See below for a summary of legislation that passed in 2019 and 2020 in state legislative sessions and in U.S. Congress.
Summaries of bills passed are updated on an ongoing basis.
**Updated July 13, 2020**
1135 Medicaid Waivers in Response to COVID-19
When the novel coronavirus (COVID-19) outbreak in the United States was declared a national emergency on March 13, 2020, the Centers for Medicare & Medicaid Service (CMS) was empowered to take proactive steps through 1135 waivers. As a result, blanket waivers are in effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration. Separate from and in addition to the blanket waivers, the secretary of the Department of Health and Human Services has authority under Section 1135 to grant waivers to states that request that CMS temporarily waive compliance with certain statutes and regulations for their Medicaid programs during the time of the public health emergency.
So far, many states have requested these additional flexibilities in order to focus their resources on combatting the outbreak and providing the best possible care to Medicaid enrollees in their states. CMS has been rapidly approving these waiver requests, but it is important to recognize that not all state requests are created equal.
CMS State-by-state 1135 Waiver Updates
Approved State Actions to Address COVID – 19
The Kaiser Family Foundation has a Medicaid Emergency Authority Tracker that details on Medicaid Disaster Relief State Plan Amendments (SPAs), other Medicaid and CHIP SPAs, and other state-reported administrative actions; Section 1115 Waivers; Section 1135 Waivers; and 1915 (c) Waiver Appendix K strategies.
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
Illinois – IL H 2894 – Covering All Kids Health Insurance Program Act
Amends the Covering All Kids Health Insurance Act; Extends the repeal date for the act. Effective August 9, 2019.
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 Hampshire – NH S 274 – Newborn Home Visiting Program
Declares that the Newborn Home Visiting Program shall be available to all Medicaid eligible families. Effective September 17, 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.
Texas – TX S 750 – Maternal and Newborn Health Care
Relates to maternal and newborn health care and the quality of services provided to women in this state under certain health care programs; provides for the application for funding to implement a model of care for Medicaid recipients; provides for referrals from the Healthy Texas Women Program to the Primary Health Care Services Program; provides for enhanced prenatal and postpartum care services; provides for postpartum depression. Effective June 10, 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.
California – CA S 260 – Automatic Health Care Coverage Enrollment
Requires the Health Care Exchange to enroll an individual in the lowest costs silver plan or another plan upon receiving the individual’s electronic account from a county, or upon receiving information from the State Department of Health Care Services regarding an individual terminated from department-administered health coverage. Effective January 1, 2020.
California – CA A 1802 – Health Care Service Plans: Claim Reimbursement
Provides that the obligation of a health care service plan to comply with specified portions of the Knox Keene Health Care Service Plan Act reimbursement provisions is not deemed to be waived if the plan requires its medical groups, independent practice associations, or other contracting entities to pay claims for covered services. Updates the information a health care service plan is required to provide. Effective January 1, 2020.
California – CA A 414 – Health Care Coverage
Requires the Office of Statewide Health Planning and Development to annually prepare a report on community benefits, as specified, and post the report and the community benefit plans submitted by the hospitals on its internet website. Authorizes the office to impose fines not to exceed $5,000 on hospitals that fail to adopt, update, or submit community benefit plans. Effective January 1, 2020.
California – CA A 1309 – Health Care Coverage: Enrollment Periods
Requires a health care service plan and a health insurer, for policy years beginning on or after a certain date, to provide a special enrollment period to allow individuals to enroll in individual health benefit plans through the Health Benefit Exchange in a specified timeframe. Effective January 1, 2020.
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.
Delaware – DE S 35 – Insurance Code
Amends the Insurance Code relating to health insurance contracts; revises provisions relating to the individual and group health insurance markets to directly incorporate into state law the Patient Protection and Affordable Care Act’s consumer protections, including the prohibition of preexisting condition provisions, guaranteed asset and availability of coverage, and permissible rating factors. Effective August 6, 2018.
Illinois – IL S 1580 – Healthcare Disability Benefits
Amends the State Employee Article of the Pension Code; allows licensed health care professionals to make certain disability determinations; defines licensed health care professional; requires a licensed health care professional to submit his or her registration number on all reports submitted to the System; eliminates the application deadline for certain disability benefits; makes changes to provisions concerning when a nonoccupational disability benefit begins to accrue. Effective July 12, 2019.
