This Week in Health Care

Every Thursday, Stateside Associates selects health care-related state and local events to highlight in This Week in Health Care.

For more information on our Health Care Practice, please visit here.

STATE AND LOCAL HIGHLIGHTS

ALASKA

The House Finance Committee will hold a hearing on April 11 regarding SB 91. This measure establishes requirements for physician multidisciplinary care teams and establishes disciplinary sanctions. 

Contact: Olivia O'Donnell

 

CALIFORNIA

The Senate Appropriations Committee will hold a hearing on April 15 regarding SB 1131. This measure allows Medicaid reimbursement for licensed physician assistants similar to certified nurse practitioners. It also requires overseeing clinicians to serve as site certifiers for Family PACT clinics.

Contact: Dylan Hughes

 

The Senate Human Services Committee will hold a hearing on April 15 regarding SB 1112. This measure requires coordination via a model MOU between Medicaid MCOs and alternative payment agencies operating subsidized childcare services. This coordination is targeted to improve enrollment in Medicaid if eligible and access to early and periodic screening, diagnostic, and treatment (EPSDT) services. It requires the state to develop the model MOU for use by MCOs.

Contact: Dylan Hughes

 

The Senate Business, Professions and Economic Development Committee will hold a hearing on April 15 regarding SB 966. This measure requires PBMs to apply for and obtain a license from the CA State Board of Pharmacy. The application must include information on interested parties or control over the PBM, a copy of all organizational and governing documents, a description of the PBM's services and facilities/personnel, and a confirmation of compliance in business practice. If any application information changes, PBMs must submit those changes to the board within 30 days of modification. 

Contact: Matthew Lidz

 

The Assembly Health Committee will hold a hearing on April 16 regarding the following:

  • AB 3275: An HMO will reimburse claims within 45 days If a healthcare service plan contests or denies such a claim, the plan shall notify the claimant, in writing and within 45 working days after receipt of the claim. 
    Contact: Allison Collins
     
  • AB 3260: This measure requires that utilization review decisions be made within 72 hours when the enrollee’s condition is urgent and would determine urgency by a referring or treating health care provider binding on the health care service plan.
    Contact: Allison Collins
     
  • AB 2340: This measure requires Medicaid-managed care plans to provide information to beneficiaries on the early and periodic screening, diagnostic, and treatment (EPSDT) services for beneficiaries between 12 and 21 years of age.
    Contact: Dylan Hughes
     
  • AB 2303: This measure requires the development of an alternative payment methodology under Medicaid for certain health care facilities to cover the cost of compliance with minimum wage schedules for health care employees. It requires public notice of state plan amendments or waiver requests 45 days before submission.
    Contact: Dylan Hughes
     
  • AB 2449: This measure expands the definition and accreditation options for qualified autism service providers within the realm of health care coverage. 
    Contact: Olivia O'Donnell

 

COLORADO

The Senate Health and Human Services Committee will hold a hearing on April 11 regarding the following:

  • SB 124: This measure requires all individual and group health benefit plans to provide coverage for biomarker testing to guide treatment decisions if the testing is supported by medical and scientific evidence.
    Contact: Olivia O'Donnell
     
  • SB 54: The bill requires all private insurance companies to provide coverage for the treatment of obesity and the treatment of pre-diabetes, including coverage for intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medication.
    Contact: Olivia O'Donnell

 

The Senate Health and Human Services Committee will hold a hearing on April 17 regarding SB 110. This measure prohibits prior authorization requirements under Medicaid for antipsychotic prescription drugs under certain circumstances. Namely, if the recipient has been unsuccessfully treated with an antipsychotic prescription drug on the PDL in the past year they are eligible. It does not preclude or discourage the use of generic drugs and applies to FFS and managed Medicaid.

Contact: Dylan Hughes

 

HAWAII

The House Committee on Human Services will hold a hearing on April 11 regarding SCR 207. This Senate Resolution requests that the Auditor conduct a sunrise analysis on mandating dental and vision insurance coverage.

Contact: Olivia O'Donnell

 

The House Health and Homelessness Committee will hold a hearing on April 11 regarding SCR 81. This resolution requests the Hawaii Department of Health to work with 340B disproportionate share hospitals and pharmaceutical manufacturers to ensure the continued integrity of the 340B system, in particular, to protect against efforts to restrict covered entity access to covered pharmaceuticals. It also requests similar action from the Hawaii congressional delegation.

