Health coverage and plan regulation 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 300: Health; to require that coverage for breast cancer screening be provided without charging an insurance deductible or copayment to a beneficiary

Takes effect 1 January 2027

SB 19: Health care insurance; to eliminate cost-sharing for screening of men who are at high risk for prostate cancer

Takes effect 1 October 2027

HB 309: Public Education Employees' Health Insurance Board; required to renegotiate contracts for Medicare retiree health benefit plans every five years

SB 252: Pharmacy Benefits Managers; providing a prescription reimbursement rate for independent pharmacies and regulating other practices

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 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

SB 1165: insurance; cost sharing; breast exams

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 2332: postpartum depression; treatment; insurers

Health care institutions must provide departing new parents and family members with written materials on maternal mental health conditions. Health care institutions, primary care physicians, primary care practitioners, and other health professionals rendering prenatal, postnatal, or pediatric infant care must provide these materials to any woman upon learning of pregnancy or presenting with signs of maternal mental health disorder.

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 1590: mental health; autism; insurance coverage

Hospital service corporations, medical service corporations, health care services organizations, group disability insurers, and blanket disability insurers must not exclude or deny coverage for treatment of autism spectrum disorder or medically necessary behavioral therapy services based solely on that diagnosis. Behavioral therapy coverage is limited to fifty thousand dollars per year for eligible persons up to age nine and twenty-five thousand dollars per year for those ages nine to sixteen.

HB 2109: forced organ harvesting; insurance; prohibition

Subscription contracts, evidence of coverage, disability insurance policies, group or blanket disability insurance policies, and Arizona Health Care Cost Containment System administration may limit coverage for human organ transplants or post-transplant care when the transplant operation is performed in the People's Republic of China or Hong Kong Special Administrative Region, or when the organ was procured by sale or donation originating in those locations.

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.

SB 1626: health insurance; surprise billing; disputes

Health insurers must include a department-prescribed notice of enrollee dispute rights in each explanation of benefits or claim adjudication notice involving noncontracted health care providers, except for claims subject to the no surprises act. Health care providers, their representatives, and billing companies must provide written notice of the dispute resolution process when contacted about surprise out-of-network bills not subject to the no surprises act.

SB 1102: pharmacy benefits; prescribing; exemption

Pharmacy benefit managers and health care insurers must not limit or exclude coverage of a prescription drug for a covered individual who is on that drug if it was previously approved and the individual remains enrolled. They must provide sixty days' notice before formulary changes and establish a clear formulary exception process with response times of seventy-two hours or twenty-four hours for expedited requests.

SB 544: To amend the arkansas pharmacy benefits manager licensure act.

Pharmacy benefits managers must provide pharmacy services administrative organizations, pharmacies, and pharmacists with pharmacy claims identification numbers and unique combinations upon request. PBMs must clearly list these identifiers in new contracts, opt-out contracts, amendments, and renewals. PBMs must not use national contracts lacking separate Arkansas-specific amendments complying with state law.

HB 1700: To amend the prior authorization transparency act; and to clarify the process of an adverse determination notice under the prior authorization transparency act.

Utilization review entities must provide written notice to subscribers upon adverse determination. If a healthcare provider submits an audio recording demonstrating a violation of prior authorization requirements, the requested prior authorization is deemed approved and the State Insurance Department must direct the utilization review entity to immediately issue it.

HB 1602: To amend the arkansas pharmacy benefits manager licensure act; to establish fees under the arkansas pharmacy benefits manager licensure act; and to require reporting of certain information by a pharmacy benefits manager.

The commissioner may reduce initial or renewal application fees for a pharmacy benefits manager if the fee would constitute financial hardship preventing the entity from doing business in Arkansas or competing in the marketplace considering limited Arkansas patients impacted or limited services offered.

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 1301: To amend the prior authorization transparency act.

Healthcare insurers and pharmacy benefits managers must send prior authorization information upon request. If a healthcare insurer approved less than eighty percent of prior authorization requests for a particular healthcare service in the most recent six-month evaluation period, that healthcare provider is ineligible for exemption.

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.

SB 104: To amend the arkansas pharmacy benefits manager licensure act; to protect patients' rights and access to medications; and to declare an emergency.

Pharmacy benefits managers and pharmacy benefits manager affiliates must not impose or represent requirements or limitations as health-benefit-plan-imposed unless those terms appear in the underlying health benefit plan document. Plan sponsors retain authority to interpret their own plan terms.

SB 103: To create the pharmacy nondiscrimination act; to require pharmacy benefits managers to accept any pharmacy or pharmacist willing to accept relevant and reasonable terms of participation; and to declare an emergency.