Illinois – IL H 2438 – Insurance Code
Amends the Insurance Code; provides that mental, emotional, nervous, or substance use disorder or condition includes any mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression, in provisions concerning mental and emotional disorders. Effective August 16, 2019.
Illinois – IL H 3487 – State Health Insurance Marketplace
Amends the University of Illinois Hospital Act and Hospital Licensing Act; provides that each hospital shall post, in each facility that has an emergency room, a notice in a conspicuous location in the emergency room with information about how to enroll in health insurance through the State Health Insurance Marketplace. Effective January 1, 2020.
Illinois – IL H 3503 – Hearing Instrument Coverage
Amends the Insurance Code; provides that a hearing care professional may also mean a licensed hearing instrument dispenser; provides that an individual or group policy of accident and health insurance or managed care plan shall offer, for an additional premium, optional coverage or optional reimbursement for hearing instruments and related services for all individuals when a hearing care professional prescribes an instrument to augment communication. Effective January 1, 2020.
Illinois – IL H 3509 – Donated Breast Milk
Amends the State Employees Group Insurance Act, the Insurance Code, and the Public Aid Code; provides that donated breast milk must be prescribed by a licensed medical practitioner; provides that milk must be obtained from a human milk bank that meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the Department of Public Health; removes a requirement that the infant must be critically ill. Effective January 1, 2020.
Illinois – IL S 162 – Mammogram Insurance Coverage
Amends the Counties Code, the Municipal Code, the Insurance Code, the Health Maintenance Organization Act, and the Public Aid Code; mandates health insurance coverage for diagnostic mammograms. Effective January 1, 2020.
Illinois – IL S 174 – In Office Membership Care Agreements
Amends the In Office Membership Care Act; provides that an in office membership care agreement provided under the Act is not insurance. Effective August 2, 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.
Michigan – MI S 362 – Healthy Plan Recipients
Provides general assistance, hospitalization, infirmary and medical care to poor or unfortunate persons; provides for compliance by this state with the Social Security Act; provides protection, welfare and services to aged persons, dependent children, the blind, and the permanently and totally disabled; administers programs and services for the prevention and treatment of delinquency, dependency and neglect of children. Effective September 23, 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.
Oregon – OR S 770 – Health Care for All Oregon Board Establishment
Establishes Health Care for All Oregon Board to be responsible for planning and oversight of Health Care for All Oregon Plan to be administered by Oregon Health Authority. Effective July 23, 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.
California – CA A 678 – Medi-Cal: Podiatric Services
Prohibits the requirement of prior authorization for podiatric services provided by a doctor of podiatric medicine if a physician and surgeon rendering the same services would not be required to provide prior authorization. Effective January 1, 2020.
California – CA A 1088 – MediCal: Eligibility
Requires the State Department of Health Care Services to seek a Medicaid state plan amendment or waiver to implement an income disregard that would allow an aged, blind, or disabled individual who becomes ineligible for MediCal benefits because of the state’s payment of the individual’s Medicare Part B premiums to remain eligible for the MediCal program if their income and resources otherwise meet all eligibility requirements. Effective January 1, 2020.
California – CA A 1642 – MediCal: Managed Care Plans
Requires a MediCal managed care plan to provide information in a request for alternative access standards and to demonstrate the delivery of MediCal services to enrollees. Requires the information compiled by the EQRO to include the extent to which each MediCal managed care plan uses clinically appropriate telecommunications technology to meet established time and distance standards. Effective January 1, 2020.
California – CA A 1705 – MediCal: Emergency Medical Transportation Services
Requires the State Department of Health Care Services to implement, subject to any necessary federal approvals, the Public Provider Intergovernmental Transfer. Authorizes the Department to continue conducting any administrative duties related to the specified supplemental MediCal reimbursement. Exempts an eligible provider from the quality assurance fee and add on increase for the duration of any MediCal managed care rating during which the Public Provider Intergovernmental Transfer Program is implemented. Effective January 1, 2020.
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 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
Amends the Procurement Code; directs the Chief Procurement Officer to work with the Department of Healthcare and Family Services to identify an appropriate method of source selection that will result in an executed contract for the technology required for the implementation of the Integrated Eligibility System; revises eligibility for the Children’s Health Insurance Program and other similar programs; establishes a dispute resolution process. Effective August 5, 2019.
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.
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.
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 Jersey – NJ A 4744 – Medicaid Medication Assisted Treatment Benefits
Requires Department of Human Services to ensure medication assisted treatment benefits under Medicaid program are provided without the imposition of prior authorization requirements. Effective October 13, 2019.
