Price transparency, billing and medical debt laws by state

SB 269: Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers

Health care insurers must contract with willing emergency medical service providers on comparable terms and reimburse in-network providers at 200 percent of Medicare Ambulance Fee Schedule rates for emergency ground transport beginning October 1, 2026, and treat in place at 200 percent beginning January 1, 2027. Out-of-network providers receive 180 percent. Reimbursement is payment in full; providers may only collect in-network cost-sharing amounts from enrollees.

Took effect 1 October 2026

HB 2175: claims; prior authorization; conduct

Before a health care insurer may deny a claim submitted by a provider based on medical necessity or issue a direct denial of a prior authorization requested by a provider involving medical necessity, the medical director shall individually review the denial and exercise independent medical judgment without relying solely on recommendations from any other source.

SB 1291: health insurers; provider; payment; claims

Health insurers must conclude credentialing within sixty calendar days and loading within one hundred thirty calendar days after receiving a complete credentialing application. Health insurers must process and pay claims as in-network claims for services rendered after notification of complete credentialing application if the provider later executes a network participation contract.

HB 1620: To amend the law concerning pharmacy benefits managers; and to regulate processing and payment of pharmacy claims.

Pharmacy benefits managers must pay clean claims within 7-14 days for electronic claims or 30 days for paper claims after receipt. Pharmacy benefits managers must notify pharmacies of claim deficiencies within 10 days for electronic or 15 days for paper claims. Pharmaceutical manufacturers must ensure vendors comply with timely payment requirements.

AB 1199: Medical staff: health care provider credentialing.

Governing bodies of general acute care hospitals and acute psychiatric hospitals must require medical staff to establish controls ensuring high standards of professional ethical practices. Medical staff must require members to demonstrate ability to perform surgical and other procedures competently at original appointment and every three years thereafter. Staff reappointments must occur at least every three years.

Takes effect 1 January 2027

AB 2499: Health care coverage: claims payments.

Health care service plans and health insurers must reimburse complete claims within 30 calendar days of receipt or notify claimants in writing that claims are contested or denied within 30 days. Plans and insurers must accept electronic medical records through standard electronic submission methods and must not deny, pend, or delay claims solely because their systems cannot accept documentation that otherwise meets requirements.

Takes effect 1 January 2027

SB 1049: Health care claims reimbursement.

Health care service plans and health insurers must allow providers 90 days from the plan's or insurer's most recent action to submit a corrected claim after a claim denial or overpayment notice based on a remediable defect. Plans and insurers must not deny corrected claims on grounds that the provider missed other applicable claim filing deadlines.

Takes effect 1 January 2027

AB 375: Medical Practice Act: health care providers: qualified autism service paraprofessionals.

Health care providers initiating telehealth must inform patients about telehealth use and obtain verbal or written consent before delivery of health care services via telehealth. The consent must be documented. Qualified autism service paraprofessionals certified by a national entity are now included in the definition of health care provider.

Takes effect 1 January 2027

AB 2311: Health care districts: employment.

Until January 1, 2037, health care districts and nonprofit corporations with a health care district as sole corporate member that own or control a general acute care hospital may employ physicians and surgeons and charge for professional services if medical staff concur by affirmative vote, the district or corporation does not interfere with professional judgment, and new positions do not supplant existing medical staff positions as of January 1, 2026. Such entities must publish annual reports on recruitment and retention data beginning July 1, 2028.

Takes effect 1 January 2027

SB 17: Out-of-Network Health Insurance Dispute Resolution

Health insurance carriers must provide remittance advice identifying when a health benefit plan is regulated by state law beginning January 1, 2027. Carriers must provide their median in-network reimbursement rate for out-of-network claims on each remittance advice. Carriers must provide data including methodology for determining median in-network rates when requested by the commissioner.

