REGULATORY INTELLIGENCE YEAR-END REPORT - 2022 Health Policy Tracking Service - Issue Briefs Healthcare Reform State Specific Responses This Issue Brief was compiled by Melissa D. Berry, principal attorney editor with Thomson Reuters and a member of the Ohio bar. 12/19/2022 I. Introduction This year see a continuation of responses from states to the coronavirus public health emergency as well as a recognition that the healthcare system may be leaving minority and vulnerable populations behind. Additionally, states continue to address cost control and cost transparency issues. Il. CORONAVIRUS RESPONSES Colorado * 2022 CO H.B. 1199 (NS), introduced February 7, relating to visitation requirements for healthcare facilities. ¢ 2022 CO H.B. 1247 (NS), engrossed April 1, concerning requirements for additional supplemental senate payments for nursing facility providers and making an appropriation. ¢ 2022 CO H.B. 1352 (NS), engrossed April 25, concerning a stockpile of essential materials that may be utilized in the event of a declared disaster emergency, and, in connection therewith, making an appropriation. * 2022 CO H.B. 1401 (NS), engrossed May 11, concerning the preparedness of health facilities to meet Senate patient needs and making an appropriation. « The purpose of this emergency regulation is to require carriers to provide access to COVID-19 vaccines without cost-sharing during the state's COVID-19 recovery. This emergency regulation also sets COVID-19 vaccine administration reimbursement requirements. See 2022 CO REG TEXT 589264 (NS). Florida ¢ 2022 FL S.B. 328 (NS), introduced January 11, defining the term 'at-home COVID-19 test kit'; requiring health insurers and health maintenance organizations to provide 100 percent coverage for at-home COVID-19 test kits; providing for expiration of the insurance coverage, etc. ¢ 2022 FL S.B. 610 (NS), introduced January 11, extending the timeframe for which COVID-19-related claims may be brought against health care providers, etc. * 2022 FL S.B. 7014 (NS), introduced January 11, extending the duration of liability protections from COVID-19-related claims against health care providers, etc. Hawaii 2021 HI S.B. 3236 (NS), amended/substituted March 4, appropriates an unspecified amount of funds to provide for a one-time enhanced payment equal to 15% of Medicaid patient payments of fiscal year 2022-2023 to each nursing facility, community care foster family homes, and expanded adult residential care homes that are caring for Medicaid patients, to assist with pandemic-related costs and lost revenues. Illinois THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ 2021 IL H.B. 4929 (NS), enrolled March 31, provides that a licensed optometrist may independently administer the influenza vaccine, the COVID-19 vaccine, or the shingles vaccine upon completion of the required training. ¢ 2021 IL H.B. 5426 (NS), introduced January 31, provides that the Act may be referred to as the Fast Access to Safe Treatments for Early Response to COVID-19 Act or the 'FASTER' Act. Amends the Pharmacy Practice Act. Sets forth provisions concerning dispensation of COVID-19 drugs or COVID-19 medicines. Provides that the Department of Financial and Professional Responsibility may adopt emergency rules to implement the provisions. Provides that the Department may adopt rules to permit direct sales from manufacturers or drug compounders if drug or medication shortages exist. Indiana 2022 IN H.B. 1372 (NS), introduced January 11, allows a physician or advanced practice registered nurse to create a standing order that allows a pharmacist to dispense ivermectin. Provides that a prescription dispensed under a standing order is considered to be issued for a legitimate medical purpose in the usual course of professional practice. Prohibits a: (1) physician or advanced practice registered nurse who issues; or (2) pharmacist or pharmacy that follows; a standing order from seeking or receiving certain personal financial benefits. Kansas ¢ 2021 KS S.B. 286 (NS), enrolled April 8, continuing the governmental response to the COVID-19 pandemic in Kansas by extending the expanded use of telemedicine, the suspension of certain requirements related to medical care facilities and immunity from civil liability for certain healthcare providers, certain persons conducting business in this state and covered facilities for COVID-19 claims until January 20, 2023, creating the crime of interference with the conduct of a hospital and increasing the criminal penalties for battery of a healthcare provider. ¢ 2021 KS 8.B. 381 (NS), introduced