Pharmacy benefits managers must accept any pharmacy or pharmacist willing to accept relevant and reasonable terms of participation. Relevant and reasonable terms must be consistent with applicable state and federal law, consistent with industry standards, and must not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.

SB 83: To mandate coverage for breast reconstruction surgeries; to require prior authorization for breast reconstruction surgeries; and to establish a minimum reimbursement rate for breast reconstruction surgeries.

This amendment modifies Senate Bill 83 to specify that breast reconstruction surgery reimbursement rates shall match the rate established under Arkansas Code Section 23-79-2904(a).

HB 1327: To amend the law concerning the eligibility of certain retired employees under the state and public school life and health insurance program.

State employee retirees and public school retirees must have participated in the State and Public School Life and Health Insurance Program for at least five cumulative years before retirement and be vested members of a specified retirement system to qualify for enrollment. Active retirees must elect to enroll within thirty days of becoming an active retiree in writing to the Employee Benefits Division.

HB 1288: To amend the arkansas health care consumer act; and to require a healthcare insurer to make certain retroactive payments to a provider upon credentialing of a provider.

This amendment adds Senator Irvin as a cosponsor to House Bill 1288, which amends the Arkansas Health Care Consumer Act to require healthcare insurers to make certain retroactive payments to providers upon credentialing.

HB 1275: To prohibit prior authorizations for healthcare services provided for treatment of a mental health crisis.

The act prohibits prior authorizations for healthcare services provided for treatment of a mental health crisis. Healthcare services at crisis stabilization units, other programs designed to provide immediate crisis services, or by healthcare providers in emergency departments cannot require prior authorization.

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

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

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.

HB 1353: To regulate a vision benefit manager; to amend the vision care plan act of 2015; to amend the healthcare contracting simplification act.

Insurers, vision benefit managers, vision care plans, and vision care discount plans must not reduce reimbursement below current calendar year Medicare rates for covered services and materials, must not use extrapolation in audits, must not modify contract terms without written provider authorization, and must not restrict providers' choice of optical labs or material suppliers.

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 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 1094: Prescription drugs.

Pharmacists may select alternative biological products that are biosimilar to or interchangeable with prescribed reference products if prescribers do not indicate "Do not substitute." Pharmacists must notify prescribers within five days of dispensing. Health care service plans and health insurers must not limit coverage for previously approved drugs if appropriately prescribed and safe and effective, but may require trial of AB-rated generics or biosimilars under specified conditions with 30 days' advance notice.

Takes effect 1 January 2027

SB 1244: Public Agency Benefits Intermediary Compensation Disclosure Act.

Covered service providers must disclose to public agencies all direct and indirect compensation they expect to receive for brokerage or consulting services before entering into, extending, renewing, or materially amending contracts, if compensation exceeds $1,000. Covered service providers must not request, accept, or receive compensation unless disclosed, and must not structure arrangements to evade disclosure.

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 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 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 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 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 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.

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.

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.

AB 594: Student health insurance.

Commencing July 1, 2026, institutions of higher education must terminate student health insurance coverage within the same calendar month if feasible, but no later than the last day of the calendar month in which a 30-day notice period ends, when a student certificate holder requests termination due to graduation, leave of absence, or no longer being enrolled. Students must receive notice of premium liability if they choose not to terminate.

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.

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

SB 167: Prescription Drug Out-of-Pocket Expense Credit

SB 6: Parity for Non-Opioid Pain Management Drugs

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 1019: Kidney Screening Mandatory Preventive Coverage

HB 1002: Provider Participation in Health Insurance

HB 1070: Third-Party Network Agreements for Dental Services

Carriers must obtain affirmative consent from participating dental providers before entering third-party network lease agreements granting access to those providers' services and discounts. Carriers must not cancel contracts or refuse to contract with providers based on refusal to consent. Carriers must provide lists of third parties, allow removal of consent, maintain updated websites, give thirty days notice before new agreements, and make contracts available within thirty days of request.

SB 32: Promoting Immunization Access

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 25-048: Diabetes Prevention & Obesity Treatment Act

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 25-118: Health Insurance Prenatal Care No Cost Sharing

Health benefit plans providing maternity coverage that are issued or renewed on or after January 1, 2027 must provide coverage without cost sharing for up to three prenatal care office visits. This requirement does not apply to standardized health benefit plans offered pursuant to section 10-16-1305.

SB 25-296: Insurance Coverage for Breast Cancer Examinations

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.

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 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

HB 5377: An act concerning return of health care provider payments.