SB 149: Pathways for Individuals with Mental Health Disorder

The department of human services must conduct competency evaluations within specified timeframes: twenty-one days for in-custody evaluations after receiving collateral materials, forty-two days for outpatient evaluations. Competency evaluators must prepare written reports including opinions on competency, restorability, and clinical appropriateness of inpatient services. Courts must order collateral materials transmitted to CDHS within two business days of ordering evaluations.

HB 1006: Improve Affordability Private Health Insurance

The Colorado Health Insurance Affordability Enterprise must allocate revenues to reinsurance programs, carrier payments to reduce individual health plan costs for those receiving premium tax credits, and state-subsidized coverage plans. Insurance companies and C corporations may purchase tax credits from the Department of Treasury by paying sale proceeds to reduce future tax liability. The Health Insurance Affordability Board must seek input from affected individuals before making final recommendations on plans and coverage.

SB 25-228: Enterprise Disability Buy-in Premiums

The Colorado healthcare affordability and sustainability enterprise must charge and collect Medicaid buy-in premiums from individuals eligible for Medicaid buy-in programs. The state department must establish premium payment schedules in consultation with the enterprise, based on a sliding-fee scale determined by the state board.

Took effect 1 May 2025

HB 25-1213: Updates to Medicaid

The state department must establish an annual process to review and update the general billing manual to include all necessary CPT codes or links to CPT codes. Managed care entities must submit annual payment and medical loss ratio information to the state department. The state department must not impose signature requirements beyond federal Centers for Medicare and Medicaid Services requirements for rehabilitation therapy plans of care.

HB 25-1033: Medicaid Third-Party Liability Payments

A third party must respond to state inquiries about health-care claims within sixty days by either paying the claim or issuing a written denial. Third parties must not deny claims solely based on submission date, claim form type or format, or missing documentation if the state commences enforcement within six years. Third parties must accept state payment as equivalent to prior authorization.

SB 22: An act to amend title 18 of the delaware code relating to insurance coverage.

Defines 'serious mental illness' using DSM-5 diagnostic criteria and allows health insurers to impose precertification, prior authorization, and referral requirements only for mental health disorders that do not meet this definition or for substance use disorders.

SB 347: An act to amend title 6 of the delaware code relating to the medical debt protection act

SB 13: An act to amend title 6 and title 16 of the delaware code relating to hospital charity care and financial assistance.

B 26-0438: Medical Debt Mitigation Amendment Act of 2025

Large health care facilities must establish financial assistance policies providing free care to patients with household income at or below 200% of federal poverty level and discounted care up to 400%. Facilities must offer 36-month payment plans with monthly payments not exceeding 3% of household income. Medical debt collectors must not report medical debt to consumer reporting agencies or garnish wages for patients below 400% poverty level.

HB 547: Medical Debt

Licensed facilities must not engage in extraordinary collection actions against individuals for medical debt before determining financial assistance eligibility, providing itemized bills, allowing insurer adjudication, and providing 30 days' written notice. Exception: facilities may sell debt under contracts prohibiting interest, fees, and other collection actions by the purchaser.

Took effect 1 July 2025

SB 276: Recovery of Medical Assistance from Third Party; certain provisions to comply with federal law; revise

Insurers, group health plans, managed care entities, pharmacy benefits managers, and other legally responsible parties must not refuse payment for healthcare items or services solely because prior authorization was not obtained. They must respond to Department of Community Health inquiries within 60 days and accept the department's authorization as their own.

SB 3025: Relating to medical debt.

The office of wellness and resilience must develop, implement, and administer a medical debt acquisition and forgiveness program to acquire and forgive outstanding medical debt for individuals with household income at or below four hundred percent of the federal poverty level, or with adjusted gross income under $100,000 and medical debt of at least five percent of household income. The office must contract with an entity holding medical debt and submit annual reports to the legislature.

SB 1411: Relating to medicaid third party liability.

Health insurers must not deny claims solely based on lack of prior authorization, submission date, claim format, or missing point-of-sale documentation. Insurers must respond to state inquiries within sixty calendar days regarding health care claims submitted within three years of service provision. Insurers must accept state medical assistance program authorization as prior authorization.

