Coverage, prior authorization and utilization review laws by state

SB 63: Health care plans; to regulate the use of artificial intelligence in determinations of coverage

Insurers must ensure that determinations to deny, reduce, or defer prior authorization requests are always made by a licensed physician or other competent health care professional, not exclusively by artificial intelligence. Insurers must base AI-assisted determinations on the enrollee's medical history, clinical circumstances, and medical records, and must disclose AI use to plan sponsors or enrollees.

Took effect 1 October 2026

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 110: An Act relating to the rural health transformation program; relating to the interstate medical licensure compact; relating to the PA licensure compact; relating to the psychology interjurisdictional compact; relating to the practice of respiratory care; relating to the duties of the Department of Commerce, Community, and Economic Development; relating to telehealth provided by respiratory care practitioners; relating to a social work licensure compact; relating to the practice of social work; relating to medical malpractice liability of respiratory care practitioners; relating to immunity from civil liability for a respiratory care practitioner providing free health care services; relating to national criminal history record checks; relating to respiratory care practitioners providing documentation and treatment plans for public school students with asthma or anaphylaxis; relating to the recognition of EMS personnel licensure interstate compact; prohibiting unfair discrimination under group health insurance against respiratory care practitioners; establishing the Rural Health Transformation Program Advisory Council; and providing for an effective date.

The Department of Commerce, Community, and Economic Development must regulate respiratory care practitioners under AS 08.90. Applicants for expedited medical licenses, compact privileges for audiologists and speech-language pathologists, and physician assistant licenses must submit fingerprints and fees for criminal history record checks. Respiratory care practitioners must use appropriate professional identification letters or titles on all signs, stationery, and advertising.

HB 14: An Act relating to health care insurance; relating to insurance reimbursement for health care services provided through telehealth; relating to telehealth; relating to workers' compensation coverage for disability from diseases for certain firefighters; repealing programs for catastrophic illness assistance and medical assistance for chronic and acute medical conditions; relating to occupational disability benefits and medical benefits available under the public employees' retirement system; providing for an effective date by amending the effective date of secs. 9 and 10, ch. 38, SLA 2022; and providing for an effective date.

Health care insurers must reimburse health care providers for health care services, including behavioral health services, provided through telehealth on the same basis and at least at the same rate as comparable in-person services, though geographic pay differentials may apply to out-of-state providers. Municipalities offering group health care insurance plans must comply with these telehealth reimbursement requirements.

SB 89: An Act relating to physician assistants; relating to collaborative agreements between physicians and physician assistants; relating to the practice of medicine; relating to health care providers; and relating to provisions regarding physician assistants in contracts between certain health care providers and health care insurers.

Physician assistants with less than 4,000 hours of postgraduate clinical experience must practice under a written collaborative agreement with a collaborating physician who oversees their performance. Health care insurers may not impose practice, education, or collaboration requirements on physician assistants that are inconsistent with or more restrictive than requirements under AS 08.64.

SB 133: An Act relating to prior authorization requests for medical care covered by a health care insurer; relating to a prior authorization application programming interface; relating to step therapy; and providing for an effective date.

Health care insurers offering health plans issued or renewed on or after January 1, 2027, must establish prior authorization processes complying with specified standards, including responding to standard requests within 72 hours and expedited requests within 24 hours, maintaining an API for prior authorization automation, and prohibiting step therapy mandates for Stage 4 advanced metastatic cancer drugs on their formulary.

Takes effect 1 January 2027

HB 2308: dental insurers; dental practice; prohibition

A dental insurer or holding company may not have any ownership interest in a business organization that offers professional services regulated by the board. Business entities offering dental services must register with the board, file applications describing services and responsible dentists, and establish written protocols for secure storage and transfer of patient dental records.

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 1320: To amend the law concerning crisis stabilization units and healthcare insurers.

Healthcare insurers shall not impose behavioral or medical management utilization limitations, measures, or controls for healthcare services by crisis stabilization units unless equivalent to or consistent with Medicaid limitations, or authorized by the Insurance Commissioner by rule. Healthcare insurers shall not require prior authorization or precertification for crisis stabilization unit services unless required by Insurance Commissioner rule.

HB 1321: To regulate step therapy and fail first protocols concerning certain prescribed ventilators.

Healthcare insurers shall not require step therapy or fail first protocols for noninvasive ventilators if the ventilator requires frequent or substantial servicing, clinical evidence suggests alternative treatments will be less effective or cause adverse reactions, or the ventilator is deemed medically necessary by the FDA. Medicaid managed care organizations must reimburse noninvasive ventilators at no less than one hundred percent of the Arkansas Medicaid Program fee schedule.

HB 1300: To amend the prior authorization transparency act.

Healthcare insurers and utilization review entities must provide prior authorization information to contracted healthcare providers, including step therapy requirements, site of service restrictions, benefit category restrictions, excluded services, and post-service review requirements, either individually or in aggregated format on their websites, with sixty days' notice of changes.

HB 1298: To modify payment of benefits for certain healthcare providers under a health benefit plan.

A healthcare insurer shall pay claims for indemnity provided by a health benefit plan on account of hospital, nursing, medical, or surgical services directly to the healthcare provider that provided the service for an out-of-network claim.

AB 1876: Health care coverage: nondiscrimination.

Health care service plans and health insurers licensed in California must not exclude, deny benefits to, or discriminate against subscribers, enrollees, policyholders, or insureds based on race, color, national origin, age, disability, or sex, including sex characteristics, intersex traits, pregnancy, sexual orientation, gender identity, and sex stereotypes. They must not deny, limit, or impose additional cost sharing on coverage based on sex assigned at birth, gender identity, or gender-affirming care.

Takes effect 1 January 2027

AB 1979: Health care services: artificial intelligence.

A health facility, clinic, physician's office, or office of a group practice must ensure no clinical decision is based solely on a clinical decision support system's output and that a licensed health care professional retains independent professional judgment when reviewing such decisions. A business offering a health care chatbot is deemed a provider of health care subject to confidentiality requirements.

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

SB 331: Health care coverage: hearing aids.

Large group health care service plans and large group health insurers must cover hearing aids for enrollees and insureds under 21 years of age if medically necessary, effective January 1, 2027. Coverage must include initial assessment, new hearing aids at least once every three years, earmolds, fittings, adjustments, auditory training, and maintenance, with maximum required coverage of $3,000 per individual hearing aid and no deductible, coinsurance, or copayment.

Takes effect 1 January 2027

AB 1629: Dental coverage.

Health care service plans and health insurers covering dental services must pay noncontracting dental providers directly for covered services upon written assignment of benefits from enrollees, provide predetermination or prior authorization, and reimburse at least that amount. Noncontracting dental providers must disclose they are noncontracting and may not charge enrollees more than estimated cost-sharing before plan payment.

Takes effect 1 January 2027

AB 1696: Emergency services and care: nurse-midwives.

Health facilities and health care service plans shall not require physician supervision of a nurse-midwife licensed under Business and Professions Code Section 2746.5 when the nurse-midwife provides emergency services and care in labor and delivery units, obstetric triage, or dedicated emergency obstetric evaluation units within the scope of licensure, or when specifically requested by the treating physician for obstetric consultation.

Takes effect 1 January 2027

AB 1770: Arbitration: health care service plans: Lindalee's Law.

Health care service plans and health insurers must include annual disclosures stating parties may appeal arbitration decisions based on legal or factual error. By February 1, 2027, the Department of Managed Health Care must establish a panel of qualified arbitrators. All arbitrations between health care service plans and enrollees after that date must use department-assigned arbitrators, with the plan paying arbitrator and court reporter costs.

Takes effect 1 January 2027

AB 1843: Communicable diseases: hepatitis C.

Health care service plans and health insurers must not subject direct-acting antiviral drugs medically necessary for hepatitis C treatment to prior authorization, except that if FDA-approved therapeutic equivalents exist, they need only cover one pangenotypic version without prior authorization. Both must align clinical criteria with standards of the American Association for the Study of Liver Diseases and Infectious Diseases Society of America and cannot request liver biopsy, genotype testing, proof of sobriety, fibrosis staging thresholds, elastography documentation, ultrasound documentation, or specialist referral for prior authorization purposes.

Takes effect 1 January 2027

AB 1887: Prescription drug coverage for rare diseases.

Health care service plans and health insurers must complete prior authorization or utilization review within 30 days for prescription drugs approved for rare diseases when prescribed by specialists who determine medical necessity, unless biosimilars, interchangeable biologics, or generics are available. Health care service plans and health insurers must not impose step therapy for such drugs.

Takes effect 1 January 2027

AB 1906: Health care coverage: home test kits.

Health care service plans and health insurers must provide coverage without cost sharing for cervical cancer screening tests ordered by in-network providers and consistent with nationally recognized clinical guidelines, including FDA-authorized or cleared self-collected cervical screening home test kits, for plans issued, amended, or renewed on or after January 1, 2027. Medi-Cal must cover cervical cancer screening tests and FDA-authorized home test kits ordered by health care providers without cost sharing on or after January 1, 2027.

Takes effect 1 January 2027

AB 2233: Behavioral health treatment plans.

Health care service plans and health insurers must not impose restrictions on utilization of authorized behavioral health treatment hours within the six-month authorization period, including weekly caps or forfeitures due to unavoidable circumstances. Authorized hours must remain available throughout the authorization period if use is reasonably consistent with the treatment plan and clinical guidelines.

