Weekly StateVitals Update: Volume 10 (March 10, 2025)
National
CMS rescinds HRSN guidance used by states. Last week, the Centers for Medicare & Medicaid Services (CMS) rescinded guidance rolled out by the previous administration that authorized housing and nutrition services as covered Medicaid benefits for high-risk Medicaid and Children’s Health Insurance Program enrollees. Notably, the two pieces of guidance provided a framework of what interventions for health-related social needs (HRSNs) were eligible for reimbursement, inclusive of housing and home environment and nutrition interventions. The rescinded guidance also affirmed previous guidance offered by CMS that such services could be covered using authority established under 1915 home and community-based services waivers, in lieu of services and settings and 1115 demonstrations, and CHIP Health Services Initiatives. In rescinding the previous HRSN guidance, the current Administration iterates that moving forward they will “consider states’ applications to cover those services and supports on a case-by-case basis to determine whether they satisfy federal requirements for approval.” States with 1115 waivers approved using the previous Administration’s HRSN framework include Arizona, Arkansas, California, Massachusetts, New Jersey, New York, Oregon and Washington.
Arizona
State’s abortion ban found unconstitutional. Following approval of Prop. 139 by voters in November, which placed abortion access rights into the state constitution, a judge based out of Maricopa county has found the state’s previously existing 15-week ban on abortion to be unconstitutional. This ruling follows the state attorney general in December agreeing not to enforce the 15 week ban as a result of Prop. 139; the ruling makes the ban permanently blocked. Given the current split government in Arizona, it remains unlikely that any limitations on access to abortion care will be pursued in the near future by the Legislature.
Colorado
General Assembly enhances coverage and reimbursement for mental health care. Following amendments by the Senate, the Senate adopted and the House concurred with the Senate’s amendments to HB25-1002. The measure would provide for standardized utilization review criteria for the treatment of behavioral and mental health disorders that would align with utilization review and determinations made of physical health treatment. Specifically, the bill requires use of criteria and guidelines as published in a most recent version of criteria developed by an unaffiliated nationally recognized non-profit clinical specialty associations of relevant behavioral or mental health disorders. Apart from standardized utilization review criteria, the measure would also codify requirements pertaining to coverage parity of the federal Mental Health Parity and Addiction Equity Act into state law.It’s now headed to the Governor’s desk where it’s expected to be signed into law.
Delaware
State hospital association announces 2025 advocacy agenda. With the session about to hit full swing, the Delaware Healthcare Association has released its advocacy agenda it will intend to focus on over the coming months. While much of the priority is focused on enhancing hospital autonomy to navigate the challenges of Delaware’s healthcare pricing, instead of relying on the Diamond State Hospital Cost Review Board, the DHA is focused on similar efforts that are seen in other states. This includes advocating for adequate Medicaid reimbursement and parity in commercial plans for behavioral and physical health, prior authorization reform, and expanding coverage for prenatal care and dialysis care. While some efforts are likely to find common ground with the legislature – such as prior authorization reform – it remains unlikely that DHA will be able to mitigate the influence of the Hospital Cost Review Board heading into this next session.
Florida
Insurance regulators request prescription data. Over the past month, Florida’s Office of Insurance Regulation (Office) has worked on a request to pharmacy benefit managers (PBMs), asking PBMs to submit a significant amount of data to the Office. The data request includes personal information and prescription drug usage by covered individuals. Specifically, the request from the Office calls for individual names, their dates of birth, the drug dispensed, the prescriber of the medication, and the pharmacy from which it was dispensed. PBMs were asked to comply with the request by February 21st but it remains unclear how many PBMs have chosen to do so. Health plans and privacy stakeholders argue that the data request risks exposing personal and sensitive data about a patient’s mental health treatment or their reproductive healthcare status, among other identifiable information that could be used for potential prosecution, such as any actions in violation of Florida’s six-week abortion ban. As of this week, it remains unclear how the Office intends to utilize the data supplied by PBMs.