New Jersey – NJ A 5021 – Prenatal Care Services
Requires Medicaid coverage for group prenatal care services under certain circumstances. Effective August 9, 2019.
New Jersey – NJ S 499 – Medicaid and FamilyCare
Provides for an improved system for eligibility determination for Medicaid and FamilyCare; relates to the time between receipt of an application and a request for verification letters sent to an applicant, the number of extensions granted to an applicant in order to permit an opportunity to provide additional documentation, and the number of fair hearings requested; requires the Department of Human Services to publish certain metrics and performance evaluation results on its website. Effective August 23, 2019.
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.
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.
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
California – CA S 407 – Medicare Supplement Benefit Coverage
Excludes outpatient prescription drugs benefits as a new or innovative benefit. Authorizes the Director of the Department of Managed Health Care and the Insurance Commissioner to issue guidance on specified requirements. Excludes new or innovative benefits from the determination of whether benefits are equal to or lesser than those provided by the previous coverage. Effective January 1, 2020.
California – CA S 784 – Medicare Supplement Benefit Coverage
Re-designates standardized Medicare supplement benefit plans C, F, and high deductible F as plans D, G, and high deductible G, respectively, for purposes of conforming state law to federal law for policies sold or issued to newly eligible Medicare beneficiaries. Requires standardized Medicare supplement benefit plans D, G, and high deductible G to provide the same coverage as required for plans C, F, and high deductible F, respectively. Effective July 30, 2019.
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.
California – CA A 577 – Health Care Coverage – Maternal Mental Health
Requires an individual, who presents written documentation of being diagnosed with a maternal mental health condition from the individual’s treating health care provider, to complete those covered services for that condition, not exceeding a certain number of months. Effective January 1, 2020.
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.
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.
Missouri – MO S 29 – Healthcare Provider Reimbursement Allowances
Extends the sunset on certain healthcare provider reimbursement allowances; modifies the managed care organization reimbursement allowance. Effective August 28, 2019.
New Jersey – NJ S 2507 – Health Care Provider Networks Access Sales
Prohibits the sale or lease of access to certain dental provider network contracts; provides an exception to identify the source of a discount on remittance advises or explanations of payments to electronic transactions mandated under the Health Insurance Portability and Accountability Act. Enacted August 23, 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.
California – CA A 744 – Health Care Coverage: Telehealth
Requires a contract between a health care service plan and a health care provider for the provision of health care services to an enrollee or subscriber, or a contract between a health insurer and a health care provider for an alternative rate of payment, to specify that the health care service plan or insurer reimburse a health care provider for the diagnosis or treatment of an enrollee or subscriber delivered through telehealth services on the same basis as an in person diagnosis or treatment.
California – CA A 1494 – MediCal: Telehealth: State of Emergency
Provides that neither face to face contact nor a patient’s physical presence on the premises of an enrolled community clinic is required for services provided by the clinic to a MediCal beneficiary during or immediately following a proclamation declaring a state of emergency. Authorizes the Department of Healthcare Services to apply this provision to services provided by another enrolled fee for service MediCal provider, clinic, or facility during or immediately following a state of emergency. Effective January 1, 2020.
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.
New Hampshire – NH S 258 – Telemedicine and Telehealth Services
Adds definitions to and clarifies the statute governing telemedicine and Medicaid coverage for telehealth services. Effective October 11, 2019 and January 1, 2020.
Texas – TX H 1063 – Telemonitoring Services Providers Reimbursement
Relates to the reimbursement of providers for the provision of certain home telemonitoring services under Medicaid; provides that home telemonitoring services are available to pediatric persons who are diagnosed with end-stage solid organ disease, have received an organ transplant, or require mechanical ventilation. Effective September 1, 2019.
Texas – TX S 670 – Telehealth Services
Revises provisions relating to Medicaid telemedicine and telehealth services; defines Medicaid managed care organization and the term platform; provides requirements and restrictions of Medicaid managed care organizations in relation to coverage for telemedicine and telehealth services; provides for telepharmacy services. Effective September 1, 2019.
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.
United States – US H 3253 – Medicaid Extensions
Provides for certain extensions with respect to the Medicaid program under Title XIX of the Social Security Act; provides for extension of the community mental health services demonstration program; provides for extension of protection for Medicaid recipients of home and community-based services against spousal impoverishment; provides for extension for family-to-family health information centers. Effective August 6, 2019.