Takes effect 1 January 2027

AB 280: Health care coverage: provider directories.

Health care service plans and health insurers must annually verify and delete inaccurate provider directory listings, meeting accuracy benchmarks of 60% by July 1, 2026, increasing to 95% by July 1, 2029. They must provide coverage for services when enrollees reasonably relied on inaccurate directory information and reimburse providers the out-of-network amount.

Takes effect 1 January 2027

SB 950: Health care coverage: dementia.

Health care service plans and health insurers must include coverage for all medically necessary FDA-approved treatments or medications for Alzheimer's disease or related dementia in contracts issued, amended, or renewed on or after January 1, 2027. They must not impose step therapy protocols as a prerequisite to authorizing such coverage, except that at least one antiamyloid therapy must be covered without step therapy.

Takes effect 1 January 2027

SB 964: Prescription drug coverage: dose adjustments.

Health care service plans and health insurers must grant treating providers authority to adjust a drug's dose or frequency without prior authorization when the drug was previously approved for a chronic medical condition or cancer treatment, the drug is not an opioid or scheduled controlled substance, the dose has not been adjusted more than twice without prior authorization, and off-label uses are supported by two major peer-reviewed medical journal articles.

Takes effect 1 January 2027

SB 1023: Health care coverage: antiretroviral drugs, drug devices, and drug products.

Health care service plans and health insurers must not subject antiretroviral drugs, drug devices, or drug products medically necessary for HIV/AIDS prevention to prior authorization or step therapy, except that at least one therapeutically equivalent version must be covered without such restrictions. Contracts or policies issued, amended, or renewed on or after January 1, 2027, covering non-self-administered antiretroviral drugs approved by the FDA must also include them as outpatient prescription drug benefits.

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

AB 2613: Health care service plans: provider contract termination: notice.

Health care service plans must notify enrollees by United States mail at least 60 days before contract termination with a provider group or general acute care hospital. Plans must also send electronic notice via text message or email if the enrollee has opted in and provided contact information. If the plan later reaches an agreement with the terminated provider, the plan must notify affected enrollees within 60 days and offer the option to return to that provider.

Takes effect 1 January 2027

AB 1126: Medi-Cal managed care plans: enrollees with other health care coverage.

The State Department of Health Care Services must ensure that providers not contracted with Medi-Cal managed care plans do not face administrative requirements significantly exceeding those for billing the fee-for-service system. Providers participating in fee-for-service need not contract with managed care plans to bill for Medi-Cal allowable costs for enrollees with other health coverage, except managed care plans may require agreements for prior authorization or non-covered services.

Takes effect 1 January 2027

SB 125: Medi-Cal: managed care organization provider tax.

Health plans must pay a managed care organization provider tax of $8.85 per countable enrollee per month for calendar years 2027, 2028, and 2029. The State Department of Health Care Services must not collect the tax until the Director certifies federal compliance or receives federal approval. Tax revenues fund Medi-Cal administrative costs and capitation payments.

AB 224: Health care coverage: essential health benefits.

Health insurers must include essential health benefits in individual and small group health insurance policies issued, amended, or renewed on or after January 1, 2027, if the United States Department of Health and Human Services approves a new benchmark plan, including coverage for specified fertility services, durable medical equipment, and hearing exams and aids.

SB 40: Health care coverage: insulin.

Health care service plans and health insurers must limit cost sharing for insulin prescription drugs to $35 for a 30-day supply for large group plans issued after January 1, 2026, and individual or small group plans issued after January 1, 2027. They must not impose step therapy as a prerequisite to insulin coverage starting January 1, 2026, and must include at least one insulin per drug type on formularies.

SB 497: Legally protected health care activity.

Providers of health care, health care service plans, and contractors must not release medical information related to individuals seeking or obtaining gender-affirming health care or mental health care in response to subpoenas based on another state's laws that interfere with such rights. State and local agencies must not provide CURES data or resources to further out-of-state investigations based on another state's laws regarding legally protected health care activity.

SB 62: Health care coverage: essential health benefits.

Health care service plans must include essential health benefits in individual or small group contracts issued, amended, or renewed on or after January 1, 2027, if the United States Department of Health and Human Services approves a new benchmark plan, including fertility services, specified durable medical equipment, and hearing exams and aids.

AB 1041: Health care coverage: health care provider credentials.

Full service health care service plans and health insurers, or their delegates, must subscribe to and use the CAQH credentialing form on and after January 1, 2028. They must make credentialing determinations within 90 days of receiving completed applications and notify applicants of receipt within 10 business days. Providers must be activated and notified within 10 days of approval.

AB 836: Midwifery Workforce Training Act.

Upon legislative appropriation, requires the Department of Health Care Access and Information to fund and administer a statewide study on midwifery education conducted by an outside consultant, and to report findings to the Legislature and post the report online within 36 months.

SB 41: Pharmacy benefits.

Pharmacy benefit managers must use passthrough pricing models, derive income only from pharmacy benefit management fees, and direct 100 percent of manufacturer rebates to payers. They must not require use of only affiliated pharmacies, discriminate against nonaffiliated pharmacies, conduct spread pricing, or impose reconciliation reductions on pharmacist services.

AB 543: Medi-Cal: field medicine.

Medi-Cal managed care plans that elect to offer field medicine services must allow members experiencing homelessness to receive services directly from in-network field medicine providers regardless of PCP or IPA assignment, allow field medicine providers to directly refer members for covered services, establish care coordination mechanisms, and provide methods for members to report homelessness status. The department must reimburse field medicine providers in fee-for-service systems and include an optional homelessness question on insurance affordability program applications by January 1, 2027.

AB 894: General acute care hospitals: patient directories.

Beginning July 1, 2026, general acute care hospitals must inform patients or their representatives at admission that they may restrict or prohibit use or disclosure of protected health information in the hospital's patient directory. Hospitals must provide this information using a separate document with a checkbox and verbal notification, in the top five non-English languages spoken in the hospital's service area.

SB 306: Health care coverage: prior authorizations.

Health care service plans and health insurers must report prior authorization statistics by December 31, 2026. By January 1, 2028, they must cease requiring prior authorization for covered health care services approved at rates of 90 percent or higher, as identified by their respective departments. They may reinstate prior authorization only for specific providers based on clear and convincing evidence of fraud or clinically inappropriate care.

SB 402: Health care coverage: autism.

Health care service plans and health insurers must include qualified autism service providers, qualified autism service professionals, and qualified autism service paraprofessionals in provider directories with accurate, current information. Plans must update online directories weekly and printed directories quarterly, investigate reported inaccuracies within 30 business days, and allow providers to verify directory information.

SB 530: Medi-Cal: time and distance standards.

Medi-Cal managed care plans must maintain provider networks meeting specified time and distance standards through January 1, 2029. Plans must ensure subcontractor networks comply with appointment time standards, demonstrate annual compliance to the department, inform enrollees of telehealth and transportation options, and submit documentation of provider contracting efforts.

SB 439: California Health Benefit Review Program: extension.

Health care service plans and health insurers must pay annual assessments determined by the Department of Managed Health Care and Department of Insurance in consultation with the University of California. Total annual assessment shall not exceed three million two hundred thousand dollars for fiscal years 2026–27 to 2032–33, inclusive. Assessments must be paid by August 1 each year.

SB 386: Dental providers: fee-based payments.

Health care service plans and health insurers that provide payment to dental providers must offer a non-fee-based default payment method. They must obtain the dental provider's affirmative consent before offering fee-based payment and must apply any opt-in or opt-out decision to the provider's entire practice and all covered products or services.

Took effect 1 January 2026

SB 81: Health and care facilities: information sharing.

Providers of health care, health care service plans, and contractors must not disclose medical information for immigration enforcement except as expressly authorized by a patient or as required by law. Health care provider entities must establish procedures for monitoring visitors, immediately notify management of immigration enforcement requests, and prohibit access to nonpublic areas for immigration enforcement unless a valid judicial warrant or court order specifically grants such access. Compliance required within 45 days.

AB 951: Health care coverage: behavioral diagnoses.

Health care service plans and health insurers must not require enrollees or insureds previously diagnosed with pervasive developmental disorder or autism to receive a rediagnosis to maintain coverage for behavioral health treatment, effective for contracts issued, amended, or renewed on or after January 1, 2026. Treatment plans must be made available upon request. Plans and insurers must not discontinue or delay existing treatment while awaiting rediagnosis.

Took effect 1 January 2026

HB 1414: Medical Record Requests

Health-care facilities and health-care providers must provide copies of patient medical records to patients, personal representatives, or third parties with valid authorization, subpoena, or court order. For requests exceeding 664 pages by attorneys, total fees must not exceed 400 dollars. Records must be invoiced within 30 days and provided upon payment, or provided at no cost if delayed beyond 30 days without written extension notice.

HB 1429: County Administration Public Assistance Programs

State departments must contract with a single county department to operate a centralized member integrity service by July 1, 2027, handling fraud investigations and program integrity functions for six public assistance programs. State departments must establish performance-based contracts with county departments by July 1, 2027, and implement a redesigned public benefits delivery model of no more than twelve county cohorts by July 1, 2028.

HB 1139: Use of Artificial Intelligence in Health Care

SB 178: Health Insurance Affordability Measures

HB 1336: Increase Access to Pharmacy Services

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.