SB 3114: Transparency in downcoding act

Health care payors must not automatically downcode claims without human review of submitted information, must not downcode based solely on diagnosis codes, and must notify billing health care professionals of downcoding decisions with specific reasons, original and revised codes, and dispute processes allowing at least 90 days for submission.

Takes effect 1 January 2028

SB 225: Health matters.

Hospitals must comply with specified statutes (IC 16-21-6, IC 16-21-9, IC 16-21-17.1, IC 16-21-19) to pursue medical debt collection. Hospitals must provide written notice at least sixty days before closing or eliminating a service line for longer than ninety days, including patient continuity of care plans.

Took effect 1 July 2026

HB 1271: Payment of health claims.

Hospitals must provide written notice of payment assistance programs during registration, at discharge, and with initial billing statements; post conspicuous signage in registration areas, financial counseling offices, and emergency departments; make program information available through patient portals; and before beginning collection action, determine eligibility and notify individuals of available programs. Insurers and health maintenance organizations may not use downcoding to prevent providers from submitting claims for actual services performed or retroactively reduce CPT code reimbursement rates.

Took effect 1 July 2026

HB 1003: Health matters.

Clinical laboratories and diagnostic imaging facilities must post pricing information on their websites by December 31, 2025, including service descriptions and standard charges by payer category. Hospitals and ambulatory surgical centers must submit claims with appropriate place of service codes. Providers must provide patients written lists of services received and intended to be billed upon discharge.

Took effect 1 July 2025

HB 1474: FSSA matters.

The office of the secretary must administer home and community based services waivers, establish eligibility and certification criteria, serve as placement authority, and ensure waivers do not exceed available funding. Providers of assisted living services must follow federal waiver requirements. Personal services attendants must register with the office and individuals must employ them under approved contracts.

Took effect 1 July 2025

SB 480: Prior authorization.

Utilization review entities must not require prior authorization for the first twelve physical therapy or chiropractic visits of each new episode of care. Insurers must not deny claims for covered services solely because the referring provider is out of network. Utilization review entities must respond to prior authorization requests within specified timeframes and may not deny authorized claims except for fraud, materially incorrect information, or other enumerated grounds.

Took effect 1 July 2025

HF 2434: A bill for an act relating to insurance coverage for health care services provided pursuant to a referral by an out-of-network primary care provider.

Health carriers shall not deny coverage for a covered benefit solely because the referral was made by an out-of-network primary care provider. Health carriers shall not impose deductibles, coinsurance, or copayments exceeding those applicable for in-network referrals. Health carriers may require evidence of a direct primary care agreement.

Took effect 1 July 2026

HB 178: AN ACT relating to the psychiatric collaborative care model.

All health benefit plans providing coverage for mental health treatment must reimburse benefits delivered through the psychiatric collaborative care model, except insurers may deny reimbursement on medical necessity grounds if compliant with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and applicable utilization review requirements. This applies to plans issued, delivered, or renewed on or after January 1, 2027.

SB 10: AN ACT relating to retiree health provisions of the County Employees Retirement System.

Employers participating in the County Employees Retirement System must contribute to the insurance trust fund the amount necessary to provide the monthly contribution rate for retiree health benefits. Members who began participating on or after July 1, 2003, must have contributions deducted from creditable compensation at one percent for nonhazardous positions or two percent for hazardous positions.

LD 2129: An Act To Prohibit Liens On Principal Residences And Wage Garnishments For Medical Debt

Courts may not issue orders for wage garnishment or execute liens on a consumer's principal residence based on medical debt. Debt collectors may not initiate actions to attach a principal residence or garnish wages for medical debt. Interest may not be collected on execution of judgments related to liens on principal residences for medical debt.

LD 1937: An Act To Require Hospitals And Hospital-Affiliated Providers To Provide Financial Assistance Programs For Medical Care

Hospitals and hospital-affiliated providers must establish financial assistance programs and determine patient eligibility within 45 days of a completed application. They must provide information about accessing plain language summaries and applications in conspicuous locations. Patients with family income not exceeding 400% of federal poverty level must be offered payment plans with monthly payments not exceeding 4% of monthly family income. Online application filing must be available by July 1, 2028.