Contracting health organizations shall not cancel, deny, or demand return of payment for authorized covered services more than fifteen months after receipt of a clean claim, except for fraud, improper billing, duplicate payment, federal or state program payment, or coordination of benefits. Health organizations must provide thirty days' advance notice and establish an electronic appeal process. Hospital-based facilities located off-site from a hospital campus must submit their national provider identifier and federal tax identification number with each claim.

Took effect 1 October 2026

HB 6436: An act concerning revisions to the health insurance statutes.

Each pharmacy benefits manager must file an annual report with the commissioner by March 1, 2026 and annually thereafter, disclosing the aggregate dollar amount of rebates collected from pharmaceutical manufacturers for outpatient prescription drugs covered by health carriers, including rebates retained by the pharmacy benefits manager.

Took effect 1 October 2025

HB 7046: An act making revisions to the second injury fund.

The State Treasurer, in consultation with the Insurance Commissioner, must adopt regulations allocating Second Injury Fund liabilities between self-insured employers and insured employers based on a percentage of paid losses for the preceding calendar year. The State Treasurer must consider effects on business costs, workers' compensation system costs, insurers and insureds, and the fund's financial condition.

HB 7192: An act implementing recommendations of the bipartisan drug task force.

Pharmacy benefits managers must owe fiduciary duty to health carriers or health benefit plan sponsors and notify them of conflicts of interest. Health carriers and pharmacy benefits managers cannot include certain provisions in pharmacy services contracts, including spread pricing arrangements and fees conditioned on wholesale acquisition cost, savings, or premiums. Health carriers must annually report pricing and profit information to the Insurance Commissioner.

Takes effect 1 October 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

HB 6434: An act concerning the legislative commissioners' recommendations for technical revisions to the insurance-related statutes.

Persons receiving a data call or subpoena from the Insurance Commissioner must comply with orders for production of books, records, papers or documents within thirty calendar days. Insurance policies must meet readability standards including a minimum Flesch reading ease score of forty-five and ten-point type.

SB 1239: An act concerning the fallen hero fund and providing health insurance coverage to survivors of first responders who are killed in the line of duty.

Nonstate public employers must continue health insurance coverage for survivors of police officers or firefighters killed in the line of duty for one year, renewable annually up to five years. Employers must facilitate continuation and renewal. The Comptroller pays one hundred thousand dollar lump sum death benefits to surviving families from the Fallen Officer and Firefighter Fund.

Took effect 1 July 2025

HB 6771: An act establishing an alzheimer's disease and dementia task force, requiring health insurance coverage for biomarker testing and concerning transfers and discharges in residential care homes, tuition waivers for nursing home residents who take courses at regional community-technical colleges and closures and evacuations of residential care homes and nursing homes.

Individual health insurance policies and group health insurance policies must provide coverage for biomarker testing for diagnosis, treatment, management or monitoring of disease or condition when clinical utility is demonstrated by FDA approval, Medicare determinations, or nationally recognized clinical practice guidelines. Entities must establish accessible processes for coverage exceptions and dispute resolution, and approve or deny prior authorization requests within seven days for non-urgent requests or seventy-two hours for urgent requests.

Took effect 1 October 2025

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

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

SB 271: An act to amend title 18 of the delaware code relating to pharmacy benefits managers.

Pharmacy benefits managers must provide 14 days' notice before initial on-site audits, conduct audits under uniform standards, limit audits to once every 12 months, bear all audit costs, respond to appeals within 10 calendar days, provide 60 days' notice before amending contracts, and reimburse pharmacies at least the national average drug acquisition cost or wholesale acquisition cost as of the date of service.

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.

HB 200: An act to amend title 18, title 29, and title 31 of the delaware code relating to insurance coverage for treatment to prevent hiv infection.

Health benefit plans must cover at least one FDA-approved therapeutic equivalent version each of PrEP and PEP medications without cost-sharing, prior authorization, or step therapy requirements. Plans must also cover medically necessary essential support services including HIV testing, hepatitis testing, kidney function assessment, pregnancy testing, STI screening and counseling, and adherence counseling.

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.

SB 12: An act to amend title 18 and title 29 of the delaware code relating to the delaware pre authorization act of 2025.

Health-care providers and consulting health-care providers must not receive compensation that is contingent upon the outcome of reviews of clean pre-authorization requests or appeals from adverse determinations. The act clarifies that health-care providers may determine that covered health-care services delivered on an expedited basis are urgent health-care services.

SJR 7: Directing the state employee benefits committee and the secretary of human resources to engage with independent consultants and other supply chain tactics for cost containment of prescription drugs for state employees and retirees’ insurance programs.