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 25-193: Sunset Primary Care Payment Reform Collaborative

Extends the sunset date of the Primary Care Payment Reform Collaborative from September 1, 2025 to September 1, 2032, and adds pediatric primary care providers to the collaborative's membership and alternative payment model development considerations.

HB 25-1094: Pharmacy Benefit Manager Practices

Pharmacy benefit managers must earn income only through a single flat-dollar service fee transparently expressed in written agreements with health benefit plans. PBMs must not earn income based on prescription drug prices, mark-ups, copayments exceeding drug costs, or manufacturer revenues. PBMs must reimburse pharmacies at national average drug acquisition cost plus reasonable dispensing fees and disclose cost information to health benefit plans within thirty days.

SB 25-308: Medicaid Services Related to Federal Authorizations

Creates two reinvestment cash funds for unspent Medicaid appropriations: one for health-related social needs services and one for reentry services for justice-involved individuals, with annual transfers beginning June 30, 2026, and appropriates $14,971,442 for fiscal year 2025-26.

SB 25-301: Remove Authorization Requirement Adjust Chronic Prescription

A prescribing provider may adjust the dose or frequency of a chronic maintenance drug prescription without prior authorization or subsequent utilization management if the drug was previously approved for the covered person's chronic or debilitating disease, is not an opioid or scheduled controlled substance, has not been adjusted more than two times without prior authorization, and the adjustment is based on evidence-based guidelines.

HB 25-1309: Protect Access to Gender-Affirming Health Care

All health benefit plans issued or renewed in Colorado must provide coverage for gender-affirming health care as medically necessary and prescribed by a physical or behavioral health-care provider, regardless of the covered person's sex or gender. Health benefit plans shall not deny or limit such coverage when medically necessary and prescribed in accordance with generally accepted standards of care.

SB 25-196: Insurance Coverage Preventive Health-Care Services

Health insurance policies must cover preventive health-care services according to task force recommendations, ACIP recommendations, or comprehensive guidelines. If those recommendations are repealed or modified, the commissioner may adopt rules requiring coverage based on guidelines in effect in January 2025 or recommendations from the Nurse-Physician Advisory Task Force. Health savings account-qualified policies are exempt to the extent necessary for federal qualification.

SB 25-183: Coverage for Pregnancy-Related Services

All individual and group health benefit plans issued or renewed in Colorado must provide coverage for the total cost of abortion care, except employers whose sincerely held religious beliefs conflict with providing such coverage or public employers prohibited by the state constitution from using public funds for induced abortions. The Medical Services Board must include abortion care in the schedule of health-care services for all enrolled pregnant persons on and after January 1, 2026.

Took effect 1 January 2026

HB 25-1002: Medical Necessity Determination Insurance Coverage

Carriers offering health benefit plans must provide coverage for behavioral, mental health, and substance use disorders no less extensive than physical illness coverage, apply utilization review criteria consistent with generally accepted standards and nationally recognized clinical specialty association guidelines, establish procedures to authorize medically necessary treatment with nonparticipating providers when in-network services are unavailable, and provide meaningful benefits across all benefit classifications.

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.

HB 5374: An act concerning health coverage mandates for certain health conditions.

Individual and group health insurance policies delivering coverage for chemotherapy on or after January 1, 2027 must provide coverage for scalp cooling systems at least equivalent to Medicare coverage. Policies cannot impose coinsurance, copayment, deductible or out-of-pocket expenses more restrictive than other benefits, except high deductible health plans are exempt from deductible limits. Prior authorization may be required on the same basis as other covered benefits.

Takes effect 1 January 2027

SB 10: An act concerning health insurance and patient protection.

Health carriers must file annual certifications with the Insurance Commissioner by March 1, 2026, and annually thereafter, certifying compliance with state and federal mental health and substance use disorder benefit reporting requirements. Insurance companies must limit step therapy to thirty days, prohibit mail order pharmacy requirements, and establish override processes for treating providers.

Took effect 1 January 2026

SB 1473: An act requiring medicaid coverage for fda-approved gene therapies to treat sickle cell disease.

The Commissioner of Social Services shall provide Medicaid coverage for gene therapies approved by the federal Food and Drug Administration to treat sickle cell disease. The commissioner shall apply for federal initiatives to increase cost-effective access to these therapies. The commissioner shall file a report by January 1, 2026, detailing efforts to increase access, number of recipients served, state costs, and estimated appropriations needed.

SB 120: An act to amend titles 18, 29, and 31 of the delaware code relating to health insurance.

Insurers, health-benefit plans, and health-service corporations must provide coverage for biomarker testing when medically necessary and supported by FDA approvals, drug labels, CMS determinations, or nationally recognized clinical practice guidelines. Coverage must limit disruptions in care including multiple biopsies. Excludes screening and investigational tests.

SB 319: An act to amend title 18, title 29, and title 31 of the delaware code relating to coverage for diagnostic services and treatment for menopause, perimenopause, and menopause and perimenopause symptoms.

Insurers and carriers must provide coverage for medically necessary diagnostic services and treatment for menopause, perimenopause, and related symptoms in individual health insurance policies, group and blanket health insurance policies, state employee health plans, and state Medicaid plans. Coverage for medically necessary hormone replacement therapy cannot be denied, limited, or subject to prior authorization or step therapy if supported by national clinical guidelines, national standards of care, or peer-reviewed medical literature.

SB 334: An act to amend titles 18 and 29 of the delaware code relating to health care.

Carriers requiring provider credentialing must use uniform credentialing applications beginning January 1, 2028, establish written credentialing policies, verify credentials before contracting, and render credentialing decisions within 30 days of clean applications. Carriers must provide provisional credentials to certain health care professionals and cannot charge application fees.

Takes effect 1 January 2028

HB 435: An act to amend titles 18, 29, and 31 of the delaware code relating to certified registered nurse anesthetists.

Health insurers, health service corporations, health maintenance organizations, and carriers must reimburse certified registered nurse anesthetists at rates not less than those paid to licensed physicians for the same services. They may establish variable rates based on quality or performance measures.

SB 238: An act to amend title 24, title 29, and title 31 of the delaware code relating to insurance coverage for chiropractic therapy and physical therapy.

HB 506: Social services; Medicaid coverage for tobacco cessation treatments; provide

Healthcare plans must cover emergency transport service as a covered service when requested by a first responder. Out-of-network ambulance providers must receive minimum reimbursement of the lesser of 325 percent of Medicare Part A or B rates or billed charges. Insurers must remit payment within 30 days of receiving a clean claim directly to the ambulance provider.

Takes effect 1 January 2027

SB 444: Private Review Agents; certain decisions with regard to the provision of insurance coverage for healthcare services shall not be based solely on artificial intelligence systems; provide

Private review agents and utilization review entities must not issue adverse determinations based solely on artificial intelligence systems, artificial intelligence, or other software tools. A natural person qualifying as a private review agent or utilization review entity must conduct utilization review with clinical peer participation before any adverse determination, and such systems shall not supersede the clinical peer's judgment.

Takes effect 1 January 2027

HB 196: State employees' health insurance plan; drugs dispensed for self-administration; provisions

On and after January 1, 2026, insurers must reimburse pharmacies for drugs dispensed to covered persons for self-administration under state health plans using the national average drug acquisition cost plus a professional dispensing fee of at least $10.50 for chain pharmacies and $11.50 for independent pharmacies. Insurers must not circumvent these reimbursement requirements through prescription drug discount cards or programs.

HB 422: State employees' health insurance; include high deductible health plans

The board must ensure that at least two high deductible health plans from different insurance providers are included in the state employees' health insurance plan by January 1, 2028, provided bids are cost neutral. By January 1, 2026, the board must ensure covered employees enrolled in such plans can make pretax contributions to health savings accounts through salary deductions. The State Accounting Office and state governmental entities must be authorized to deduct amounts designated by covered employees for health savings account contributions.

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 5: Private Review Agents; health insurers to implement and maintain a program that allows for the selective application of reductions in prior authorization requirements; provide

Each insurer that utilizes prior authorization requirements must implement and maintain a program allowing selective reductions in prior authorization requirements based on healthcare providers' performance and adherence to evidence-based medicine. Insurers must file program details with the department by July 1, 2026, and annually thereafter. Health benefit policies issued or renewed on or after July 1, 2025, must cover healthcare services for PANDAS and PANS when supported by nationally recognized clinical practice guidelines, subject to standard deductibles but not special deductibles.

Took effect 1 July 2025

SB 847: Relating to psychologists.

Licensed clinical psychologists meeting specified education, training, and examination requirements may prescribe psychotropic medications only to patients at federally qualified health centers in Kauai County under supervision of a licensed physician or psychiatrist. The state health planning and development agency must report to the legislature by twenty days before the 2030 regular session with recommendations on the pilot program's expansion, permanence, or termination.

HB 1974: Relating to health.

The state agency shall develop and publish a comprehensive state plan on hearing loss by twenty days prior to the 2027 regular legislative session, and submit update reports by twenty days prior to each odd-numbered regular session thereafter, covering assessment of current policies, epidemiological data, gaps in screening, access to care, workforce development, and recommendations for improving services and affordability.

SB 3045: Relating to health insurance.

Health insurers, hospital and medical service plans, and health maintenance organizations in Hawaii must provide coverage for continuous glucose monitors and related supplies for individuals diagnosed with diabetes, including gestational diabetes, regardless of insulin use, for policies issued or renewed after December 31, 2026. Coverage must include repairs and replacement parts and be subject to no less favorable cost-sharing than other medical services.