Took effect 1 July 2026

LD 1834: An Act To Allow Dental Care Providers To Opt In To Receive Claim Reimbursement Payments Made By Virtual Credit Cards

Upon request by a health care provider, a carrier shall provide the health care provider a method for making a claims payment using an electronic funds transfer through the automated clearinghouse network. The term health care provider includes persons licensed to provide dental care services, and carrier includes insurers that provide dental insurance.

LD 558: An Act To Strengthen Consumer Protections By Prohibiting The Report Of Medical Debt On Consumer Reports

A medical creditor, debt collector, or debt buyer may not report a consumer's medical debt to a consumer reporting agency. The act defines medical debt, medical creditor, debt buyer, and debt collector by reference to other Maine statutes.

HB 268: Hospitals - Financial Assistance and Collection of Debts - Policies

Hospitals must provide free medically necessary care to patients with family income at or below 200% of federal poverty level and reduced-cost care to those above 200% with specified percentage reductions. Hospitals must not file civil actions to collect debt within 240 days of initial bill, against patients with outstanding debt at or below $500, or against patients eligible for free or reduced-cost care without first determining eligibility and offering income-based payment plans.

Took effect 1 October 2025

HB 765: Hospitals - Medical Debt Collection - Sale of Patient Debt

Hospitals may sell patient medical debt only to governmental units, their contractors, or nonprofit organizations for the sole purpose of canceling the debt. Hospitals must dismiss pending collection actions on sold debt and prohibit further collection activities on it. Debt purchasers must notify patients that debt is canceled and seek to vacate judgments or strike adverse credit reporting.

SB 981: Hospitals - Financial Assistance and Collection of Debts - Policies

Acute care and chronic care hospitals must develop financial assistance policies providing free medically necessary care to patients with family income at or below 200% of federal poverty level and reduced-cost care to those above 200% with specified percentage reductions based on income brackets up to 500% of poverty level. Hospitals must prohibit civil debt collection actions for 240 days after initial billing, prohibit actions against patients with outstanding debt at or below $500, and provide income-based payment plans with monthly payments not exceeding 5% of household income.

Took effect 1 October 2025

HB 428: Medical Debt - Complaints for Money Judgment and Real Property Liens

A lien on owner-occupied residential property may not be created by contract or as a result of a breach of contract for the payment of medical debt. Complaints seeking a money judgment must indicate whether the judgment sought is for medical debt. Complaints seeking a money judgment for medical debt must include the address of the primary residence of the defendant.

Took effect 1 October 2025

SB 349: Medical Debt - Complaints for Money Judgment and Real Property Liens

A lien on owner-occupied residential property may not be created by contract or as a result of a breach of contract for the payment of medical debt. Complaints seeking a money judgment for medical debt must indicate whether the judgment is for medical debt and include the defendant's primary residence address.

Took effect 1 October 2025

HB 1020: Consumer Protection - Credit Reporting - Medical Debt (Fair Medical Debt Reporting Act)

Health care facilities, health care practitioners, and ambulance services must not disclose medical debt to consumer reporting agencies and must include in contracts with collection entities a provision prohibiting such disclosure. Consumer reporting agencies must not include medical debt information in consumer reports or maintain such information in consumer files. Persons must not use medical debt information to determine creditworthiness.

Took effect 1 October 2025

AB 52: Revises provisions relating to the payment of claims under policies of health insurance. (BDR 57-367)

Administrators of health insurance plans and all private health insurers must approve or deny claims and pay approved claims within 21 days if submitted electronically or 30 days if not. They must request additional information within 20 working days and pay interest at 10 percent per annum on late payments. They cannot deny claims without reasonable basis or request resubmitted information without legitimate reason.

Took effect 1 January 2026

HB 297: relative to providing self-funded employer health benefit plans access to their claims data.

