This update regards select legislative updates from Q3 & Q4 2020.
District of Columbia —DC B 326 – Postpartum Coverage
This act amends the Telehealth Reimbursement Act to extend postpartum inpatient and outpatient benefits to at least a year after childbirth, and to require the mayor to seek approval from the Centers for Medicare and Medicaid Services that all health policies offered through the district’s Medicaid program cover inpatient and outpatient maternity and newborn care for at least one year after childbirth. Enacted Oct. 20, 2020.
Delaware —DE H 348– Telemedicine Services
This Act continues certain provisions related to telemedicine from the Declaration of a State of Emergency issued March 12 due to the COVID 19 pandemic; maintains authorization for telemedicine to be provided without a pre-existing provider-patient relationship and through the use of land-lines and other technology which does not have a video component; and permits out-of-state mental health practitioners to practice in Delaware subject to Division of Professional Regulation oversight. Effective July 21, 2020.
Illinois —IL S 1864– Health Care
Permits the Department of Healthcare and Family Services to take necessary actions to address the COVID-19 public health emergency to the extent such actions are authorized by the Centers for Medicare and Medicaid Services; and provides that such actions may continue throughout the public health emergency and for up to 12 months after the period ends, and may include, but are not limited to accepting an applicant’s or recipient’s attestation of income, incurred medical expenses, residency, and insured status when electronic verification is not available. Permits the Department of Healthcare and Family Services to cover the treatment of COVID-19 to persons who qualify for medical assistance under federal law and regulations and to noncitizens. Amends the medical assistance program to provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial. Creates the Health Care Affordability Act requiring a feasibility study be conducted to explore options to make health insurance more affordable for Illinois residents, and a proposal for a state option for health care coverage that leverages existing state infrastructure be presented to the General Assembly and Governor. Changes the name of the Health Information Exchange Authority to the Health Information Exchange Office. Establishes the Kidney Disease Prevention and Education Task Force. Amends the Pharmacy Practice Act to permit off-site institutional pharmacies to supply emergency kits to licensed facilities. Contains provisions concerning payment claims for ambulance providers that are unable to obtain a Physician Certification Statement; assessment forms for long-term care facilities; income verification for medical assistance recipients; remote monitoring and support services as a waiver-reimbursable service for persons with intellectual and developmental disabilities; and other matters. Effective July 7, 2020.
Louisiana —LA HCR 21 b– Medicaid
Requests the Department of Health to submit documentation to the federal Medicaid agency to provide financial relief for providers of services for people with developmental disabilities. Enacted Oct. 22, 2020.
Michigan —MI H 4459– Nonparticipating Health Providers
Regulates charges by nonparticipating providers. Limits, in certain circumstances, a nonparticipating provider’s payment to the greater of the average amount negotiated by the patient’s health benefit plan with participating providers (excluding any in-network coinsurance, copayments, or deductibles), or 150% of the amount that would be covered by Medicare for the health care service provided (excluding any in-network coinsurance, copayments, or deductibles). Enacted Oct. 22, 2020.
Michigan —MI H 4460– Health Care Providers
Requires nonparticipating providers who are providing a health care service to a nonemergency patient to make certain disclosures. Effective Oct. 22, 2020.
Missouri — Medicaid Expansion
On Aug. 4, Missouri voters approved expanding Medicaid coverage in the state through an amendment to its constitution. It is anticipated to provide coverage to an additional 230,000 low-income residents. The amendment requires Missouri to submit a state plan amendment to the federal government by March 1, 2021, for expansion to begin July 1, 2021.
New Jersey –NJ S 2465– State Health Care Transparency Act
Creates the State Health Care Transparency Act; requires health care professionals to communicate their professional licensure and professional degree under certain circumstances; establishes requirements for advertisements for health care services. Enacted Dec. 14, 2020.
New York —NY A 9538– Health Consumer Assistance Notice
Relates to adverse determination notices to Medicaid recipients; requires managed care providers to provide written notice of certain information of the Department of Health independent consumer assistance program and the independent substance use disorder and mental health ombudsman on all notices of adverse determinations, grievances, and appeals. Enacted Dec. 2; effective May 31, 2021.
Ohio—OH H 287– Medicaid Waiver Services for Active Duty Military
Provides for Medicaid home and community-based waiver services for relatives of active duty military. Enacted June 16; effective Sept. 15.
Oklahoma – Medicaid Expansion
On June 30, the citizens of Oklahoma approved a measure to expand Medicaid in the state. State Question 802 is predicted to allow at least 200,000 Oklahoma adults to become eligible for the program. It will provide coverage for those ages 18-64 who are not already covered and whose annual income is at or below 133% of the federal poverty line. The passed measure calls for expansion to be implemented by July 1, 2021.
Pennsylvania –PA H 941– Medical Assistance Pharmacy Services
Provides for medical assistance pharmacy services and for a prescription drug pricing study. Effective Jan. 25, 2021.
Texas –Texas Medicaid Spell of Illness Amendment for COVID-19
In September, the Texas Health and Human Services Commission (HHSC) received federal approval through a disaster 1115 authority to extend the 30-day spell of illness limitation that applies to certain adult Medicaid clients for an additional 30 COVID-19-related days to allow an individual to stay up to 60 days in a hospital. HHSC is also waiving the $200,000 benefit limitation for COVID-19-related stays, which applies to adults in fee-for-service Medicaid, and for some members who remain in STAR Health after their 21st birthday.
Virginia —VA H 822– Health Insurance and Credentials
Requires health insurers and other carriers that credential certain health professionals in their provider networks to establish reasonable protocols and procedures for reimbursing a professional who has submitted a completed credentialing application to a carrier for services provided to covered persons. Effective July 1, 2020.
Virginia —VA H 826 – State Plan for Medical Assistance
Requires the Department of Medical Assistance Services to convene a work group to provide recommendations related to amending the state plan for medical assistance services to include a provision for the payment of medical assistance for services provided by certified doulas. Effective July 1, 2020.
Virginia —H 5046 a – Telemedicine Services
Directs the Board of Medical Assistance Services to amend the state plan for medical assistance services to provide for payment of medical assistance for medically necessary health care services provided through telemedicine services, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. Effective Oct. 1, 2020, and Nov. 9, 2020.
Virginia —S 5080 a – Telemedicine Services
Provides that no health care provider who provides health care services via telemedicine services shall be required to use proprietary technology or applications to be reimbursed for providing telemedicine services, and eliminates provisions stating that telemedicine services does not include audio-only telephone. Effective Oct. 1, 2020, and Nov. 9, 2020.
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