Health providers and insurers will have to navigate a bevy of state laws that took effect with the new year, covering key issues such as reproductive care, patient documentation, wages and reimbursement.
Here are some of the laws affecting healthcare.
Arizona
Arizona updated two laws. Assisted living facilities have new requirements for discharging patients to emergency providers, including providing additional information in written documents such as resident information, care needs or requests and the overall state of health when discharging a patient to an emergency provider. Facilities are required to contact the patient’s authorized representative if a patient is transferred to a hospital and maintain a copy of the required resident information.
Additionally, ambulances are required to install an electronic GPS monitoring device to measure response times, tracking when ambulances arrive on a scene.
California
California has updated and established several laws.
- Borderline personality disorder has been added to the list of mental illnesses that make an individual eligible for pretrial diversion, meaning an individual may be able to avoid jail time if charged with a non-violent offense. Previously, the list was limited to bipolar disorder, schizophrenia and post-traumatic stress disorder.
- Providers who distribute mail-ordered abortion pills or perform gender-affirming treatment have received new protections. Law enforcement officials no longer are allowed to cooperate in out-of-state investigations of those actions. The law also outlaws bounty hunters who attempt to apprehend providers to stand trial in a state outside of California.
- Physician assistants are allowed to provide surgical abortions without direct physician supervision.
- The minimum wage for healthcare workers, including nursing assistants, medical technicians and janitorial staff, will be raised to $23 per hour June 1. The wage will reach $25 per hour by 2026.
Colorado
Providers no longer are allowed to perform intimate examinations on patients who are sedated or unconscious unless the patient is in a life-threatening situation or gives prior, informed consent.
Connecticut
Pharmacy benefit managers and 340B-protected organizations' agreements can no longer contain the following: a reimbursement rate for a prescription drug that is less than the rate paid to non-340B pharmacies; a fee or adjustment not required for non-340B providers or pharmacies; a fee or adjustment that "exceeds the fee or adjustment amount" enforced for non-340B providers or pharmacies; "any provision that prevents or interferes with a patient’s choice to receive a drug from a 340B-covered entity;" or any provision that excludes a 340B-covered organization from the PBM’s network based on participation in the 340B program. Additionally, if an organization is 340B-covered, it cannot be a factor of consideration when a PBM determines reimbursement rates.
Idaho
The state amended an existing law to outlaw any surgical or medical intervention involving a person’s gender or genitals except in the case of life-threatening situations.
Illinois
Healthcare facilities are required to notify the state’s attorney general within 30 days of a proposed merger or acquisition. For each day an organization fails to abide by the law, it could incur a $500 civil penalty.
Maine
All health plans that start after Jan. 1 cannot enforce any deductible, copayment, coinsurance or cost-sharing requirements for abortion procedures.
Minnesota
Any healthcare facilities that earn average annual revenue between $10 million and $80 million need to inform the state health department of upcoming mergers or acquisitions. Neither the health department nor the attorney general are allowed to stop a transaction. The state plans to use the information to track the number of transactions in the state and how they might affect access, cost and quality of care services.
The state also updated laws related to contraceptive care and doula-related services.
- MinnesotaCare enrollees must be provided with comprehensive and scientifically accurate contraception options by hospitals and primary care providers.
- Health plans must cover contraceptive care without cost-sharing or referral requirements.
- The state's Medicaid and MinnesotaCare programs must provide a separate reimbursement to hospitals for long-acting, reversible contraceptives, such as an IUD, given immediately after birth in an inpatient hospital setting.
- Medical assistance and health plans must cover a year’s supply of any prescribed contraceptive.
- Reimbursement for doula services increased to $100 per prenatal or postpartum visit and $1,400 for services provided at birth.
Nebraska
Medicaid postpartum coverage has been extended to 12 months, from 60 days.
Nevada
A new law has raised damage caps, the maximum amount a plaintiff can receive from a defendant, by $80,000 for victims of medical malpractice. The cap will be increased each year until Jan. 1, 2028, when the maximum amount reaches $750,000. Beginning Jan. 1, 2029, the damage cap for malpractice will be increased each year by 2.1%, rounded to the nearest dollar.
Oregon
Individual and fully insured group health insurance plans must cover three primary care visits per covered individual per year. Insurers also must cap the copay, waive the deductible for the visits and assign a primary care provider to the individual within 90 days of enrollment, if a member has not selected one within that period.
Pennsylvania
Insurers are required to have an electronic communications network that allows prior authorization requests to be submitted and returned electronically.
Rhode Island
Properly trained pharmacists can prescribe and dispense hormonal contraceptives.
Texas
Health insurers are required to create and maintain a website where providers can verify if patients are covered by the issuer and see a patient’s potential deductible, copayment or coinsurance.
Utah
Healthcare employees are eligible to receive mental health treatment coverage from an out-of-network mental health provider on a one-time basis through their health benefit plan.
Virginia
Changes to its laws on health benefit plans’ provider panels, the group of providers an insurer works with to offer services to its members, include notifying enrollees when a provider is no longer part of the carrier’s panel.
Additionally, the state has created the Smartchart Network Program, a tech initiative that will connect providers, insurers and other healthcare organizations with a treatment, payment or operations relationship with patients statewide.
West Virginia
The maximum copay for insulin was lowered from $100 per 30-day supply of covered prescription insulin to $35. The maximum copay for insulin devices was set at $100. The same law allows patients to purchase blood testing equipment for ketones without a prescription.