Health carriers, licensed third party administrators, and entities registered under RSA 402-H must notify employers annually upon renewal of their option to authorize submission of self-funded health benefit plan claims data to the state system. If an employer authorizes submission, the insurance commissioner must provide the employer annual access to a utilization report based on de-identified and aggregated claims data.

HB 306: Prohibit certain health care facility fees

Beginning January 1, 2027, health care providers and health systems shall not charge facility fees directly from patients for preventive health care services, vaccination services, or telehealth services provided in outpatient settings. Exceptions apply to critical access hospitals, sole community hospitals in rural areas, and affiliated community clinics. Providers must notify patients of facility fees at appointment scheduling and service delivery, post visible signage, provide itemized bills, and report facility fee data to the all-payer claims database.

A 10008: Enacts into law major components of legislation necessary to implement the state transportation, economic development and environmental conservation budget for the 2026-2027 state fiscal year

Owners of motor vehicles in New York City who receive sixteen notices of liability for speeding violations in school speed zones within twelve months must install and maintain an intelligent speed assistance device for twelve to thirty-six months depending on repeat violations. Owners must provide proof of installation within thirty days and bear installation and maintenance costs unless financially unable.

Took effect 1 July 2026

A 3986: Relates to the use of virtual credit cards by insurers and certain health care plans

Insurers, health care corporations, and health care plans may pay provider claims using credit cards, virtual credit cards, or electronic funds transfer methods that impose fees only if they notify providers of potential fees in advance, offer an alternative fee-free payment method, and obtain provider consent. Vendors processing such payments must comply with these requirements.

Took effect 17 June 2026

S 753: Relates to the definition of medical debt

Amends the definition of medical debt in General Business Law to include any obligation related to health care services, products, or devices from hospitals, health care professionals, or ambulance services, excluding credit card debt unless the card is issued specifically for health care payments.

HB 1322: AN ACT to create and enact a new section to chapter 23-27 and a new section to chapter 26.1-47 of the North Dakota Century Code, relating to ambulance service balanced billing and provider reimbursement; to amend and reenact section 23-27-04.8 of the North Dakota Century Code, relating to emergency medical services communication; to provide for a legislative management study; and to provide an appropriation.

Health care insurers must pay ambulance service providers directly for covered services at the lesser of four hundred percent of the Medicare reimbursement rate or the provider's billed charges, excluding the covered person's cost-sharing amounts. Ambulance service providers must not balance bill covered individuals beyond their deductible, coinsurance, copayment, or other cost-sharing amounts.

HB 4040: Relating to health care; and declaring an emergency.

Hospitals licensed under ORS 441.025 must screen uninsured patients, those enrolled in state medical assistance, or those owing over $1,500 for presumptive eligibility for financial assistance before billing, without requiring documentation. Hospitals must adopt written appeal processes and suspend collection activities during pending appeals. Parent providers must be employed as direct support professionals or personal support workers to provide attendant care to their minor children with very high medical or behavioral needs.

HB 3409: Relating to health care; and prescribing an effective date.

The Department of Revenue shall annually adjust the maximum medical care expense subtraction allowable under Oregon tax law and the qualifying federal adjusted gross income levels by multiplying specified amounts by the percentage increase in the U.S. City Average Consumer Price Index for the 12 consecutive months ending August 31 compared to the index for the 12 consecutive months ending August 31, 2024.

HB 2010: Relating to funding to improve access to health care; and prescribing an effective date.

Extends health insurance premium assessments on insurers and managed care organizations, and hospital assessments through December 31, 2032, with repeal dates moved to January 2, 2038. Removes Oregon Reinsurance Program credit provision and makes conforming amendments to tax and fee statutes.

HB 7002: An act relating to businesses and professions -- board of medical licensure and discipline

Healthcare entities and health plans must pay complete written claims within 40 calendar days or complete electronic claims within 30 calendar days of receipt. They must not deny claims solely because the bill arose from a third-party claim, except workers' compensation claims. Physicians must not submit medical bills based solely on third-party claim status.