January 24, allowing for the prescribing and dispensing of medications for off-label use to prevent and treat COVID-19 infections. * 2021 KS H.B. 2477 (NS), adopted January 21, renewing certain provisions of law authorizing expanded practice by certain healthcare professionals and suspending certain licensure and other requirements for adult care homes. ¢ 2021 KS H.B. 2280 (NS), amended/substituted March 21, authorizing the prescribing and dispensing of medications for off-label use to prevent and treat COVID-19 infections and requiring child care facilities and schools to grant religious exemptions from vaccination requirements without inquiring into the sincerity of such religious beliefs. ¢ 2021 KS H.B. 2652 (NS), introduced February 9, continuing the governmental response to the COVID-19 pandemic in Kansas by extending the expanded use of telemedicine, the authority of the board of healing arts to grant certain temporary emergency licenses, the suspension of certain requirements related to medical care facilities and immunity from civil liability for certain healthcare providers, certain persons conducting business in this state and covered facilities for COVID-19 claims until January 20, 2023. * 2021 KS H.B. 2748 (NS), introduced April 1, enacting the no patient left alone act to require certain healthcare facilities to allow in- person visitation of patients or residents. ¢ The Kansas Department of Health and Environment, Division of Health Care Finance (KDHE-DHCF) is amending the Kansas Medicaid State Plan. In response to the American Rescue Plan (ARP), the state is adding the following mandatory benefits as stated in the act: Mandatory benefit for coverage of COVID-19 vaccines and administration without cost sharing; Mandatory benefit for coverage of COVID-19 testing, including at-home tests, without cost-sharing for most Medicaid beneficiaries; Mandatory benefit for coverage of COVID-19 related treatments, including specialized equipment and therapies, and related provisions. See 2022 KS REG TEXT 608243 (NS). ¢ The Kansas Department of Health and Environment, Division of Health Care Finance (KDHE-DHCF) is amending the Kansas Medicaid State Plan. In response to the American Rescue Plan (ARP), the state is adding the following mandatory benefits to the Alternative Benefit Plan (ABP): Mandatory benefit for coverage of COVID-19 vaccines and administration without cost sharing; Mandatory benefit for coverage of COVID-19 testing, including at-home tests, without cost-sharing for most Medicaid beneficiaries; Mandatory benefit for coverage of COVID-19 related treatments, including specialized equipment, and related provisions. See 2022 KS REG TEXT 608244 (NS). Louisiana 2022 LA H.R. 62 (NS), adopted May 18, requests the Louisiana Department of Health to develop a proposal for a statewide hospital coordination plan and patient transfer strategy for use in disasters and other emergency situations and to report the proposal to the House Committee on Health and Welfare and the House Select Committee on Homeland Security. Maine 2021 ME S.P. 610 (NS), introducing January 5, regarding point-of-dispensing sites for immunization against COVID-19. Massachusetts THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ MA Bulletin No. 2-4-2021 (#2) (February 4, 2022), set forth vaccine requirements for home care workers at home health agencies participating in MassHealth. ¢ MA Bulletin No. 2-4-2021 (#3) (February 4, 2022), set forth vaccine requirements for hospice providers participating in MassHealth. ¢ MA Bulletin No. 2-4-2021 (#4) (February 4, 2022), set forth vaccine requirements for independent nurses participating in MassHealth. ¢ This bulletin adds codes and rates for the new Moderna and Pfizer bivalent COVID-19 vaccine boosters. Rates are identical to those for other COVID-19 vaccines. See MA Bulletin No. 9-29-2022 (September 29, 2022). ¢ The Executive Office of Health and Human Services (EOHHS) recognizes that a strong direct care and support workforce is essential to any effort to strengthen, enhance, and expand Home and Community-based Services (HCBS) and behavioral health outpatient and diversionary services. Accordingly, as part of its implementation of increased funding available under Section 9817 of the American Rescue Plan Act (ARPA) and by using additional Medicaid funding, EQHHS provided immediate time-limited rate enhancements from July through December 2021, to support HCBS and behavioral health workforce development. EOHHS later extended these rate enhancements through June 30, 2022, through Managed