Program
Revises provisions relating to the State Medical Assistance Program; provides for public notice requirements in relation to contract amendments; provides for the implementation of a policy for the adoption of policies and procedures. Effective August 1, 2019.

Louisiana S 173 – Families Protection Act
Provides for the Healthcare Coverage for Families Protection Act; relates to health insurance; provides relative to enrollment, dependent coverage, rate setting, preexisting conditions, annual and lifetime limits, and essential benefits under certain circumstances; requires the commissioner of insurance to establish a risk-sharing program. Enacted June 11, 2019.

Maine – ME H 64 – MaineCare Family Planning Budget
Establishes presumptive eligibility for individuals who are likely to qualify for the family planning benefit; requires the Department of Health and Human Services to provide for presumptive eligibility and to automatically review an individual’s eligibility for the family planning benefit if, upon application, the individual is found ineligible. Effective September 19, 2019.

New Jersey – NJ S 3375 – Maternal Health Care Pilot Program
Establishes a maternal health care pilot program to evaluate shared decision making tools developed by the Department of Health and used by hospitals and birthing centers providing maternity services. Enacted June 24, 2019.

New Mexico — NM H 137 – Community and Health Tribal Councils Act
Enacts the County and Tribal Health Councils Act to improve the health of state residents by encouraging the development of comprehensive, community based health planning councils to identify and address local health needs and priorities; repeals the Maternal and Child Health Plan Act. This Act is effective June 14, 2019.

New York – NY S 6318 – Managed Care Organizations
Extends certain provisions providing enhanced consumer and provider protections under contracts with managed care organizations. Effective July 3, 2019.

North Dakota — ND S 2106 – Children’s Health Insurance Program
Revises provisions relating to the Children’s Health Insurance Program; provides for the continuing appropriation of grants and donations received for the Program. This Act is effective January 1, 2020.

Oregon – OR H 2266 – Patient Protection and Affordability Care Act Study
Requires Oregon Health Policy Board to study changes in health care coverage in Oregon since implementation of Patient Protection and Affordable Care Act and report results of study to interim committees of Legislative Assembly related to health. Effective June 25, 2019.

Rhode Island – RI H 5401 – Health Care Services Funding Plan Act
Requires TriCare to pay the healthcare services funding contributions for their contribution enrollees. Enacted July 8, 2019.

Rhode Island – RI S 139 – Comprehensive Discharge Planning
Amends the current law so that, as part of a comprehensive discharge plan, a hospital or an emergency care facility would be required to attempt to contact the patient’s emergency contact and the certified peer recovery specialist, in accordance with federal law. Effective June 28, 2019.

Texas – TX H 170 – Coverage for Mammography
Revises provisions relating to coverage for mammography under certain health benefit plans; provides that a health benefit plan that provides coverage for a screening mammogram must provide coverage for a diagnostic mammogram that is no less favorable than the coverage for a screening mammogram. Effective September 1, 2019.

Texas – TX H 2048 – Driver Responsibility Program
Relates to the repeal of the driver responsibility program and the amount and allocation of state traffic fine funds; eliminates program surcharges; authorizes and increases criminal fines; increases a fee. Effects trauma care funding. Effective September 1, 2019.

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