H 4069: Patient-Friendly Billing

Beginning January 1, 2027, healthcare facilities that request payment from patients must provide an electronic itemized bill and a written copy upon request. The itemized bill must include plain language descriptions compliant with Centers for Medicare and Medicaid Services reading-level requirements, the amount due, and the patient's responsibility amount per electronic remittance advice.

SB 2431: Health Care - As enacted, makes various changes to health-related laws, including, but not limited to, requiring the commissioner of health to prescribe conditions under which processed and verified claims data found on the UB-92 form are made available to the public; revising law relative to critical access hospitals, and revising law relative to certificates of need. - Amends TCA Title 33; Title 63 and Title 68.

Magnetic resonance imaging and positron emission tomography equipment that are not used for diagnostic purposes do not require a license under Tennessee Code Annotated Section 68-11-204. Magnetic resonance imaging and positron emission tomography used for diagnostic purposes require a license under that section.

Took effect 1 July 2026

SB 881: Insurance, Health, Accident - As enacted, removes the aggregate penalty limits for violations of law concerning pharmacy benefits managers; provides that a pharmacy benefits manager regulated under law relative to pharmacy benefits managers is subject to the insurance laws relative to timely reimbursement of health insurance claims and its requirements for timing of payments to pharmacists; provides that a violation of the prompt pay standards is governed by the penalties set out in insurance laws relative to timely reimbursement of health insurance claims. - Amends TCA Title 56.

Pharmacy benefits managers must pay clean claims within thirty calendar days for paper submissions or fourteen calendar days for electronic submissions. They must pay the covered amount, pay undisputed portions with written notice of disputed portions, or notify the provider in writing why the claim is not clean and what documentation is needed.

SB 1284: Boards and Commissions - As enacted, removes requirement that a license issued by a health related board be signed by members of the board prior to such issuance; authorizes the presiding officer to divide the board into panels to conduct contested case hearings or disciplinary matters; includes patient billing records as part of the medical and practice records that providers must make available for inspection upon the department's request; clarifies that identifying information of certain parties to a contested case hearing involving disciplinary charges filed against a provider must only be produced by the provider in response to a subpoena from a law enforcement agency. - Amends TCA Title 4; Title 63 and Title 68.

Healthcare providers and facilities licensed under Title 63 or Title 68 must make medical and practice records, including patient billing records, available for inspection and copying by the department of health within ten business days of a written request from department investigators or upon written patient authorization.

HB 216: Relating to itemized billing for health care services and supplies provided by health care providers.

A health care provider that requests payment from a patient for a health care service or supply must submit a written, itemized bill for each service and supply provided, not later than 30 days after receiving final payment from a third party. The provider must issue the bill electronically through a patient portal, by mail, or as a physical copy, and must mail or email a copy if the patient lacks an active patient portal.

Took effect 1 September 2025

HB 2254: Relating to certain health care services contract arrangements entered into by insurers and health care providers.

Preferred provider benefit plans and exclusive provider benefit plans may contract with primary care physicians or primary care physician groups for compensation through fee-for-service, risk-sharing, capitation, or combined arrangements. Insurers must not discriminate against physicians or groups electing not to participate in value-based or capitated arrangements. Contracts must specify performance measures, attribution processes, capitation terms, and shared savings calculations.

HB 4145: Relating to the timely billing of health care services related to a personal injury claim.

A health care service provider shall bill a patient or other responsible person for services provided not later than the first day of the 11th month after the date services are provided. If services relate to a personal injury claim where the patient is represented by an attorney, the provider may instead submit the bill to the patient's attorney by that deadline unless otherwise directed.

Took effect 1 September 2025

SB 2480: Relating to the Texas Physician Health Program and the regulation of certain occupations by the Texas Medical Board; expanding the applicability of surcharges.

The Texas Medical Board shall run continuous queries on the National Practitioner Data Bank for all individuals holding licenses regulated by the board and update physician profiles within 10 working days of finding new information. The board shall collect surcharges not exceeding $15 for license issuance and renewal to administer the Texas Physician Health Program and a separate surcharge to cover continuous query costs.