Care Entity (MCE) Bulletin 86 (https:/Avww.mass.gov/doc/managed- care-entity-bulletin-86-extension-of-and-updates-to-the-temporary-rate-increases-due-to-the-american-rescue-plan-act-home-and- community-based-services-and-temporary-rate-increases-for-behavioral-health-services-0/download). Now, EOHHS is extending these rate enhancements through December 31, 2022, by using Medicaid funding. These investments are aimed at strengthening and stabilizing the state's HCBS and behavioral health workforce in response to the COVID-19 public health emergency. See MA Bulletin No. 10-7-2022 (#1) (October 7, 2022) and MA Bulletin No. 10-7-2022 (#2) (October 7, 2022). ¢ This bulletin is being issued in accordance with 101 CMR 206.10(18): Payments for Quality Improvements through COVID-19 Preparedness. This bulletin applies to nursing facilities participating in the MassHealth program that seek payments for quality improvements through COVID-19 preparedness ('COVID-19 Preparedness Payments") under 101 CMR 206.10(18)(b). See MA Bulletin No. 11-7-2022 (November 7, 2022). Minnesota ¢ 2021 MN S.F. 2876 (NS), engrossed March 21, reinstatement and extension of COVID-19 program waivers and modifications establishment; Commissioner of health temporary emergency authority permission to grant certain COVID waivers. ¢ 2021 MN S.F. 3889 (NS), introduced March 10, relating to pharmacists authorization to prescribe, dispense and administer ivermectin and hydroxychloroquine for preexposure prophylaxis use, postexposure prophylaxis use and for the treatment of COVID-19. ¢ 2021 MN S.F. 3940 (NS), engrossed March 29, providing licensed pharmacists authority to initiate, order, and administer vaccines and certain medical and laboratory tests expansion; medical assistance coverage requirement. Nevada ¢ A regulation relating to health care; authorizing the Chief Medical Officer to impose certain reporting requirements during a pandemic or epidemic; adopting certain publications by reference; prescribing certain requirements concerning the operation of a medical facility or facility for the dependent. See 2022 NV REG TEXT 512627 (NS). ¢ Aregulation relating to health care; authorizing the Chief Medical Officer to impose certain reporting requirements during a pandemic or epidemic; adopting certain publications by reference; prescribing certain requirements concerning the operation of a medical facility, facility for the dependent or certain other licensed facilities; requiring a medical facility to report the acquisition or loss of certain accreditation; providing for the licensure and regulation of certain referral agencies. See 2022 NV REG TEXT 612627 (NS). New Jersey 2022 NJ S.B. 1896 (NS), introduced March 3, extends COVID-19 Medicaid per diem rate, and requires Medicaid coverage without prior authorization, for certain partial care behavioral health and substance use disorder treatment services. New York ¢ 2021 NY A.B. 9532 (NS), introduced March 16, directs the commissioner of health to conduct an investigation of the department's performance, compliance and enforcement of applicable state laws, rules, regulations, and directives or executive orders, with respect to mitigating the impact of COVID-19 in nursing homes, adult care facilities, and assisted living residences, and to propose a pandemic response plan for future disease outbreaks. ¢ To implement a COVID-19 vaccination program in OMH Operated or Licensed Hospitals. See 2022 NY REG TEXT 597203 (NS). * To require covered entities to ensure their personnel are fully vaccinated against COVID-19 subject to certain exemptions. See 2022 NY REG TEXT 601321 (NS). * To prevent the ongoing threat to public health of the spread of COVID-19 in OASAS settings. See 2022 NY REG TEXT 602739 (NS). ¢ To establish minimum standards to control the spread of COVID-19 at residential congregate programs. See 2022 NY REG TEXT 602741 (NS). THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ To require NH's and ACF's to establish policies and procedures relating to personal caregiving and compassionate caregiving visitors. See 2021 NY REG TEXT 601336 (NS). ¢ To require immediate coverage, without cost-sharing, for COVID-19 immunizations and the administration thereof. See 2022 NY REG TEXT 603110 (NS). * To waive cost-sharing for in-network visits and laboratory tests necessary to diagnose the novel coronavirus (COVID-19). See 2022 NY REG TEXT 603111 (NS). * To ensure that all general hospitals and nursing homes maintain a 60-day supply of PPE during the COVID-19 emergency. See 2022 NY REG TEXT 607452 (NS). ¢ To