This amendment clarifies that strategies and policies guiding the State Employee Benefits Committee and Secretary of Human Resources in engaging consultants and supply chain tactics for prescription drug cost containment must be consistent with applicable State and federal law.

HB 128: An act to amend title 19 of the delaware code relating to the family and medical leave insurance program.

Individuals filing new claims for family and medical leave benefits must disclose child support obligations. The Department must notify child support enforcement agencies of eligible individuals and deduct and withhold child support obligations from benefits. Employers with private plans need not provide claim documentation to the Department unless there is an appeal, complaint, audit, or specific inquiry.

HB 55: An act to amend the delaware code relating to prohibited discrimination on the basis of military status.

Owners, lessees, proprietors, managers, and employees of places of public accommodation, housing providers, employers, employment agencies, labor organizations, insurance companies, and charter schools must not discriminate based on military status. Military status includes members of uniformed forces, reserve components, veterans, and dependents of servicemembers. Distinctions allowed by state, federal law, or government contract are excepted.

HB 209: An act to amend title 18 of the delaware code relating to health care and the patient protection and affordable care act.

Health insurers offering group or individual health insurance coverage must ensure coverage includes essential health benefits, establish special enrollment periods of 30 calendar days for qualifying events, comply with nondiscrimination provisions, and limit annual cost-sharing, all as defined under the Patient Protection and Affordable Care Act as in effect January 1, 2025.

SJR 2: Requiring the division of medicaid and medical assistance to present the general assembly with a report and plan to provide insurance coverage for community health worker services.

The Division of Medicaid and Medical Assistance, in collaboration with stakeholder groups including the Community Health Workers Association of Delaware, must present the General Assembly with a plan for insurance coverage for Community Health Worker services by January 1, 2026, including a draft State plan amendment or waiver as appropriate.

SB 1668: Florida Birth-Related Neurological Injury Compensation Association

Family members of plan participants must continuously maintain comprehensive major medical health insurance coverage for the participant, obtaining such coverage within 60 days of final award or applying for Medicaid within 30 days. The plan must reimburse Medicaid for services provided to participants enrolled in state Medicaid and must reimburse participants for certain care received before June 30, 2026, if unpaid due to lack of insurance coverage.

HB 697: Drug Prices and Coverage

Pharmacy benefit managers must include in participation contracts an administrative appeal procedure allowing pharmacies to challenge maximum allowable cost pricing as below acquisition cost, with 30 business days to respond. Pharmacy benefit managers must not prohibit pharmacies from declining to dispense drugs when reimbursement is below actual acquisition cost, and must not reimburse affiliated pharmacies differently than non-affiliated ones.

Took effect 1 July 2026

SB 944: Insurance Overpayment Claims Submitted to Psychologists

Health insurers and health maintenance organizations must submit all claims for overpayment to providers licensed under chapters 458, 459, 460, 461, 466, or 490 within 12 months after payment of the claim. Claims for overpayment may not be permitted beyond 12 months after payment, except for providers convicted of fraud.

Took effect 1 July 2025

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

HB 1138: Increasing Access to Contraceptives Act; enact

The act authorizes pharmacists to dispense self-administered hormonal contraceptives or administer injectable hormonal contraceptives in certain circumstances. It requires insurers to provide minimum amounts of certain contraceptives. The act amends Titles 26, 33, and 49 of the Official Code of Georgia Annotated.

Takes effect 1 January 2027

HB 1374: Insurance; methods of payment to healthcare providers; provide certain requirements

A Health Insurer shall not terminate, remove, or exclude a participating provider from its network during a plan year if such action would cause a covered person to lose access to covered services from that provider.

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 197: Insurance; health care provider to respond to a private review agent or utility review entity's attempt to discuss the patient's care; detail the effort

Before making an adverse determination on medical necessity, private review agents or utilization review entities must attempt to discuss the patient's care with the treating health care provider or their designee during normal working hours, using methods including direct contact, callback systems, or scheduled website communication. Health insurers using prior authorization must implement and maintain a program allowing selective reductions in prior authorization requirements based on healthcare provider performance, and must file program details with the department annually by July 1, 2026.

Took effect 1 January 2026

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

HB 94: Insurance; medically necessary expenses for standard fertility preservation services when a medically necessary treatment for cancer, sickle cell disease, or lupus may directly or indirectly cause an impairment of fertility; require coverage

HB 1864: Relating to insurance.

Issuers of individual or group accident and health insurance policies, hospital or medical service plan contracts, and health maintenance organizations must provide coverage for standard fertility preservation services to policyholders or covered persons undergoing medically necessary cancer treatment that may cause iatrogenic infertility, effective after December 31, 2026. Issuers must not exclude, limit, or discriminate based on prior diagnosis, fertility treatment, life expectancy, disability, or health conditions.