Took effect 1 September 2025

SB 815: Relating to the use of certain automated systems in, and certain adverse determinations made in connection with, the health benefit claims process.

Utilization review agents may not use automated decision systems to suggest, recommend, generate, or assist in making adverse determinations; only appropriate physicians, dentists, or other licensed health care providers may make adverse determinations. Health maintenance organizations and insurers must disclose in written explanations of benefits whether artificial intelligence was used in the claims process and describe the method if applicable.

Took effect 1 September 2025

SB 916: Relating to consumer protections against certain medical and health care billing by emergency medical services providers.

Emergency medical services providers must submit correct information required under Section 38.006, Insurance Code. Political subdivisions may annually adjust rates submitted under Section 38.006 by not more than the lesser of the Medicare Ambulance Inflation Factor or 10 percent of the provider's previous calendar year rates.

Took effect 1 September 2025

HB 142: Relating to the Health and Human Services Commission's office of inspector general, the review of certain Medicaid claims, and the recovery of certain overpayments under Medicaid.

Recovery audit contractors must obtain approval from the office of inspector general or its designee before initiating a claim review, and must determine the review would be cost-effective. Contractors may not initiate recovery efforts if a managed care organization is already auditing the claim. Managed care organizations and providers must submit requested information within specified timeframes.

Took effect 1 September 2025

SB 855: Relating to the authority of certain medical consenters to assume financial responsibility for certain out-of-network medical care provided to children in foster care.

A medical consenter other than the department may assume financial responsibility for out-of-network medical care provided to a foster child. The medical consenter must notify the child's caseworker within 10 business days of care provision. A Medicaid managed care organization may not take adverse action to prevent or discourage access to such care.

Took effect 1 September 2025

S 27: An act relating to medical debt relief and excluding medical debt from credit reports

Credit reporting agencies must not report or maintain medical debt information in consumer files. Large health care facilities and medical debt collectors must not report medical debt to credit reporting agencies. The State Treasurer shall contract with a nonprofit entity to purchase and abolish medical debts of Vermont residents with household income at or below 400 percent of federal poverty level or owing medical debt of five percent or more of household income.

Took effect 1 July 2025

HB 184: All-Payer Claims Database; Virginia Department of Health shall conduct an evaluation, report.

The Virginia Department of Health, in consultation with Virginia Health Information, shall conduct an evaluation of the All-Payer Claims Database and submit a report to the Governor and General Assembly no later than December 1, 2026. The report must include findings on capabilities and limitations, recommendations for improving utility, analysis of necessary legislative and regulatory changes, and a proposed implementation timeline.

Took effect 1 July 2026

HB 603: Virginia All-Payer Claims Database; disclosure of information, limitation.

Data suppliers including health insurers, third-party administrators, and government health plans must submit paid claims data to the Virginia All-Payer Claims Database. The nonprofit organization must protect patient privacy, not disclose provider-specific reimbursement information beyond what is publicly available, and provide affected entities 30 days to review accuracy before public release of reports naming providers or where one provider represents 60 percent or more of data.

Took effect 1 July 2026

SB 164: Health insurance; ethics and fairness in carrier business practices, downcoded claims.

Carriers must pay clean claims within 40 days of receipt, notify providers of defects within 30 days, disclose bundling and downcoding policies, permit providers to dispute downcoded claims within 180 days, and prohibit retroactive denials of previously paid claims except within 12 months for fraud or duplicate payment.

HB 606: Medical care facility data reporting; value of charity care, gross patient charges, report.

Every medical care facility subject to certificate of public need conditions must annually report charity care data including total amount, number of patients, specific services, and service portions. The value must be based on Centers for Medicare and Medicaid Services methodology using gross patient charges. Nursing homes must report utilization and other data per Board regulations.

HB 618: Health insurance; reporting requirements.