HB 1875: Relating to health care.

Covered entities must not disclose protected health information for investigations into persons seeking, receiving, providing, or facilitating reproductive or gender-affirming health care services lawful in Hawaii. Insurers issuing medical malpractice policies must not deny, cancel, or refuse to renew policies solely because providers offer such lawful services. Health carriers must not terminate contracts with providers on that sole basis.

Took effect 1 July 2026

HB 2319: Relating to the state health planning and development agency.

The state agency must promote universal access to high-quality, equitable, and affordable health care for all people of the State. The state agency must conduct health planning activities in collaboration with state agencies and private health care sector participants to assess and address gaps affecting access, quality, and cost, including artificial intelligence. The state agency must establish and update a state health services and facilities plan at least every four years.

HB 1643: Relating to pharmacy.

Entities conducting audits of registered pharmacists or pharmacies must provide written electronic notice at least two weeks before on-site audits, identify prescriptions by number or date range, consult a registered pharmacist for clinical judgments, and limit audit periods to two years. Clerical errors alone cannot constitute fraud or be recouped unless they result in actual overpayment or wrong medication dispensing.

SCR 50: Establishing the hawaii health plan working group to design and recommend a basic, affordable hawaii health plan available to every resident of the state.

Establishes the Hawaii Health Plan Working Group to design and recommend a basic, affordable health plan available to all state residents. The working group must submit findings and recommendations to the Legislature by twenty days before the 2027 Regular Session and ceases to exist June 30, 2027.

SB 1245: Relating to pharmacists.

Insurers issuing individual or group accident and health insurance policies and mutual benefit societies issuing hospital or medical service plan contracts in Hawaii must recognize pharmacists licensed under chapter 461 as participating providers, provide coverage for services provided by participating registered pharmacists within their scope of practice to the same extent as other health care providers, and pay or reimburse pharmacists for covered services. These requirements apply to policies and contracts delivered or issued for delivery on or after July 1, 2026.

HB 250: Relating to health.

Utilization review entities doing business in the State must submit annual prior authorization data to the state agency by January 31 each year in a format specified by the agency. The state agency must compile and post findings by March 1. A health care appropriateness and necessity working group must research clinical standards and make recommendations on prior authorization processes.

H 648: INSURANCE – Adds to existing law to establish provisions regarding coverage of anticancer medications under health benefit plans.

Health benefit plans issued or renewed on or after January 1, 2027, must ensure that coverage for prescribed orally administered Food and Drug Administration-approved anticancer medications is subject to the same plan design cost sharing with respect to copayment, coinsurance, and deductible as injected or intravenously administered anticancer medications.

Took effect 1 July 2026

H 38: INSURANCE – Amends existing law to revise provisions of the Idaho Life and Health Insurance Guaranty Association Act.

The Idaho Life and Health Insurance Guaranty Association must provide coverage for specified life, health, and annuity policies and contracts issued by member insurers, subject to defined coverage limitations and exclusions. Member insurers must pay authorized and called assessments to fund the association's obligations.

Took effect 1 July 2025

HB 1331: Network adequacy-genetic med

The Department of Insurance shall consider establishing ratios for providers of genetic medicine and genetic counseling as part of network adequacy standards for insurers providing network plans. Insurers must demonstrate minimum ratios of these providers to plan beneficiaries and maximum travel and distance standards for beneficiaries to access genetic medicine and genetic counseling services.

Took effect 1 January 2026

HB 2464: Ins-health/neonatal cost share

Health insurance issuers must ensure that patients incur no greater out-of-pocket costs for neonatal care at any hospital than they would with in-network providers, applying in-network cost-sharing based on the recognized amount. No health insurer may charge out-of-network rates for neonatal care at any hospital.

Took effect 1 January 2026

SB 189: Nonparticipating providers.

Health carriers may not assess health provider facilities or providers an administrative fee related to provision of care to an individual involving an out of network provider.

Took effect 1 July 2026

HB 1114: Coverage for certain cancer prescriptions.

State employee health plans, policies of accident and sickness insurance, and health maintenance organizations that provide coverage for advanced, metastatic cancer and associated conditions may not require that an insured or covered individual fail to successfully respond to a different prescription drug or prove a history of failure of a different prescription drug before providing coverage for a qualifying prescription drug.

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 1587: Insurance matters.

State employee health plans, policies of accident and sickness insurance, and health maintenance organization contracts must provide reimbursement for emergency medical services performed by certified advanced life support provider organizations during 911 responses or as part of mobile integrated healthcare programs. Managed care organizations and providers may agree in writing to different reimbursement rates for emergency department services, subject to secretary review.

Took effect 1 July 2025

HB 1604: Cost sharing; out-of-pocket expense credit.

A health plan must credit toward a covered individual's deductible and annual maximum out-of-pocket expenses any amount the covered individual pays directly to a health care provider for a medically necessary covered health care service if no claim is submitted and the amount paid is less than the health plan's average discounted network rate. A health plan must establish a procedure for claiming credits, identify required documentation, and publish average discounted rates on its website.

Took effect 1 July 2025

HB 1666: Ownership of health care providers.

Hospitals must file annual financial reports within 120 days of fiscal year end, including ownership information for persons or entities with at least 5% ownership interest, controlling interest, or private equity partnership interest. Health care entities, insurers, third party administrators, and pharmacy benefit managers must report similar ownership information to the secretary of state or department of insurance.

Took effect 1 July 2025

SB 140: Pharmacy benefits.

Ambulatory pharmacies must provide dispensing cost data to the Indiana board of pharmacy before March 1, 2027, and March 1 of every other year thereafter. Insurers, pharmacy benefit managers, and other pharmacy benefit administrators must ensure networks are reasonably adequate and accessible, file annual reports, and comply with minimum reimbursement requirements and prohibitions on retroactive denials and discriminatory practices.

Took effect 1 January 2026

SB 146: Teacher compensation.

Beginning June 30, 2025, school corporations must pay teachers a minimum salary of $45,000 and expend at least 65% of state tuition support on teacher compensation. School corporations and charter schools must provide health coverage under a state employee health plan if less expensive than alternatives. Full-time teachers receive 20 days paid parental leave; part-time teachers receive 10 days upon birth, adoption, or stillbirth.

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 473: Various health care matters.

Managed care organizations must submit home modification requests to certified project specification writers within 15 days, approve or deny with explanation within 15 days, request bids within 5 days of approval, and notify winning and unsuccessful bidders within 30 days. Opioid treatment programs must conduct monthly random drug tests for patients testing positive until passing. Programs may close Sundays and federal holidays. Medical directors need not obtain hospital admitting privileges.

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

HB 1466: Various agency administrative procedures.

The secretary of family and social services is the ultimate authority for Medicaid applicant and recipient eligibility appeals. For Medicaid applicant eligibility cases, the administrative law judge's order becomes final after 61 days without further affirmation from the ultimate authority, absent objection or notice. The department of child services is the ultimate authority for reviews of residential child care base rates.

Took effect 1 July 2025

SB 3: Fiduciary duty in health plan administration.

Any third party administrator, pharmacy benefit manager, employee benefit consultant, or insurance producer acting on behalf of a plan sponsor owes a fiduciary duty to the plan sponsor.

Took effect 1 July 2025

HF 2635: A bill for an act relating to health carriers standards of conduct; utilization review organizations, artificial intelligence, audits, and prior authorizations; certificate of need processes; and including applicability provisions.

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

HF 2739: A bill for an act relating to state finances by modifying the taxes imposed on health maintenance organizations, making transfers from the taxpayer relief fund, making and supplementing appropriations to the department of health and human services, and including effective date, contingent effective date, and retroactive applicability provisions.

Each health maintenance organization transacting business in Iowa must pay a health care-related tax equal to ninety-five hundredths of one percent of the applicable percentage of taxable funds, commencing January 1, 2026. Health maintenance organizations must remit prepayments on or before June 1 and August 15 based on prior year taxable funds.

HF 303: A bill for an act relating to prior authorization and utilization review organizations.

SF 565: A bill for an act providing for the continuation of health insurance in certain circumstances for the surviving spouse and each surviving child of employees of the state of Iowa and including retroactive applicability provisions.

HF 875: A bill for an act relating to health insurers’ credentialing process.

SF 470: A bill for an act relating to prior authorization for dental care services, notice to dental care providers that a dental care service plan is state-regulated, and the recovery of overpayments by a dental carrier.

Took effect 1 July 2025

HF 309: A bill for an act relating to the review by the department of inspections, appeals, and licensing of certain deficient practices by nursing facilities.

The department of inspections, appeals, and licensing shall establish and maintain a process to review each deficient practice identified by the department for which a citation may be issued to a nursing facility for immediate jeopardy or substandard quality of care prior to issuance of final findings. Representatives of the nursing facility may participate in the review to provide context and evidence.

Took effect 1 July 2025

HB 2: AN ACT relating to Medicaid, making an appropriation therefor, and declaring an emergency.

The cabinet must condition Medicaid eligibility on demonstrated community engagement for applicable individuals by January 1, 2027, requiring monthly engagement of eighty hours of work, community service, education, or equivalent income. The cabinet must begin providing notice by July 1, 2026, and conduct eligibility redeterminations every six months starting July 1, 2026.