require nursing homes and adult care facilities to conduct ongoing COVID-19 vaccinations of their residents and personnel. See 2022 NY REG 607453 (NS). ¢ To ensure continuity of care of telehealth services provided to Medicaid enrollees. See 2022 NY REG TEXT 610097 (NS). * To require immediate coverage, without cost-sharing, for COVID-19 immunizations and the administration thereof. See 2022 NY REG TEXT 6111471 (NS). * To waive cost-sharing for in-network visits and laboratory tests necessary to diagnose the novel coronavirus (COVID-19). See 2022 NY REG TEXT 611142 (NS). ¢ To allow telemedicine in some circumstances due to COVID-19 and keep in effect during permanent telehealth proposal process. See 2022 NY REG TEXT 612959 (NS). ¢ To ensure that all general hospitals and nursing homes maintain a 60-day supply of PPE during the COVID-19 emergency. See 2022 NY REG TEXT 613995 (NS). ¢ To require nursing homes and adult care facilities to conduct ongoing COVID-19 vaccinations of their residents and personnel. See 2022 NY REG TEXT 613996 (NS). * To ensure that all general hospitals and nursing homes maintain a 60-day supply of PPE during the COVID-19 emergency. See 2022 NY REG TEXT 616229 (NS). ¢ To require nursing homes and adult care facilities to conduct ongoing COVID-19 vaccinations of their residents and personnel. See 2022 NY REG TEXT 616230 (NS). ¢ To allow telemedicine in some circumstances due to COVID-19 and keep in effect during permanent telehealth proposal process. See 2022 NY REG TEXT 620286 (NS). * To require immediate coverage, without cost-sharing, for COVID-19 immunizations and the administration thereof. See 2022 NY REG TEXT 624996 (NS). * To waive cost-sharing for in-network visits and laboratory tests necessary to diagnose the novel coronavirus (COVID-19). See 2022 NY REG TEXT 624997 (NS). ¢ To allow telemedicine in some circumstances due to COVID-19 and keep in effect during permanent telehealth proposal process. See 2022 NY REG TEXT 627269 (NS). Oklahoma * 2021 OK S.B. 1518 (NS), engrossed March 22, relating to long-term care; eliminating temporary emergency waiver for employment of noncertified nurse aides; stating requirements for training and competency evaluation program. * 2021 OK H.B. 3313 (NS), amended/substituted March 2, relating to hospital visitation under the No Patient Left Alone Act; modifying requirements; requiring agency reporting; requiring agency investigation of claims; creating private cause of action; creating requirements; specifying damages; providing for codification; providing an effective date; and declaring an emergency. ¢ 2021 OK H.B. 4294 (NS), prefiled January 22, relating to medical licensure; amending O.S. 2021, Section 637, which relates to medical licensure; creating license protections for physicians prescribing treatments related to COVID-19; and providing an effective date. Oregon The Department is amending OAR chapter 411, division 027 to continue the temporary COVID-19 rate increase authorized by the Executive Branch and Legislature through June 30, 2023, and to increase the Legislatively approved Medicaid rates effective July 1, 2022. Other changes may be made to OAR 411-027-0170 to correct grammatical errors, ensure consistent terminology, address issues identified during the public comment period, and to improve the accuracy, structure, and clarity of the rule. See 2022 OR REG TEXT 616524 (NS). Pennsylvania THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. 2021 PA H.B. 1420 (NS), amended/substituted July 7, mending the act of June 13, 1967 (P.L.31, No.21), known as the Human Services Code, in general powers and duties of the Department of Public Welfare, providing for COVID-19 mental health public awareness campaign; in public assistance, further providing for eligibility and for medical assistance payments for institutional care and providing for resident care and related costs and for pharmacy benefits manager audit and obligations; in the aged, further providing for LIFE program and providing for agency with choice; in children and youth, further providing for limits on reimbursements to counties; in nursing facility assessments, further providing for time periods; in managed care organization assessments, further providing for assessment amount; providing for innovative health care delivery models; abrogating regulations; and making a related repeal. Rhode Island ¢ 2021 RI S.B. 2325 (NS), introduced February 15, mandates that health insurance companies and Medicaid provide coverage for FDA approved COVID-19 home testing kits. ¢ 2021 RI H.B. 7298 (NS), introduced February 2, requires that all COVID-19 testing, inclusive of rapid antigen testing and/or PCR testing are covered by insurance regardless of whether such testing is ordered by a doctor. ¢ 2021 RI H.B. 7626 (NS), introduced March 2, mandates health insurance companies and Medicaid provide coverage for FDA approved COVID-19 home testing kits. ¢ 2021 RI H.B. 7795 (NS), introduced March 3, would mandate that health insurance companies and Medicaid provide coverage for mental illness related to COVID-19. Subsidies for coverage would be provided by the Families First Coronavirus Response Act that requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. ¢ 2021 RI H.R. 7882 (NS), introduced March 4, resolution requesting the Executive Office of Health and Human Services to create a COVID-19 surge plan for handing the increasing need for behavioral health services and substance use disorder treatments. ¢ 2021 H.B. 7990 (NS), introduced March 16, authorizes pharmacists to dispense ivermectin for the treatment of COVID-19 pursuant to a standing order issued by licensed health care providers. ¢ 2021 RI H.B. 8063 (NS), introduced March 30, would, due to the COVID-19 health crises, suspend the provisions of 23-17.5- 33, relating to nursing home staffing and unless extended by the general assembly, the suspension would sunset on June 30, 2022 at which time the provisions of 23-17.5-33 would be restored. * 2021 RI H.B. 8076 (NS), introduced April 1, would provide for a two hundred million dollar ($200,000,000) fund to administer retention payments of two thousand five hundred dollars ($2,500) for certain health care workers who worked during the COVID-19 pandemic without regard to vaccination status and provide two hundred million dollar ($200,000,000) fund for payments to acute care or psychiatric hospitals who can demonstrate losses as a result of the COVID-19 pandemic. ¢ 2021 RI H.B. 8284 (NS), amended/substituted June 14, due to the COVID-19 health crisis, suspends the provisions of ? 36-10-36 relating to reemployment of retired sheriffs and employees of the department of health and the provisions of ? 23-17.5-33, relating to monetary penalties, with sunset provisions. * The Rhode Island Department of Health is proposing amendments to the regulation, Licensing of Nursing Homes in order to incorporate new references, add definitions for declaration of disaster emergency, direct care nursing staff, direct caregiver, essential caregiver, hours of direct nursing care, occupational therapist, physical therapist, physical therapist assistant, soeech language pathologist, and vaccinated. The regulation also provides procedures for COVID-19 testing for residents and personnel; provides procedures for essential caregivers during a declared emergency and related provisions. See 2022 RI REG TEXT 603692 (NS). South Carolina ¢ 2021 SC H.B. 4941 (NS), introduced February 8, to require vaccine administrators to obtain written informed consent before administering a COVID-19 vaccination to a person; and to create criminal penalties. * 2021 SC H.B. 4942 (NS), introduced February 8, to require vaccine administrators to obtain written informed consent before administering a COVID-19 vaccination to a person; and to provide for the appropriation of related funding. * 2021 SC H.B. 5018 (NS), introduced February 23, to amend the Code of Laws of South Carolina to enact the 'No Patient Left Alone Act' by adding sections 44-7-395 and 44-71-120 so as to safeguard patient and resident visitation rights in certain health care facilities during declared disasters and emergencies, to direct the Department of Health Environmental Control to impose a civil penalty for any violation of those rights and for other purposes. Tennessee 2021 TN S.B. 1880 (NS), introduced January 26, as introduced, prohibits a licensing board or disciplinary subcommittee from taking action against a physician's license based solely on the physician's recommendations to a patient regarding treatment for COVID-19 subject to certain conditions; prohibits a pharmacy from blocking or attempting to block a patient's access to COVID-19 treatments in certain circumstances. Vermont THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ 2021 VT S.B. 160 (NS), introduced January 4, bill proposes to limit the amount a health care provider may charge for a diagnostic test for the coronavirus to twice the Medicare rate. It would prohibit a hospital from imposing a lien on a patient injured in an accident without first billing and accepting payment from the patient's health insurance