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

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.

SB 1281: Relating to telehealth.

Health care providers must conduct an in-person visit within six months before an initial audio-only telehealth visit, or within twelve months before any subsequent audio-only visit, to be reimbursed for two-way, real-time audio-only telehealth services. Reimbursement for telehealth via interactive telecommunications system must be equivalent to in-person services. Verification of patient's lack of video capability or consent must be appended to claims for audio-only telehealth services.

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 929: HEALTH CARE – Adds to existing law to establish provisions regarding certain out-of-pocket payments for health care services.

Health carriers must not prohibit health care providers from offering covered persons discounted cash prices for health care services. Health carriers must count out-of-pocket amounts paid by covered persons toward deductibles and annual maximum out-of-pocket expenses when the covered person negotiates a lower price than the plan's allowed amount and provides required documentation.

Takes effect 1 January 2027

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 645: PORTABLE BENEFIT PLAN ACT – Adds to existing law to establish the Portable Benefit Plan Act.

Portable benefit account providers must administer portable benefit accounts consistent with this chapter's requirements. Hiring parties may voluntarily contribute funds to independent contractors' portable benefit accounts. Contributions must not be treated as evidence of employment under employment security, worker's compensation, tax, or labor laws.

Took effect 1 July 2026

H 116: INSURANCE – Amends and repeals existing law to remove the Idaho Small Employer Carrier Reinsurance Program.

Repeals the Idaho Small Employer Carrier Reinsurance Program and related provisions, removes definitions and code references associated with that program, and makes technical corrections to insurance statutes governing small employer and individual health benefit plans.

Took effect 1 July 2025

SB 3707: Vision benefit managers

Vision care organizations must not require eye care providers to provide noncovered services or materials at vision care plan-set fees. Vision care organizations must provide eye care providers with reasonable fee schedules before entering provider agreements and update them quarterly. Vision care organizations cannot require eye care provider participation in supplemental health plans or vision care discount plans as conditions of contracting.

Takes effect 1 January 2027

SB 2770: Loc first responder insurance

Counties and municipalities that self-insure health coverage for employees must include mental health counseling for first responders at no cost starting June 1, 2025. First responders include police officers, firefighters, emergency medical services personnel, dispatchers, public safety telecommunicators, mental health professionals dispatched for crisis calls, and medical examiners or coroners.

Takes effect 1 January 2027

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 1577: Ins cd-dependent parents

Issuers of group or individual accident and health insurance policies must make dependent coverage available to the parent or stepparent of the insured if the parent or stepparent qualifies as a dependent under 26 U.S.C. 152(d) and resides within the policy's service area. This requirement applies to policies issued, amended, delivered, or renewed after January 1, 2026, but excludes student health insurance coverage and certain specialized policies.

HB 3796: Insurance-provider panels

Carriers offering provider panels must file notice with the Department of Public Health before establishment, provide enrollees and providers at least 60 days' notice before terminating providers, establish procedures for continued care for pregnant, terminally ill, life-threatening condition, and hospitalized enrollees, maintain personnel for preauthorization at all times, and prohibit contracts requiring providers to deny medically necessary services or waive legal redress.

Takes effect 1 January 2027

SB 1346: Managed care & insurance cards

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 1392: Dental insurance assignability

Insurers, health maintenance organizations, managed care plans, health care plans, preferred provider organizations, dental service plan corporations, dental insurers, and third party administrators must make direct payment to health care professionals, health care facilities, dental care providers, or dental care facilities when an enrollee or insured assigns a claim to them, including any interest required under Section 368a for failure to pay claims within 30 days after receipt of due proof of loss.

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 1260: Various insurance matters.

Insurers must mail notice of nonrenewal to insureds at least 60 days before policy expiration for automobile and residential policies. Insurers must respond within 30 days to insured requests for explanations of material changes to personal automobile or homeowner's policies. Insureds have 30 days to request such explanations.

Took effect 1 July 2026

HB 1271: Payment of health claims.

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

Took effect 1 July 2026

HB 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 1044: Insurance coverage for public safety employees.

Local unit public employers must provide group health insurance to public safety employees who become disabled on or after January 1, 2020 and receive Class 1 or Class 2 impairment benefits. Disabled employees must file a written request before June 1, 2026, or within 90 days after receiving disability benefits, whichever is later, and must pay the same premium amount as active employees. Surviving spouses and dependents of public safety employees who die in the line of duty must pay the same premium amount as active employees for coverage they select.

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 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 1595: Long term care insurance partnership program.