SB 173: AN ACT relating to legislative oversight of the Medicaid state plan and declaring an emergency.

The Department for Medicaid Services must submit by July 1 each year to the Legislative Research Commission copies of current Medicaid and KCHIP state plans and summaries of all state plan amendments approved, denied, or pending with CMS since the prior July 1. The Medicaid Oversight and Advisory Board must review these by August 31 and the Interim Joint Committee on Health Services must review by October 31.

HB 169: AN ACT relating to coverage for feeding or eating disorders.

Health plans must provide coverage for diagnosis and treatment of feeding or eating disorders. Insurers offering such coverage cannot deny, limit, or restrict coverage based on body mass index, ideal body weight, or achieved weight standards, but may consider eating behaviors, supervised meals, laboratory results, recovery environment, and co-occurring disorders when determining medical necessity.

HB 176: AN ACT relating to prior authorization.

Every insurer shall offer a program allowing participating providers to qualify for prior authorization exemptions for covered health care services based on meeting performance standards during an evaluation period. Insurers must not condition exemptions on exceeding a 93% approval rate and must conduct annual evaluations and notify qualifying providers within 30 days.

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.

HB 689: AN ACT relating to the establishment of a Medicaid state-directed payment program.

The Department for Medicaid Services must submit a Medicaid preprint with January 1, 2026 effective date to the federal Centers for Medicare and Medicaid Services within sixty days of the Act's effective date. Qualifying hospitals must report applicable quality measures. Medicaid managed care organizations must make enhanced add-on payments to qualifying hospitals based on commercial or Medicare rates.

HB 527: AN ACT relating to insurance regulatory requirements and declaring an emergency.

The act amends Kentucky insurance regulatory definitions and requirements. Insurers must consider complaints before issuing or renewing certificates of authority or licenses. Licensed business entities must designate individuals to act under their licenses and maintain at least one designated licensee at all times. Financial institutions engaging in insurance activities must comply with all applicable licensing provisions and provide required consumer disclosures.

SB 97: AN ACT relating to coverage for prostheses and orthoses.

All health benefit plans must provide coverage for prostheses and orthoses at least equivalent to Medicare coverage, including coverage for materials, components, instruction, repair, and replacement without continuous use or useful lifetime restrictions. Insurers must maintain reasonably adequate networks with at least two distinct licensed prosthetists or orthotists and must make utilization review decisions nondiscriminatorily without denying coverage solely based on disability.

Takes effect 1 January 2027

HB 870: INSURANCE/HEALTH: Provides relative to formulary placement and cost-sharing requirements for certain generic drugs and biosimilars (EN NO IMPACT See Note)

Health insurance issuers must provide detailed accounting of portfolio rebates or discounts by NDC when net cost is based on rebates including multiple drugs. Issuers must not remove reference listed drugs from formularies, increase cost sharing, or impose new utilization management for current users unless the provider agrees a switch is medically appropriate or a medical-necessity exception is granted.

HB 1235: INSURANCE/HEALTH: Modifies provisions of law regarding health insurance coverage of prosthetic and custom orthotic devices and services (EN INCREASE EX See Note)

Health coverage plans must determine eligibility and coverage limits for prosthetic and orthotic devices based on medical necessity in consultation with the enrollee's medical providers. Coverage must equal at minimum the federal payment rates under 42 U.S.C. 1395k, 1395l, and 1395m. Plans may not exclude coverage for devices designed for physical activity or showering and bathing through blanket exclusions.

HB 1196: INSURANCE/HEALTH: Provides relative to coverage of colorectal cancer screening, colonoscopies, and associated preventive services (EN NO IMPACT See Note)

HB 622: INSURANCE/HEALTH: Requires health insurance coverage for histotripsy procedures (EN NO IMPACT See Note)

Creates an advisory board within the Department of Insurance to review and provide medical recommendations for approving new treatments for rare cancers, specifies the board's composition of 14 members from various health organizations and agencies, and requires quarterly public meetings with written reports submitted to the legislature.

LD 1502: An Act To Update The Requirements For Health Insurance Coverage Of Prostate Cancer Screening

Individual and group nonprofit hospital and medical services plans, individual insurance policies, group insurance policies, and health maintenance organization contracts must provide coverage for services for the early detection of prostate cancer (digital rectal examination and prostate-specific antigen test) if recommended by a physician at least once a year for men 50 years of age or older until age 72 when supported by the most recently published nationally recognized clinical practice guideline. These entities must not impose any deductible, copayment, coinsurance, or other cost-sharing requirement for these services.

LD 163: An Act To Require Health Insurance Coverage For Federally Approved Nonprescription Oral Hormonal Contraceptives And Nonprescription Emergency Contraceptives

Nonprofit hospital and medical services plans, insurers offering individual and group health policies, and health maintenance organizations must provide coverage for all federally approved nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives without deductibles, coinsurance, copayments, or cost-sharing. Coverage must last 12 months and require no prescription.

LD 178: An Act Regarding Coverage For Step Therapy For Advanced Metastatic Cancer

Carriers and utilization review organizations may not require enrollees to use step therapy protocols before providing coverage of FDA-approved prescription drugs for treatment of metastatic cancer and associated conditions. These requirements apply to health plans issued or renewed on or after January 1, 2026.

LD 843: An Act To Continue Funding For The Health Insurance Consumer Assistance Program

Amends the reporting deadline for the Health Insurance Consumer Assistance Program from January 15th to January 31st and appropriates $300,000 annually for fiscal years 2025-26 and 2026-27 to fund the program through a designated nonprofit entity.

LD 1785: An Act To Encourage Competition By Requiring Independent Health Care Provider Cost-Of-Living Adjustments In Health Insurance Contracts

Carriers offering health plans must include compensation increases in contracts with individual practices not affiliated with hospitals or group practices up to 25 members not affiliated with hospitals, reflecting Consumer Price Index for All Urban Consumers increases year-over-year for plans issued or renewed on or after January 1, 2026. Carriers may not reduce fees except to reflect changes to national relative value unit standards. Carriers may not alter reimbursement during 2025 to reduce baseline reimbursement to offset required compensation increases.

LD 270: Resolve, Regarding Legislative Review Of Portions Of Chapter 850: Health Plan Accountability, A Major Substantive Rule Of The Department Of Professional And Financial Regulation, Bureau Of Insurance

Authorizes final adoption of the Department of Professional and Financial Regulation's Chapter 850 Health Plan Accountability rule only if two amendments are made: replacing name and title requirements with credential attestations and non-involvement confirmations, plus carrier contact information requirements in adverse decision notices.

SB 496: Maryland Medical Assistance Program - Coverage for the Treatment of Obesity - Authorization

Beginning January 1, 2027, the Maryland Medical Assistance Program may provide comprehensive coverage for the treatment of obesity, including intensive behavioral therapy, bariatric surgery, and FDA-approved medications for chronic weight management. If the Department elects to provide this coverage, it must notify Program recipients.

Took effect 1 October 2026

HB 1091: Health Insurance and Dental Plan Organizations - Dentists - Assignment of Benefits and Reimbursement of Nonpreferred Providers

Insurers may not prohibit assignment of benefits to dentists or refuse to directly reimburse nonpreferred dentists. Dental plan organizations may not prohibit assignment of benefits to dentists or refuse to directly reimburse nonpreferred dentists. Nonpreferred dentists seeking assignment of benefits must provide specified disclosures to enrollees before performing services and submit disclosure forms to document assignments.

Takes effect 1 January 2027

HB 1093: Health Insurance - Provider Panels - Requirements

Carriers must send written notice within 15 days of receiving a completed provider application stating intent to continue processing or rejection, sent to the email or mailing address listed. Carriers must accept or reject providers within 30-60 days and send written notice. Carriers must update provider directories at least every 15 days using the online credentialing system as primary information source. Carriers cannot charge application fees or limit numbers of behavioral health providers, federally qualified health center providers, local health department providers, school-based health center providers, or other essential community providers.

Took effect 1 October 2026

HB 1118: Health, Health Insurance, and Health Occupations - Perinatal Behavioral Health Conditions

Carriers must provide standing referrals to mental health care providers for members during pregnancy and 1 year after birth. Insurers, nonprofit health service plans, and health maintenance organizations must cover screening for perinatal mental health conditions at each prenatal visit, within 6 weeks postpartum, and at each well child visit within the first year. Health care providers must provide perinatal mental health information to patients and conduct screenings. Applicants renewing health occupation licenses must complete 2 continuing education credit hours on perinatal mental health conditions.

Took effect 1 October 2026

HB 445: Maryland Medical Assistance Program and Health Insurance - Coverage for Orthoses and Prostheses (So Every Body Can Move Act)

Beginning January 1, 2027, insurers, nonprofit health service plans, and health maintenance organizations must provide annual coverage for orthoses, orthosis components, repairs, and replacements. Coverage must include all orthoses a treating health care provider determines medically necessary for activities of daily living, job-related activities, or physical activities to maximize health and limb function. The Maryland Medical Assistance Program must provide the same orthosis coverage.

Takes effect 1 January 2027

HB 684: Health Insurance - Material Changes to Provider Networks - Notification and Special Enrollment Period

Carriers must notify enrollees of termination of primary care providers and behavioral health care providers within 3 months of claims, including contact information and instructions for transitional care. Carriers and health systems must provide 90 days' written notice before contract termination or nonrenewal. Carriers and health systems must continue adhering to contract terms for 90 days after termination. Carriers must provide special enrollment periods for individuals whose providers are terminated from the plan.