Idaho
Negotiated Medicaid expansion reform bill passes the House. Following introduction two weeks prior of HB 328 to be the compromise Medicaid expansion reform measure, the House of Representatives took up another vehicle to serve that purpose in passing HB 345. Similar to its predecessor vehicle, the measure was introduced by Rep. Jordan Redman (R-Coeur d’Alene) and would implement a number of reforms to the state’s Medicaid expansion program with the intent to control costs. Among other provisions, key elements include:
Require cost-sharing from enrollees as a condition of participation at levels developed by other states and up to the maximum charged by other states.
Transition of the Medicaid program to managed care.
Establish work requirements for able-bodied adults enrolled in Medicaid expansion, requiring 20 hours or more of work per week, averaged monthly, inclusive of numerous exempted populations.
Establishes site-neutrality requirements, ensuring that reimbursement rates for hospital outpatient departments and hospital-acquired physician practices are reimbursed at the same rate as physician-owned medical practices for equivalent outpatient services.
The measure now goes to the Senate for consideration where it’s likely to receive serious consideration given the work by the sponsor and House leadership to get to this negotiated position.
Missouri
House advances measure to provide Medicaid coverage for hearing aids and cochlear implants. Following efforts in recent years to extend Medicaid coverage to hearing aids and cochlear implants, the House voted recently to adopt HB 177 by a 148 to 8 margin. While efforts in previous years had been stalled due to cost, the effort this year was guided by the potential for long-term savings provided the eligibility for benefits was limited to eligible children, pregnant individuals, and individuals who are blind. Sponsors and proponents also made the argument that coverage helps to ensure enrollees can maintain work and eventually lift themselves off of the Medicaid rolls. The measure now goes to the Senate for consideration. At least 35 states currently provide some limited coverage or coverage without limitation for hearing aids and cochlear implants.
Mississippi
CON reform bill fails to advance before Senate committee deadline. Despite passage by the House at a 107 to 5 margin, HB 922 failed to advance out of the Senate Public Health and Welfare Committee prior to a deadline that committees had to report out general bills originating from the other chamber. The measure would have exempted a litany of the following facilities from adhering to certificate of need (CON) requirements, including: chemical dependency services and facilities, hospital-based end stage renal disease facilities, intermediate care facilities, intermediate care facilities for individuals with intellectual disabilities, psychiatric residential treatment facilities, magnetic resonance imaging services, and diagnostic imaging services. It also would have doubled the capital expenditure limits that hospitals could spend on renovations or equipment without obtaining a CON approval. Additionally included was a provision that authorized hospitals to use existing dialysis facilities for outpatient renal care as opposed to just in-patient. While it remains possible the bill could later be amended into a shell bill, the prognosis is more bleak compared to when session started.
In lieu of HB 922, the Senate passed out of the Public Health and Welfare Committee an amended version of HB 569. The committee amendment would include a provision raising the threshold for a medical facility needing to file a CON application when purchasing medical equipment from $1.5 million to $3 million. The amendment would also increase the amount that health stakeholders would need to seek a CON application for in building a new clinical building, from $5 million to $10 million and non-clinical building, from $10 million to $20 million. Finally, among other provisions, the amendment would have the Dept. of Health conduct a study on CON laws pertaining to small hospitals and their dialysis units, geriatric psychiatric units, and acute adult psychiatric units. The amended bill now heads to the full Senate for consideration.
House PBM reform bill passes out of Senate Committee. The Senate Public Health and Welfare Committee passed out of committee for consideration to the full chamber HB 1123. As part of the committee process, language from SB 2677 was amended into the bill. The underlying bill would establish limitations on what pharmacy benefits managers (PBMs) charge for prescription drugs and enhanced reporting requirements on PBMs, manufacturers and insurers. Specifically, the measure would prohibit PBMs from charging an insurer more for a drug than what pharmacists are paid. Additionally, PBMs would be required to submit reports to the state Board of Pharmacy detailing rebates received from manufacturers and any affiliate pharmacies that they may have a financial interest in. For manufacturers and insurers, the bill requires manufacturers and insurers to submit reports to the Board of Pharmacy detailing wholesale drug costs and spending.