The office of the secretary of family and social services must reapply to the United States Department of Health and Human Services before September 1, 2025, for a state plan amendment establishing a long term care partnership program and discontinuing the current long term care program. If approved, the office must implement the amendment within sixty days and publish notice in the Indiana Register.

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

HB 1226: Medicare supplement insurance.

Issuers of Medicare supplement policies or certificates must not deny, condition the issuance or effectiveness of, or discriminate in pricing based on health status, claims experience, receipt of health care, or medical condition for applicants who are at least sixty-five years old and either apply within six months of first enrolling in Medicare Part B, or apply within sixty days of their birthday to switch to the same lettered plan type.

Took effect 1 January 2026

SB 486: Family and social services matters.

Sheriffs must assist individuals incarcerated at least 30 days in county jails or specified juvenile facilities in applying for Medicaid if eligible, before release. Insurers must respond to Medicaid claim inquiries within 60 days and cannot deny claims solely for lack of prior authorization. Child care providers must ensure at least one adult certified in pediatric CPR is present when children are in care.

Took effect 1 July 2025

HF 2185: A bill for an act relating to cost sharing for health savings accounts and qualified high-deductible health plans.

For group insurance and accident and health insurance, if a copayment, coinsurance, or deductible paid as cost sharing by an enrollee may result in the enrollee becoming ineligible for a health savings account associated with the enrollee's qualified high-deductible health plan, the cost sharing shall apply only after the enrollee satisfies the minimum deductible, except for preventive care.

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 330: A bill for an act relating to insurance coverage for covered individuals for the treatment of autism spectrum disorder and including applicability provisions.

Third-party payment providers and group plans for state employees must provide coverage for autism spectrum disorder treatment to covered individuals under specified age limits. Group policies must allow minimum thirty inpatient days and fifty-two outpatient visits annually without aggregate annual or lifetime limits on autism spectrum disorder benefits. Coverage for applied behavior analysis is required for covered individuals under nineteen years of age.

Took effect 1 July 2025

SF 383: A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions.

Pharmacy benefits managers must use pass-through pricing in contracts effective January 1, 2026. PBMs must reimburse retail pharmacies at least the national average drug acquisition cost plus a ten dollar sixty-eight cent professional fee, and must not reimburse pharmacies less favorably than their affiliates. PBMs must provide appeals processes and cannot discriminate against pharmacies or restrict patient choice.

Took effect 1 July 2025

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

SB 20: Enacting the Kansas consumer prescription protection and accountability act and providing for regulation and registration of pharmacy benefits managers.

HB 2050: Authorizing the commissioner of insurance to set the amount of certain fees and cause the publication of such fees in the Kansas register, authorizing the commissioner to reduce the number of board members on certain insurance-related boards, renaming the Kansas insurance department as the Kansas department of insurance, renaming the office of the securities commissioner as the department of insurance, securities division, renaming the securities commissioner as the department of insurance, assistant commissioner, securities division and eliminating the requirement of senate confirmation for appointees to such position, requiring the commissioner of insurance to maintain a list of eligible nonadmitted insurers and authorizing such nonadmitted insurers to transact business in Kansas with vehicle dealers and to provide excess coverage insurance on Kansas risks.

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 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 164: AN ACT relating to coverage for hearing aids and related services.

Health benefit plans must cover hearing aids and related services for insured individuals under eighteen years of age up to two thousand five hundred dollars per hearing-impaired ear every thirty-six months. Insurers using networks must ensure reasonably adequate and accessible networks for hearing aid provision. Insurers must not deny claims if less than three years have passed since a prior paid claim.

Takes effect 1 January 2027

HB 184: AN ACT relating to health savings account-qualified insurance plans.

Cost-sharing requirements in Kentucky state law apply to health savings account-qualified insurance plans only after the minimum deductible under 26 U.S.C. sec. 223 has been satisfied, if applying the requirement would cause the plan to lose its qualified status under federal law. Section 1 controls in conflicts with other state law.

HB 421: AN ACT relating to colorectal cancer screenings.

Health benefit plans issued or renewed on or after January 1, 2026 must provide coverage for all colorectal cancer examinations and laboratory tests specified in American Cancer Society or United States Multi-Society Task Force guidelines for individuals age 45 or older, or younger individuals at high risk, without prior authorization or cost-sharing requirements except as limited by Health Savings Account rules.

HB 210: AN ACT relating to dental benefit plans.

Insurers providing dental benefit plans must honor written assignments of benefits from covered persons to providers using a commissioner-established form. Insurers must pay assigned providers directly at in-network rates upon receipt of the signed assignment and necessary coverage verification documentation. Covered persons may revoke assignments in writing to the insurer at any time.