Took effect 1 October 2026

HB 746: Maryland Medical Assistance Program and Health Insurance - Collaborative Care Model - Cost Sharing Prohibition and Coverage Requirements

The Maryland Department of Health may not impose copayments, coinsurance, or deductibles for Collaborative Care Model services provided to Program recipients. Insurers, nonprofit health service plans, and health maintenance organizations may not impose such cost sharing for Collaborative Care Model services, except that high-deductible health plan enrollees may be subject to the plan's deductible.

Took effect 1 July 2026

SB 276: Maryland Medical Assistance Program and Health Insurance - Coverage for Orthoses and Prostheses (So Every Body Can Move Act)

Beginning January 1, 2027, insurers, nonprofit health service plans, and health maintenance organizations must provide annual coverage for orthoses, orthosis components, repairs, and replacements. The Maryland Medical Assistance Program must provide the same coverage. Coverage must include all orthoses a treating health care provider determines medically necessary for daily living, job activities, or physical activities to maximize health and limb function.

Takes effect 1 January 2027

SB 428: Maryland Medical Assistance Program and Health Insurance - Collaborative Care Model - Cost Sharing Prohibition

The Maryland Department of Health must implement and provide reimbursement for Collaborative Care Model services statewide in primary care settings and may not impose copayments, coinsurance, or deductibles for such services. Insurers, nonprofit health service plans, and health maintenance organizations must provide coverage for Collaborative Care Model services and may not impose cost-sharing except deductibles for high-deductible health plans.

Took effect 1 July 2026

SB 521: Health Insurance - Material Changes to Provider Networks - Notification and Special Enrollment Period

Carriers must notify enrollees of provider terminations including behavioral health providers with claims in the prior 3 months, offer 90-day continuity of care, and provide contact information and complaint procedures. Carriers and health systems must give 90 days' notice before terminating contracts and continue adhering to contract terms for 90 days post-termination. Carriers must provide special enrollment periods for patients of terminated providers.

Took effect 1 October 2026

SB 808: Health Insurance - Provider Panels - Requirements

Carriers must send written notice within 5 or 15 days of receiving a completed provider application stating intent to continue processing or rejection. Carriers must accept the uniform credentialing form as sole application for provider credentialing. Carriers cannot limit numbers of behavioral health providers, federally qualified health center providers, local health department providers, school-based health center providers, or other essential community providers on panels.

Took effect 1 October 2026

SB 891: Health, Health Insurance, and Health Occupations - Perinatal Behavioral Health Conditions

Carriers must provide standing referrals to mental health care providers for pregnant members and 1 year postpartum. Insurers, nonprofit health service plans, and health maintenance organizations must cover screening for perinatal mental health conditions at prenatal visits, within 6 weeks postpartum, and at well child visits within the first year. Health care providers evaluating pregnancy or postpartum care must provide information and conduct screenings. License renewal applicants managing perinatal populations must complete 2 continuing education credit hours on perinatal mental health conditions by April 1, 2027.

Took effect 1 October 2026

HB 1376: Maryland Medical Assistance Program, Maryland Children's Health Program, and Health Insurance - Transfers to Special Pediatric Hospitals - Requirements

The Maryland Medical Assistance Program, Maryland Children's Health Program, managed care organizations, insurers, nonprofit health service plans, and health maintenance organizations must provide prior authorization determinations for transfers to special pediatric hospitals within 3 business days upon request by a special pediatric hospital or referring health care provider, and must reimburse for all administrative days at the applicable rate from the medical necessity determination date until retrospective review conclusion.

Takes effect 1 January 2027

HB 1094: Health Insurance - Graduate-Level Clinical Interns - Required Reimbursement

Insurers and nonprofit health service plans must reimburse insureds and covered persons for services provided by graduate-level counseling, social work, and psychology clinical interns when services are provided at outpatient health care facilities under direct supervision of appropriately licensed professionals and billed by the supervising professional.

Takes effect 1 January 2027

HB 280: Health Insurance - Mental Health and Substance Use Disorders - Codification of Federal Requirements

Carriers must identify and conduct comparative analyses of nonquantitative treatment limitations applied to mental health, substance use disorder, and medical/surgical benefits. Carriers must collect and evaluate relevant data on access impacts, provide comparative analyses within 30 days of member request, and submit reports to the Commissioner. Carriers must demonstrate that nonquantitative treatment limitations are applied no more stringently to mental health and substance use disorder benefits than to medical/surgical benefits.

Took effect 1 July 2026

HB 637: Public Health - Recommendations for Immunizations, Screenings, and Preventive Services - Pharmacist Administration and Required Health Insurance Coverage (The Vax Act)

The Secretary of Health must issue recommendations for immunizations, screenings, and preventive services based on guidance from specified authoritative medical organizations and federal agencies, holding a 30-day notice and comment period before adopting non-immunization preventive service recommendations. Pharmacists may administer specified vaccinations to individuals at least 3 years old if they complete required training and comply with reporting requirements. Carriers must provide coverage without cost-sharing for recommended immunizations and preventive services.

Took effect 1 July 2026

SB 910: Health Insurance - Graduate-Level Clinical Interns - Required Reimbursement

Insurers and nonprofit health service plans must reimburse insureds and covered persons for services provided by graduate-level counseling, social work, and psychology clinical interns when services are provided at outpatient health care facilities under direct supervision of appropriately licensed professionals and billed by the supervising professional.

Takes effect 1 January 2027

HB 1087: Health Insurance - Step Therapy or Fail-First Protocols - Drugs to Treat Associated Conditions of Advanced Metastatic Cancer

Insurers, nonprofit health service plans, and health maintenance organizations may not impose step therapy or fail-first protocols on prescription drugs used to treat stage four advanced metastatic cancer or its associated symptoms or treatment side effects, if the drug is FDA-approved and use is consistent with FDA-approved indications, National Comprehensive Cancer Network Compendium indications, or best practices, and supported by peer-reviewed medical literature.

Took effect 1 January 2026

HB 11: Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage

Carriers must establish procedures allowing members to request referrals to nonparticipating specialists or nonphysician specialists when the carrier lacks appropriate providers or cannot provide reasonable access. For mental health or substance use disorder services, carriers must provide additional assistance identifying and arranging coverage. Carriers cannot require prior authorization for scheduling, reimbursing, or continuing treatment with nonparticipating providers.

Took effect 1 June 2025

HB 1243: Health Insurance - Coverage for Specialty Drugs

Insurers, nonprofit health service plans, and health maintenance organizations may not exclude coverage for covered specialty drugs administered or dispensed by in-network medical oncology providers who comply with state regulations, if the drugs are infused, auto-injected, oral targeted immune modulators, or oral medications requiring complex dosing or used with infusion or radiation therapies. Reimbursement rates must be agreed upon and may not exceed designated specialty pharmacy rates.

Took effect 1 January 2026

HB 1251: Hospitals and Medical Professional Liability Insurers - Obstetric Services Policies (Doula and Birth Policy Transparency Act)

Health care facilities providing obstetric care must adopt and provide evidence to the Maryland Department of Health of a policy allowing certified doulas at birth, prioritizing newborn bonding, prohibiting significant medical interventions without informed consent, detailing processes for receiving medical information from health care providers, and establishing transfer processes for pregnant persons. Insurers issuing medical professional liability insurance in the State must provide the Department information regarding their obstetric services coverage policies upon request.

Took effect 1 October 2025

HB 1292: Health Insurance - Provider Directory - Required Updates

Carriers must update provider directory information on the Internet within 2 working days after receiving notification from a participating provider of a change, except dental carriers which have 15 working days. Carriers must verify and update their provider directory at least once every 90 days. Carriers must update printed directories at least annually and include a statement about accuracy and how to obtain current information.

Took effect 1 October 2025

HB 1301: Maryland Medical Assistance Program, Maryland Children’s Health Program, and Health Insurance – Transfers to Special Pediatric Hospitals – Prior Authorizations

Beginning January 1, 2026, the Maryland Medical Assistance Program, the Maryland Children's Health Program, insurers, nonprofit health service plans, and health maintenance organizations may not require prior authorization for transfers to special pediatric hospitals. A special pediatric hospital is a state facility providing nonacute medical, rehabilitation, therapy, and palliative services to individuals under 22 years old or those 2 to 23 years old with co-occurring physical and behavioral health conditions.

Took effect 1 January 2026

HB 1315: Vaccinations by Pharmacists and Health Insurance Coverage for Immunizations

Each individual hospital or major medical insurance policy, group or blanket health insurance policy, and nonprofit health service plan delivered or issued in the State must include coverage for all visits and costs of childhood and adolescent immunizations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention or the American Academy of Pediatrics. These policies and plans may not impose a deductible on such coverage.

Took effect 1 January 2026

HB 1351: Health Insurance - Provider Panels - Credentialing for Behavioral Health Care Professionals

Carriers must accept providers on their provider panels if the providers deliver community-based health services under COMAR 10.63.02 and hold specified licenses as social workers, counselors, therapists, or psychology associates. Carriers must notify providers of application status within 30 days and make acceptance or rejection decisions within 60 days for specified behavioral health professionals or 120 days for others.