United States – Executive Order – Protecting and Improving Medicare
On October 3, 2019, President Trump issued an Executive Order entitled the Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors. The order aims to “protect and improve” the Medicare program by allowing seniors to have more control over the type of health insurance they receive and the providers by which they are treated. The Order focuses mainly on Medicare Advantage plans, Medicare plans that are run by private insurance plans.
The Executive Order directs the Secretary of Health and Human Services to, within 1 year, propose regulations and implement administrative actions that give Medicare enrollees more diverse and affordable plan choices. Additionally, the Secretary is to take actions that
encourage innovative Medicare Advantage benefit structures and plan designs, including regulations that reduce barriers to obtaining a Medicare Medical Savings Account, increase supplemental benefits and telehealth services, create a pay model that adjusts supplemental Medicare Advantage benefits to allow beneficiaries to share directly in the cost savings from the program through cash or monetary rebates, and ensure that fee for service Medicare is not advantaged or promoted over Medicare Advantage with respect to its administration.
It also directs that a report shall be issued within 180 days that identifies approaches to modify Medicare fee for service payments to more closely reflect the prices paid under Medicare Advantage and the commercial insurance market to encourage more robust price competition.
Within one year, the Secretary must also propose a regulation that will provide beneficiaries with improved access to providers and plans by adjusting network adequacy requirements for Medicare Advantage plans, including greater use of telehealth services. And, reforms must be introduced to allow providers more time with patients by eliminating burdensome regulatory billing requirements and implementing appropriate reimbursements. Additionally, an emphasis on decreasing administrative burdens and cost, and increasing ease for patients to enroll, navigate, and select their providers and plans shall be implemented.
California – CA A 204 – Hospitals: Community Benefits Plan Reporting
Requires the Office of Statewide Health Planning and Development to annually prepare a report on community benefits, as specified, and post the report and the community benefit plans submitted by the hospitals on its internet website. Authorizes the office to impose fines not to exceed $5,000 on hospitals that fail to adopt, update, or submit community benefit plans. Effective January 1, 2020.
California – CA A 651 – Air Ambulance Services
Requires a health care service plan contract or a health insurance policy to provide that if an enrollee, insured, or subscriber receives covered services from a noncontracting air ambulance provider, the individual shall pay no more than the same cost sharing that the individual would pay for the same covered services received from a contracting air ambulance provider, referred to as the in network cost sharing amount. Provides for the MediCal fee rate for such services. Provides for penalties. Effective January 1, 2020.
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.
Missouri – MO S 514 – HealthNet Benefits for Foster Care
Provides HealthNet Benefits for persons in foster care. Effective July 11, 2019 and August 28, 2019.
New Hampshire – NH H 508 – Direct Primary Care
Relates to direct primary care and establishing a committee to study direct primary care; declares that primary care providers providing direct primary care pursuant to a primary care agreement are not subject to the insurance laws, provided that certain conditions are met. Effective August 16, 2019 and October 15, 2019.
New Hampshire – NH H 725 – Managed Care Organization Standards
Establishes certain credentialing standards and claims quality assurance standards for managed care organizations for the purposes of the Medicaid program. Effective September 8, 2019.
New Hampshire – NH S 58 – Low Dose Mammography Coverage Rates
Clarifies the reimbursement rates for low dose mammography. Effective September 10, 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 Jersey – NJ S 3963 – Unreimbursed Medical Expense Recovery
Revises existing law concerning the recovery of unreimbursed medical expenses as economic loss in a civil action for damages arising from an automobile accident. Effective August 1, 2019.
New Jersey – NJ S 984 – Patient Medical Records Access and Fees
Establishes certain requirements, including allowable fees, for the provision of medical records to patients, legally authorized representatives, and authorized third parties. Effective March 1, 2020.
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.
New York – NY A 264 – Excessive Hospital Emergency Charges
Amends the Financial Services Law; establishes protections from excessive hospital emergency charges; includes specific charges in patient protection provisions. Effective October 17, 2019.
New York – NY S 6544 – Excess Hospital Charges
Amends the Financial Services Law; establishes protections from excessive hospital charges; includes specific charges in patient protection provisions.
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.
MedData Disclaimer – This document is provided for general informational purposes only and is not intended as legal advice. The providing of the information in this document is neither intended to establish an attorney-client relationship nor to expand the existing contractual relationship with MedData. MedData would recommend that you consult with your own internal legal resources before taking any action in reliance on this information.