Contact: Dylan Hughes

 

LOUISIANA

The House Appropriations Committee will hold a hearing on April 15 regarding HB 702. This measure requires Medicaid coverage for doula services. In particular, it requires Medicaid MCOs to cover the service at a rate of $1250 per pregnancy, with the following benefits included: five prenatal visits, three postpartum visits, and attendance through labor and birth, including Caesarian deliveries. It also requires doula care to be eligible for coverage and meet minimum standards.

Contact: Dylan Hughes

 

The House Civil Law and Procedure Committee will hold a hearing on April 15 regarding HB 742. This measure establishes immunity from civil and criminal liability for in vitro fertilization service providers, including physicians, hospitals, in vitro fertilization clinics, or their agents. 

Contact: Erin Fitzpatrick

 

NEW HAMPSHIRE

The Senate Health and Human Services Committee will hold a hearing on April 17 regarding HB 1616. This measure requires parental consent for services provided under Medicaid. 

Contact: Dylan Hughes

 

OKLAHOMA

The Senate Health and Human Services Committee will hold a hearing on April 11 regarding HB 3567. This measure establishes that, related to violations of drug control, if a party fails to request an administrative hearing promptly, the written order as issued shall be deemed adopted as the final order by the Director of the Oklahoma State Bureau of Narcotics and Dangerous Drugs Control as the final agency order concerning the matter without further action by the Director. 

Contact: Matthew Lidz

 

RHODE ISLAND

The Senate Finance Committee will hold a hearing on April 11 regarding SB 2360. This measure makes the Medicaid reimbursement rate increase authorized in 2023 for the first connections program permanent. It also ties the rates to inflation, to be adjusted annually starting on July 1, 2025.

Contact: Dylan Hughes

 

The Senate Health and Human Services Committee will hold a hearing on April 11 regarding SB 2872. This measure requires a group health plan, an individual or group health insurance plan, and any contract between the Rhode Island Medicaid program and any health insurance carrier to provide coverage for treating mental health disorders and substance use disorders.

Contact: Olivia O'Donnell

 

The House Corporations Committee will hold a hearing on April 11 regarding the following:

  • HB 7720: This measure bans PBMs from reimbursing pharmacies or pharmacists for a prescription drug or service in an amount less than the national average drug acquisition cost for the drug or service, plus a dispensing fee equal to Medicaid's. 

    Contact: Matthew Lidz
     
  • HB 8143: This measure limits pharmacy audits to a maximum of one audit every 12 months unless fraud or misrepresentation is reasonably suspected. The Rhode Island Attorney General can impose fines, penalties, or other appropriate sanctions to ensure compliance.

    Contact: Matthew Lidz
     
  • HB 8041: This measure states that when calculating an enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, an insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person.

    Contact: Erin Fitzpatrick
     
  • HB 7082: This measure mandates carriers offering dental benefit plans to annually submit detailed financial and operational information to the health insurance commissioner. This information includes current and projected medical loss ratios for in-state claims, total claims for their plans, and a comprehensive breakdown of administrative expenses and financial data. The data encompasses various aspects like income sources, underwriting, marketing, claims operations expenses, and other administrative costs.
    Contact: Allison Collins
     
  • HB 8056: This measure aims to modify current laws related to health insurance companies. It prohibits them from doing the following:
    • Paying a rate that is less than the approved Medicaid rate established by the Executive Office of Health and Human Services.
    • Filing any proposed rate with state agencies for review or approval, which the company intends to use in the state. 
    Contact: Allison Collins

 

VERMONT

The House Committee on Health Care will hold a hearing on April 11 regarding SB 98. This measure states that the Green Mountain Care Board shall hall explore and create a framework and methodology for implementing a program to regulate the cost of prescription drugs for Vermont consumers and Vermont’s health care system. 

Contact: Erin Fitzpatrick

 

The Senate Health and Welfare Committee will hold a hearing on April 11 regarding the following:

  • HB 622: This measure allows Medicaid reimbursement to providers of emergency medical services for delivering emergency medical services to Medicaid enrollees who were not transported to a different location during the emergency.
    Contact: Dylan Hughes
     
  • HB 233: This measure requires pharmacy benefit managers (PBMs) to obtain licensure from the Department of Financial Regulation.  
    Contact: Matthew Lidz

GROUPS EVENTS

There are no upcoming health care-related groups events this week.


Learn the Latest Developments in Prescription Drug Affordability Boards

Prescription Drug Affordability Boards (PDABs) are gaining substantial influence within the pharmaceutical and healthcare sectors. With eight states having already established PDABs and others in the process of forming their own, it's important for businesses to actively monitor and assess their progress.

Our comprehensive engagement and monitoring services can help you stay informed on the latest developments in the PDAB landscape. Contact us or visit www.stateside.com/PDABs for more information.

Prescription Drug Affordability Boards Map