HB 1236: INSURANCE: Provides relative to pharmacy benefit managers reimbursements (EN +$2,265,844 SG EX See Note)

Amends Louisiana insurance law to require pharmacy benefit managers to adopt reimbursement formulas with adjustment factors resulting in no more than two percent claim payment error rates per drug, and to establish professional dispensing fees at least equal to Louisiana Medicaid rates.

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.

SB 387: HEALTH/ACC INSURANCE: Provides relative to pharmacy benefit managers. (1/1/27) (EN INCREASE SG EX See Note)

Adds exemptions to pharmacy benefit manager regulations, excluding health benefit plans established under and regulated by the Employee Retirement Income Security Act (ERISA) of 1974 from two sections of the bill's provisions.

HB 1199: INSURANCE/HEALTH: Provides relative to health insurance coverage for genetic testing and the treatment of SCN2A-associated medical conditions (EN NO IMPACT See Note)

HB 1231: MEDICAID MANAGED CARE: Provides relative to Medicaid coverage for continuous glucose monitoring devices for individuals with certain conditions (EN NO IMPACT See Note)

The Louisiana Medicaid program shall provide coverage for continuous glucose monitors for enrollees with any type of diabetes, including gestational diabetes, requiring insulin use more than two times daily or showing evidence of level 2 or level 3 hypoglycemia.

HB 291: INSURANCE/HEALTH: Prohibits health insurers from taking adverse payment or contracting actions against participating facilities based solely on another provider's network status (EN INCREASE EX See Note)

HB 591: INSURANCE: Creates the Paid Family Leave Insurance Act

HB 766: INSURANCE/HEALTH: Provides relative to coverage for orally administered anti-cancer medications (EN +$66,367 SG EX See Note)

HB 909: INSURANCE: Required coverage for behavioral health crisis services (EN INCREASE EX See Note)

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 740: MEDICAID MANAGED CARE: Provides for independent claims review of Coordinated System of Care providers

HB 1154: INSURANCE: Prohibits prior authorizations requirements for certain generic medications prescribed by qualified physicians (EN NO IMPACT GF EX See Note)

Prohibits insurance companies from requiring prior authorization for certain generic medications prescribed by qualified physicians or authorized providers.

HB 1176: INSURANCE/HEALTH: Requires that Medicare Advantage plans provide insurance coverage for integrative care services (EN SEE FISC NOTE See Note)

Takes effect 1 January 2027

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

HB 430: LAW ENFORCE/OFFICERS: Enacts the MJ 911 Act to extend health insurance coverage for families of law enforcement officers and firemen employed by the City of Lafayette who are killed in the line of duty (EN INCREASE LF EX See Note)

Enacts the MJ 911 Act to extend health insurance coverage to families of law enforcement officers and firemen employed by the City of Lafayette who are killed in the line of duty.

SB 155: HEALTH/ACC INSURANCE: Provides for coverage of certain dental care when connected with cancer treatment. (gov sig) (EN INCREASE GF EX See Note)

Health insurers must cover evaluation, imaging, clinical examination, and dental procedures that are medically necessary to reduce infection risk, eliminate infection, or treat tooth loss or decay as part of pre-cancer treatment screening when performed as part of pre-treatment medical clearance protocol for insureds scheduled to undergo cancer treatment.

SB 295: HEALTH/ACC INSURANCE: Provides for insurance coverage of services for persons with acquired brain injuries. (8/1/26) (EN NO IMPACT See Note)

Requires health insurance coverage of services for persons with acquired brain injuries that are not progressive, hereditary, congenital, or degenerative, including functional daily activities and appropriate care levels.

HB 786: MEDICAID MANAGED CARE: Prohibits certain processes used in healthcare provider claim payments

SB 192: HEALTH/ACC INSURANCE: Provides for the method of dental reimbursement or payments. (gov sig)

A dental plan initiating or changing payments to a dentist using electronic funds transfers or credit card payments must obtain express acceptance from the provider through clear and direct written agreement to the payment method. Violation of this requirement nullifies any election on claim payment methodology until a new express agreement is executed.

SB 84: HEALTH/ACC INSURANCE: Provides relative to health insurance coverage for prostate cancer screening. (gov sig) (EN +$5,100 SG EX See Note)

Any health coverage plan delivered or issued for delivery in Louisiana must provide coverage for prostate cancer screening including digital rectal examination and prostate-specific antigen testing for men over fifty years and as medically necessary for men ages forty to forty-nine in accordance with National Comprehensive Cancer Network guidelines. Coverage must have no deductibles, coinsurance, copayments, or out-of-pocket expenses.