Took effect 1 October 2025

HB 297: Maryland Health Benefit Exchange - State-Based Young Adult Health Insurance Subsidies Pilot Program - Sunset Repeal

The Maryland Health Benefit Exchange may establish and implement the State-Based Young Adult Health Insurance Subsidies Program to provide subsidies to young adults for health benefit plans in the individual market, but may not implement the program for calendar years when funds from the assessment under § 6–102.1 are not available. The Exchange must track monthly expenditures and impacts on rates and post information on its website.

Took effect 1 July 2025

HB 666: Maryland Medical Assistance Program and Health Insurance - Required Coverage for Calcium Score Testing

Insurers, nonprofit health service plans, health maintenance organizations, and managed care organizations must provide coverage for calcium score testing for individuals with at least three of the following risk factors: diabetes, high blood pressure, high cholesterol, or family history of premature coronary artery disease, in accordance with American College of Cardiology guidelines. The Maryland Medical Assistance Program must provide such coverage beginning January 1, 2026.

Took effect 1 January 2026

HB 718: Maryland Health Insurance Coverage Protection Commission - Established

Establishes the Maryland Health Insurance Coverage Protection Commission to monitor and assess impacts of federal changes to the ACA, MHPAEA, Medicaid, Medicare, and related programs, and provide recommendations to protect residents' access to affordable health coverage. The Commission expires June 30, 2029.

Took effect 1 June 2025

HB 820: Health Insurance - Utilization Review - Use of Artificial Intelligence

Carriers, pharmacy benefits managers, and private review agents using artificial intelligence, algorithms, or software tools for utilization review must ensure these tools base determinations on individual enrollee medical history and clinical circumstances rather than group datasets alone, do not replace healthcare provider roles, do not discriminate, are fairly applied, undergo quarterly performance reviews, and cannot deny, delay, or modify health care services. Carriers must report quarterly whether artificial intelligence was used in adverse decisions.

Took effect 1 October 2025

HB 848: Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations

Carriers must include specific information in prominent bold print at the top of adverse decision and grievance decision notices, including that the notice is a denial, the member may appeal or file a complaint, and contact information for the private review agent's dedicated phone and email. Carriers must submit quarterly reports to the Commissioner aggregated by zip code, and if adverse decisions for a service type grow more than 10% annually or 25% over three years, must describe contributing changes and efforts to determine reasons for the increase.

Took effect 1 October 2025

HB 970: Health Insurance - Insulin - Prohibition on Step Therapy or Fail-First Protocols

Insurers, nonprofit health service plans, and health maintenance organizations may not impose step therapy or fail-first protocols on insured or enrollee prescriptions for insulin or insulin analogs used to treat type 1, type 2, or gestational diabetes, or other prescription drugs performing similar insulin functions.

Took effect 1 January 2026

HB 974: Health Insurance - Preventive Services - High Deductible Health Plans and Enforcement Authority

Carriers must provide coverage without cost-sharing requirements for evidence-based items or services rated A or B by the United States Preventive Services Task Force, immunizations recommended by the Advisory Committee on Immunization Practices, and preventive care guidelines supported by the Health Resources and Services Administration. Out-of-network cost-sharing is permitted.

Took effect 1 June 2025

SB 474: Health Insurance - Adverse Decisions - Notices, Reporting, and Examinations

Carriers must include specific information in adverse decision and grievance decision notices, including prominent bold print stating the notice is a denial, that members may appeal or file complaints, and a dedicated telephone number and email address for utilization review. Private review agents must post utilization review criteria on member and provider website pages and maintain a dedicated telephone number and monitored email address responding within 2 business days.

Took effect 1 June 2025

SB 547: Commission to Study Health Insurance Pooling - Establishment

Establishes the Commission to Study Health Insurance Pooling to analyze pooling public employee health insurance purchasing between the State, counties, municipal corporations, and county boards of education, and report findings and recommendations by December 1, 2026.

Took effect 1 July 2025

SB 641: Health Insurance - Required Coverage - Hearing Aids

Insurers, nonprofit health service plans, and health maintenance organizations must provide coverage for hearing aids prescribed, fitted, and dispensed by a licensed audiologist or licensed hearing aid dispenser for both minor children and adults. Entities may limit benefits to $1,400 per hearing aid per ear every 36 months.

Took effect 1 January 2026

SB 773: Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements

Insurers, nonprofit health service plans, health maintenance organizations, administrators, carriers, and pharmacy benefits managers must include discounts, financial assistance payments, product vouchers, and other out-of-pocket expenses paid by or on behalf of enrollees when calculating cost-sharing contributions. These entities cannot set coverage terms based on availability of financial assistance. Third parties providing assistance must notify enrollees within 7 days of acceptance.

Took effect 1 January 2026

SB 902: Health Insurance - Access to Nonparticipating Providers - Referrals, Additional Assistance, and Coverage

Carriers must establish procedures allowing members to request referrals to nonparticipating specialists or nonphysician specialists when the carrier lacks adequate in-network providers or cannot provide reasonable access. For mental health and substance use disorder services, carriers must provide additional assistance identifying coverage if referral procedures fail. Carriers cannot require prior authorization for scheduling, reimbursing, or continuing treatment with approved nonparticipating providers.

Took effect 1 June 2025

SB 975: Health Insurance - Coverage for Specialty Drugs

Insurers, nonprofit health service plans, and health maintenance organizations may not exclude coverage for covered specialty drugs administered or dispensed by in-network medical oncology providers who comply with state regulations, if the drugs are infused, auto-injected, oral targeted immune modulators, or oral medications requiring complex dosing or used with infusion or radiation therapies. Reimbursement rates must be agreed upon or not exceed designated specialty pharmacy rates.

Took effect 1 January 2026

HB 1045: Health Insurance, Family Planning Services, and Confidentiality of Medical Records - Consumer Protections - Updates

The Department shall ensure continuity of family planning services through family planning providers, including those that lost federal Title X funding due to scope of services. The Department may not accept Title X federal funds if the program excludes family planning providers or does not require them to provide a broad range of medically approved family planning methods. The Commissioner shall adopt regulations consistent with specified federal provisions as of December 31, 2024.

Took effect 1 June 2025

HB 1082: Health Insurance - Individual Market Stabilization - Establishment of the State-Based Health Insurance Subsidies Program

The Maryland Health Benefit Exchange, in consultation with the Insurance Commissioner and as approved by the Board, must establish and implement a State-Based Health Insurance Subsidies Program to provide subsidies to individuals purchasing health benefit plans in the individual market, designed to maintain affordability and target individuals experiencing increased applicable percentages for premiums in calendar year 2026 compared to 2025.

Took effect 1 July 2025

HB 1069: Life and Health Insurance Policies and Annuity and Health Maintenance Organization Contracts - Discretionary Clauses - Prohibition

Carriers, defined as insurers, nonprofit health service plans, and health maintenance organizations, may not sell, deliver, or issue health insurance policies, life insurance policies, annuity contracts, or disability insurance policies in Maryland if the policy contains a clause reserving sole discretion to the carrier to interpret policy terms or providing standards of interpretation inconsistent with Maryland law.

Took effect 1 October 2025

HB 94: Opioid-Associated Disease Prevention and Outreach Programs - Appeals and Membership of Standing Advisory Committee

The Secretary of Health or the Secretary's designee must grant or deny appeals from local health departments or community-based organizations regarding adverse authorization decisions within 60 days and provide written explanation. The Department must adopt regulations establishing an appeals process and standard of review.

Took effect 1 July 2025

SB 224: Opioid-Associated Disease Prevention and Outreach Programs - Appeals and Membership of Standing Advisory Committee

The Department and a local health officer must approve or deny applications for authorization to operate an Opioid-Associated Disease Prevention and Outreach Program within 60 days and provide written explanation. A local health department or community-based organization may appeal adverse decisions to the Secretary of Health or the Secretary's designee.

Took effect 1 July 2025

HF 2: Health/children and families finance bill.

Health maintenance organizations must pay increased renewal fees to the commissioner of health: $30,000 plus 88 cents per enrolled person annually (up from $10,000 plus 20 cents). Various well contractors, explorers, and environmental professionals must pay increased licensing and certification fees ranging from $75 to $325.

HB 565: Health benefit plans and Medicaid; require to offer coverage for biomarker testing.

Each health benefit plan, including Medicaid and the State and School Employees Health Insurance Plan, must offer coverage for biomarker testing when supported by medical and scientific evidence, including FDA approvals, CMS determinations, or nationally recognized clinical practice guidelines. Plans must limit coverage disruptions, update policies within sixty days, provide written denial justifications, and establish accessible exception processes.

Took effect 1 July 2026

HB 856: Advanced, metastatic cancer; delete repealer on prohibition against health plans requiring step therapy before covering certain drugs to treat.

A health benefit plan that provides coverage for advanced, metastatic cancer and associated conditions may not require step therapy or fail-first protocols before covering a prescription drug approved by the FDA for such treatment. A prescribing practitioner must have access to an expeditious process to request an override of step therapy restrictions from the insurer.

Took effect 30 June 2026

SB 2415: Health insurance and employee benefit plans; extend repealer on mandated coverage for telemedicine services.

Health insurance plans and employee benefit plans must provide coverage for telemedicine services to the same extent as in-person consultation. Plans must reimburse out-of-network telemedicine providers under the same policies as other out-of-network providers. Deductibles, copayments, and coinsurance for telemedicine cannot exceed those for in-person consultation.