Language included from SB 2667 would establish the Clean Claim and Prompt Payment Act for PBMs and pharmacy services administrative organizations (PSAOs), which enhances disclosure requirements for reasonable administrative appeal procedures, enhanced rationale provided by the PBM or similarly regulated entity for any denial of appeal, and required auditing disclosures. Importantly, the bill would also prohibit patient steering tactics by PBMs. The bill will now head to the Senate floor for consideration, and would require concurrence by the House given inclusion of the amendment before being enrolled.
New Hampshire
Bill to terminate the state’s vaccine purchasing mechanism passes House. This past week, HB 524 passed the House of Representatives on a vote of 189-181. The measure would eliminate the New Hampshire Vaccine Association, a government established non-profit organization tasked in 2002 with being the universal purchasing program with the intent to provide access to vaccines for all children across the state. Proponents of the measure argue that the private sector is much more adept to handle such a function and there lacks cost savings to the state given the administrative cost to run the Association. Under the status quo, it is estimated that the Association is able to receive up to a 30 percent discount on acquiring vaccines in bulk. If authorized by the Senate, providers would no longer receive access to free vaccines under the program and would instead be responsible for acquiring their supply under their own terms.
Ohio
Department of Medicaid submits 1115 application to add work requirements to Medicaid. Following a number of other Republican-controlled states that have submitted similar applications, the Ohio Department of Medicaid submitted an 1115 demonstration application to the Centers for Medicare & Medicaid Services (CMS) to add work requirements to its Medicaid expansion population. Albeit, the rationale for doing so was based on a bill passed by the General Assembly in 2023 requiring the state to reinstate work requirements. The waiver application provides a broad interpretation of work requirements, simply iterating that enrollees must be employed. Otherwise, enrollees are exempt from that work requirement if they are 55 or older, are enrolled in school or an occupational training program, participate in an alcohol and drug addiction treatment program, or have intensive physical health care needs or serious mental illness. Ohio previously had approval from 2019 to implement work requirements before it was eventually pulled back.
Oregon
Senate committee hears corporate practice of medicine bill. Earlier this week, the Senate Healthcare Committee heard SB 951, which would further regulate the corporate practice of medicine in Oregon. Currently, medical practices must have 51% physician ownership. The pending legislation would put restrictions on Management Service Organizations (MSOs), prohibiting them from intervening in medical decisions. It would also prohibit noncompete and nondisparagement agreements between medical professionals and practices. Representative Bowman (D-Tigard) introduced similar legislation last year that passed the House, but failed to pass the Senate. The current bill appears to have bipartisan support and is scheduled for the Committee’s work session on March 11 where amendments aimed exempting certain long-term facilities and independent contractors will be offered.
South Dakota
Senate approves 2026 ballot measure on Medicaid expansion funding. Recently, the South Dakota Senate signed off on House Joint Resolution 5001. The resolution will put a question back on the ballot for voters to decide whether to add a poison pill to the program, eliminating the expansion program if federal funding ever dips below a 90 percent match rate. The Senate sponsor, Sen. Casey Crabtree (R-Madison) estimates that it would cost the state an additional $72 million to fund its share of Medicaid expansion if the federal government dropped the match rate back to its traditional match rate level. The resolution has already passed the House and will be on the ballot for the November 2026 general election.
West Virginia
Senate committee debates universal licensure bill. The Senate Committee of Government Organization held a hearing on SB 458 that would authorize nearly automatic licensure reciprocity for certain professions moving into West Virginia licensed in the state they are moving from. Notably, these professions include lawyers, doctors, nurses, accountants, and engineers, among others. During the hearing, both the dental profession and the Board of Medicine issued concerns pertaining to how the bill may lower the standards expected of licensees in West Virginia and expose patients in the state to a lower quality of care. The bill was laid over for consideration in a future meeting.