The Department of Human Resource Management must establish and administer a health insurance plan for state employees that includes mandated benefits such as screening mammograms, postpartum services, early intervention services, contraceptive coverage, cancer drug coverage, diabetes equipment and training, reconstructive breast surgery, and colorectal cancer screening. Health carriers must report annually on mandated benefits' costs and utilization.

HB 676: Health insurance claims; electronic attachments accepted, delayed effective date.

Carriers must accept electronic attachments for health insurance claims documentation and shall not require paper, facsimile, or other nonelectronic submission. Carriers must pay clean claims within 40 days of receipt and notify providers of defects within 30 days. Beginning January 1, 2026, all notifications must be delivered electronically.

Takes effect 1 January 2027

HB 1725: Medical Debt Protection Act; created, prohibited practices, penalties.

Large health care facilities and medical debt buyers must not charge interest or late fees on medical debt. Medical creditors and medical debt collectors must not use extraordinary collection actions to collect medical debts. Medical creditors must not sell medical debt unless the buyer agrees not to use extraordinary collection actions, charge interest, or violate financial assistance procedures. Collection actions cannot begin until 120 days after first bill, with 30 days' notice required.

HB 2085: Health insurance; carrier business practices, method of payment for claims.

Carriers must pay clean claims within 40 days of receipt and notify providers of defects within 30 days. Carriers must include specific contract provisions regarding fee schedules, reimbursement policies, bundling and downcoding disclosures, prior authorization procedures, and prohibitions on retroactive denials beyond 12 months. Carriers must offer alternative payment methods without transaction fees.

Took effect 1 July 2025

HB 2375: Prescription drug price transparency; pharmacy services administrative organizations.

Carriers, pharmacy benefits managers, pharmacy services administrative organizations, wholesale distributors, and manufacturers must annually report prescription drug pricing and rebate information to a nonprofit data services organization by April 1. The Department shall contract with a nonprofit data services organization to collect and publicly aggregate this data without disclosing proprietary information.

SB 925: Health insurance; carrier business practices, method of payment for claims.

Carriers must pay clean claims within 40 days of receipt, notify claim submitters of defects within 30 days, offer alternative payment methods without transaction fees, provide bundling and downcoding policies within 10 business days upon request, and prohibit retroactive denials of previously paid claims except within 12 months for fraud or duplicate payment.

Took effect 1 July 2025

HB 2441: Concerning medical insurance premium reimbursements for surviving spouses of line of duty deaths.

The retirement allowance paid to surviving spouses, domestic partners, and dependent children of members killed in the course of employment must include reimbursement for medical insurance premium payments from the date of the member's death through determination of line of duty death, including employer-provided insurance, COBRA, and Medicare Parts A and B.

HB 1382: Modernizing the all payers claim database.

The health care authority must establish or select a lead organization through competitive procurement to coordinate and manage a statewide all-payer health care claims database. Data vendors must collect, process, and secure claims data from carriers, third-party administrators, and public programs. The lead organization must release data only in compliance with privacy protections and established procedures.

SB 5480: Protecting consumers by removing barriers created by medical debt.

Persons, health care providers, health care facilities, and licensed collection agencies must not furnish information regarding medical debt to consumer credit reporting agencies. Medical debt becomes void and unenforceable if this prohibition is violated. Collection agencies must provide itemized statements to debtors upon request and cease collection efforts until provided.

SB 5493: Concerning hospital price transparency.

Hospitals shall publish all data and comply with all rules related to hospital price transparency pursuant to 45 C.F.R. Part 180, subparts A and B, as they existed on January 1, 2025, by July 1, 2027. Beginning July 1, 2027, hospitals shall submit the most recent machine-readable file and consumer-friendly list of standard charges to the department at least once a year.

SF 57: Transparency in hospital service pricing.

Hospitals must maintain and publicly display lists of standard charges for all facility items and services, including at least 300 shoppable services or all shoppable services provided. Lists must be free, searchable, digitally accessible without login, updated annually, and displayed prominently on the facility's website.