Took effect 30 June 2025

SB 2401: Study Committee on the certification of Health Benefit Plans and Insurers; create.

Creates a study committee to examine certification of health benefit plans and health insurance issuers, their financing and delivery of health care services, and related regulatory matters, requiring the committee to report findings and recommendations by December 1, 2025.

Took effect 1 July 2025

HB 2596: Modifies provisions relating to health benefit plans

SB 535: Revise laws related to experimental treatments

Operators of experimental treatment centers must obtain a license from the department, pay a $10,000 application fee and $5,000 annual renewal fee, and allocate 2% of net annual profits to support experimental treatment access for qualifying Montana residents or contribute to an insurance premium support account. Health care providers may recommend experimental treatments to patients meeting eligibility requirements.

SB 447: Revise laws related to prior authorization

Health insurance issuers and utilization review organizations must extend prior authorization certifications to at least 12 months from receipt. For chronic conditions, certifications must remain valid for the condition's duration without requiring recertification, though documentation of the condition's presence may be required annually. Health insurance issuers must prohibit prior authorization for certain prescription drugs and must have physicians make adverse determinations for prescription drugs.

SB 446: Revise laws related to healthcare utilization review

Only physicians licensed in Montana may make adverse determinations or review grievances for utilization review organizations. Physicians making adverse determinations must have specialty focus on the condition reviewed. Physicians reviewing grievances must have the same specialty as providers treating the condition, possess experience treating it, and cannot have been involved in the original determination or have financial interest in the outcome. Health insurance issuers cannot perform prior authorization on certain prescription drugs after six months continuous use, on therapeutic duplication grounds after prior approval, on dosage adjustments within FDA approval, on substance use disorder medications at FDA dosages, or on long-acting injectable antipsychotics.

SB 449: Generally revise health utilization review laws

Health insurance issuers and utilization review organizations must honor prior authorizations from previous insurers for at least 90 days when enrollees change plans. They must immediately approve prescriptions written at discharge for at least 3 days if medication cost does not exceed $5,000 daily. They must accept and respond to prior authorization requests electronically using secure transmission.

SB 317: Prohibit health insurers from performing prior authorization on psychiatric drugs in shortage or discontinued

Health insurance issuers must not perform prior authorization on prescription drugs that are designated as in shortage pursuant to the quarterly shortage list published by the United States Food and Drug Administration on April 1, July 1, October 1, or January 1. Manufacturers of such drugs must not engage in predatory pricing or marketing related to shortages.

HB 544: Generally revise health insurance laws relating to health utilization review

Health insurance issuers may not rescind prior approval for covered services after they are provided, except in cases of fraud, misrepresentation, nonpayment of premium, exhaustion of benefits, loss of coverage, or if the service provided differs from the approved service. Entities performing utilization review must approve or deny prior authorization requests for biologic therapies prescribed to minors under 18 within timeframes set forth in the chapter.

HB 398: Generally revise insurance laws related to prior authorization of chronic conditions

Health insurance issuers and utilization review organizations must ensure only physicians make adverse determinations and review grievances, with physicians possessing current unrestricted licenses in relevant specialties under medical director oversight. Certifications for health care services must be honored for at least 3 months when covered persons change health plans and for 12 months for chronic condition treatments.

HB 399: Revise prior authorization laws

Health insurance issuers and entities performing prior authorization on their behalf must not require prior authorization for oral or inhaled generic prescription drugs, inhaled prescription drugs for asthma or chronic obstructive pulmonary disease or chronic lung disease, insulin, long-acting injectable antipsychotics, or generic prescription drugs after 6 months continuous use. Adverse determinations must be made by physicians specializing in the relevant condition and must include a list of covered therapeutic alternatives.

LB 365: Require coverage of self-measure blood pressure monitoring services under the Medical Assistance Act

The Department of Health and Human Services must provide coverage and reimbursement for self-measure blood pressure monitoring services for pregnant and postpartum women eligible under the medical assistance program no later than January 1, 2027. Such services must include education and training on device setup and use, separate self-measurement blood pressure readings, daily collection, and transmission of data to healthcare providers.

LB 867: Change provisions relating to special needs trusts, fingerprints under the Uniform Credentialing Act, child care grants, the Title IV-D Division Customer Service Unit, eligibility for young adults in the bridge to independence program, licensed and self-funded insurers under the Medical Assistance Act, medicaid nursing facility rates, assistance to aged, blind, or disabled persons, and the state Commodity Supplemental Food program; provide for a money follows the person program for medicaid benefits, a youth afterschool eligibility letter for child care employment, use of wholesale drug distributor license fees for the prescription drug monitoring program, and maintenance of epinephrine by certain schools; change provisions of and rename the Alzheimer's Disease and Other Dementia Support Act , the Alzheimer's Disease and Other Dementia Advisory Council, the State Advisory Committee on Mental Health, the Division of Developmental Disabilities of the Department of Health and Human Services, and the Director of Developmental Disabilities; and eliminate provisions relating to divisions of the Department of Health and Human Services, the Division of Medicaid and Long-Term Care Advisory Committee on Aging, the Maternal and Child Health and Public Health Work Fund, and an obsolete Nurse Licensure Compact

Each state agency providing governmental benefits to individuals with disabilities through means-tested programs must adopt rules and regulations regarding special needs trusts that are not more restrictive than federal law, allow pooled trust accounts without financial limits, permit funding without age limits or transfer penalties except for individuals sixty-five or older, and allow assignment of legally assignable income or resources without limit.

LB 77: Adopt the Ensuring Transparency in Prior Authorization Act and provide for insurance and medicaid coverage of biomarker testing

Utilization review agents must make prior authorization requirements and clinical review criteria accessible on websites in searchable format by July 1, 2027, provide sixty days notice before implementing new requirements, ensure adverse determinations are made by physicians or clinical peers, and comply with decision timeframes of seventy-two hours for urgent services and seven days for nonurgent services before January 1, 2028, then forty-eight hours for urgent services thereafter. Health carriers must cover biomarker testing for specified conditions when clinical utility is demonstrated, effective January 1, 2028.

LB 527: Adopt the Medicaid Access and Quality Act and change provisions relating to taxes on health maintenance organizations, prepaid limited health service organizations, and insurance companies

Health maintenance organizations must pay a six percent tax on non-medicare direct writing premiums to the Director of Insurance by January 1, 2026. The Department of Health and Human Services must use the resulting Medicaid Access and Quality Fund to enhance rates for nonhospital providers of physical health services and establish primary care medical home fees.

HB 241: relative to health insurance coverage of pain management services for the management of chronic pain.

Insurers issuing or renewing individual and group accident or health insurance policies must provide coverage for pain management services including behavioral health interventions, manual treatments, movement therapies, acupuncture, and massage therapy, with at least 12 visits per category. Insurers must submit comprehensive pain management plans to the insurance commissioner and cannot impose more restrictive utilization controls on nonopioid therapies than on opioid drugs.

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.

SB 548: relative to health carrier provider contract standards.

Health carriers must provide covered persons continued access to a terminated provider for 60 days from termination, except for unprofessional conduct. Health carriers must provide written notice to affected covered persons within 5 business days of termination explaining continued access rights and whether a public hearing will be held.

Took effect 18 August 2026

HB 1323: relative to parental alienation, limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services, relative to children's mental health services for persons 18 years of age and younger.

Health carriers must not require prior authorization for the first physical or occupational therapy visit in each new episode of care and must approve at least 8 medically necessary treatments after initial evaluation before requiring additional review. Assessable entities must pay assessments to the New Hampshire children's behavioral health association to fund childhood behavioral health services for children under 19.

HB 1216: AN ACT to create and enact a new section to chapter 26.1-36 of the North Dakota Century Code, relating to out-of-pocket expenses for prescription drugs; to amend and reenact section 26.1-36.6-03 of the North Dakota Century Code, relating to self-insurance health care plans; to provide for application; and to provide an effective date.

SB 2280: AN ACT to create and enact chapter 26.1-36.12 of the North Dakota Century Code, relating to prior authorization for health insurance; to provide for a legislative management study; to provide for a legislative management report; and to provide an effective date.

Prior authorization review organizations must make authorization or adverse determination decisions within two business days for nonurgent services, twenty-four hours for urgent services, and two business days for post-stabilization services. Adverse determinations must be made by licensed physicians or dentists of similar specialty. Prior authorization review organizations may not require prior authorization for emergency services, medication assisted treatment for opioid use disorder, or prehospital transportation.

SB 2375: AN ACT to create and enact a new section to chapter 43-28 of the North Dakota Century Code, relating to joint negotiations by dental providers with dental insurers.

Two or more dental providers may jointly negotiate with dental insurers on non-fee matters without commissioner permission. Upon finding substantial market power and threat to care quality, they may jointly negotiate fees with commissioner approval. A joint negotiation representative must obtain express commissioner permission and submit proposed and negotiated contracts for commissioner approval within specified timeframes.

HB 1087: AN ACT to amend and reenact sections 26.1-27-03 and 26.1-27.1-02 of the North Dakota Century Code, relating to licensing for administrators of life and health insurance and pharmacy benefit managers.

A person may not act as or hold oneself out to be an administrator of life and health insurance in North Dakota without a license issued by the commissioner. A pharmacy benefits manager must hold a license as an administrator under chapter 26.1-27. Applications require a one hundred dollar filing fee and annual renewal requires a fifty dollar fee.