SB 275: HEALTH/ACC INSURANCE: Provides for reimbursement rates of services provided by CRNAs within their lawful scope of practice. (1/1/27)

Takes effect 1 January 2027

HB 46: INSURANCE/GROUP-SHERIFFS: Provides relative to premium costs of group hospital and health insurance for retired sheriffs and retired deputy sheriffs in DeSoto Parish

The sheriff of DeSoto Parish must pay from the sheriff's general fund specified percentages of group hospital, surgical, medical expense, and dental insurance premium costs, plus the first ten thousand dollars of life insurance, for retired sheriffs and retired deputy sheriffs based on years of creditable service and hire date.

HB 264: INSURANCE/HEALTH: Provides for transparency and compensation practices relative to pharmacy benefit managers (EN +$90,000 SG EX See Note)

Pharmacy benefit managers and health insurance issuers must not directly or indirectly charge or hold pharmacists or pharmacies responsible for any fee. Pharmacy benefit managers must notify pharmacies of claim payment errors and make retroactive price adjustments in the next payment cycle. Pharmaceutical drug manufacturers must provide notice within thirty days of increasing wholesale acquisition cost by more than fifteen percent annually or introducing new specialty drugs.

HB 408: INSURANCE/HEALTH: Requires health insurance coverage relative to pediatric acute-onset neuropsychiatric syndrome and related conditions (EN INCREASE GF EX See Note)

HB 467: INSURANCE/HEALTH: Requires health insurance coverage for amino acid-based elemental formulas (EN INCREASE GF EX See Note)

The state risk director shall pay extraordinary medical and dental expenses for firemen and law enforcement officers injured in the course of their official duties, as determined by the Law Enforcement Officers and Firemen's Survivor Benefit Review Board, up to a maximum of fifty thousand dollars per injury per officer.

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.

SB 16: HEALTH/ACC INSURANCE: Provides relative to health stop-loss insurance. (8/1/25) (EN NO IMPACT See Note)

Health stop-loss policies issued to small employers after January 1, 2026, must contain specific attachment points and aggregate attachment points, guarantee rates for at least twelve months, align benefit limitations with the employer's health plan, and pay claims within forty-eight months after contract expiration. Insurers must provide a separate disclosure form explaining coverage limitations and potential employer risk before purchase.

SB 182: MEDICAID: Provides relative to Medicaid prior authorization during a declared emergency. (8/1/25) (EN NO IMPACT See Note)

During a declared emergency, the Louisiana Department of Health may suspend utilization management requirements, including prior authorization and concurrent review, for the Medical Assistance Program to ensure uninterrupted access to healthcare services.

HB 635: INSURANCE DEPARTMENT: Establishes the Creating Holistic Options in Coverage for Enterprise and Self-Insurance (CHOICES) Law

HB 357: INSURANCE/HEALTH: Requires health insurance coverage for integrative cancer treatments (EN INCREASE GF EX See Note)

Requires health insurance coverage for integrative cancer treatments without cost-sharing barriers like deductibles, coinsurance, copayments, or prior authorization, except insurers may limit acupuncture to fifteen visits per plan year unless nationally recognized cancer guidelines recommend more.

HB 382: INSURANCE/HEALTH: Requires insurance coverage of home visiting services for newborns and young children (EN NO IMPACT See Note)

A health coverage plan delivered or issued in Louisiana that provides maternity services benefits must include coverage for voluntary home visiting services, including at least one visit during a newborn's first three months of life and at least one follow-up visit no later than three months after the last visit, with a maximum of five visits from birth to age three.

SB 129: INSURERS: Requires health insurers to cover proton therapy for cancer patients. (8/1/25) (EN NO IMPACT See Note)

SB 138: HEALTH/ACC INSURANCE: Provides for health insurance coverage for retired employees of district attorneys' offices. (8/1/25)

Health insurance issuers must accept for enrollment retired former employees of district attorneys' offices funded by local sales and use tax, provided the individual was formerly a certificate holder, is no longer employed due to retirement, and is not yet Medicare-eligible. Health insurance issuers must not discriminate between active and retired employees based on employment status.

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 1365: Health Occupations, Public Health, and Insurance - Menopause - Provider Training Coverage Requirements, Policy Initiatives, and Access to Care

Insurers, nonprofit health service plans, and health maintenance organizations must provide coverage for the evaluation and management of menopause and menopause-associated symptoms as determined by the treating health care provider. Health occupations boards must grant at least 2 hours of continuing education credits for every 1 hour of continuing education on menopause completed by licensees or certificate holders.

Took effect 1 July 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