and would prohibit the hospital from balance billing the patient or from filing a lien for sums charged in excess of the insurance reimbursement amounts. ¢ 2021 VT H.B. 654 (NS), adopted March 22, proposes to express legislative intent to extend certain provisions of law offering regulatory flexibility to health care providers and relevant State agencies during the COVID-19 pandemic. Virginia * 2022 VA S.B. 73 (NS), introduced January 12, provides that licensed health care providers with prescriptive authority may prescribe, administer, or dispense hydroxychloroquine and ivermectin to a patient with a clinical diagnosis of COVID-19. The bill prohibits the Board of Medicine from initiating a disciplinary action against a licensed health care provider solely for prescribing, administering, or dispensing hydroxychloroquine or ivermectin to a patient with a clinical diagnosis of COVID-19 and related provisions. ¢ 2022 VA H.B. 102 (NS), introduced January 12, provides that a licensed health care provider with prescriptive authority may prescribe, administer, or dispense a drug that has been approved for a specific use by the U.S. Food and Drug Administration for an off-label use when the health care provider determines, in his professional judgement, that such off-label use is appropriate for the care and treatment of the patient, and prohibits a pharmacist from refusing to dispense a drug for off-label use if a valid prescription is presented. ¢ 2022 VA S.B. 672 (NS), adopted May 27, allows pharmacists and pharmacy technicians acting under the supervision of a pharmacist to initiate treatment with and dispense and administer vaccines for COVID-19, nicotine replacement and other tobacco cessation therapies, and tests for COVID-19 and other coronaviruses to persons aged 18 years and older and vaccines included on the Immunization Schedule published by the Centers for Disease Control and Prevention and vaccines for COVID-19 and tests for COVID-19 and other coronaviruses to persons three years of age or older in accordance with a statewide protocol established by the Board of Medicine in collaboration with the Board of Pharmacy and the Department of Health. Includes related provisions. * 2022 VA H.B. 1323 (NS), adopted May 27, allows pharmacists and pharmacy technicians acting under the supervision of a pharmacist to initiate treatment with and dispense and administer vaccines for COVID-19, nicotine replacement and other tobacco cessation therapies, and tests for COVID-19 and other coronaviruses to persons aged 18 years and older and vaccines included on the Immunization Schedule published by the Centers for Disease Control and Prevention and vaccines for COVID-19 and tests for COVID-19 and other coronaviruses to persons three years of age or older in accordance with a statewide protocol established by the Board of Medicine in collaboration with the Board of Pharmacy and the Department of Health. Includes related provisions. Washington ¢ The department is enacting WAC 388-845-2019 on an emergency basis to make temporary modifications to developmental disabilities administration's (DDA) home and community-based services (HCBS) waivers to control the spread of the COVID-19 virus and to meet immediate health and safety needs. This subsequent emergency filing keeps the rule in place until the permanent rule is effective, 31 days after filing. See 2022 WA REG TEXT 552057 (NS). ¢ WAC 246-945-010 Prescription labeling, records, and advertising - Minimum requirements. The pharmacy quality assurance commission (commission) is adopting emergency rules to reduce burdens on practitioners prescribing Schedule II substances during the coronavirus disease (COVID-19) outbreak. This adopted emergency rule will extend WSR 22-06-017 filed on February 22, 2022. This emergency rule was originally filed on April 21, 2020, under WSR 20-09-133. See 2022 WA REG TEXT 553783 (NS). ¢ The department is extending the amendment of the rules listed below and making the suspension retroactive to August 13, 2021, to ensure assisted living facilities are not significantly impeded during the hiring process due to an administrator's inability to obtain a certificate of completion of a recognized administrator training as referenced in WAC 388-78A-2521. This will help to increase the number of long-term care administrators necessary to provide essential services to some of Washington's most vulnerable adults during the outbreak of COVID-19. See 2022 WA REG TEXT 554942 (NS). * WAC 246-840-365 and 246-840-367. The nursing care quality assurance commission (commission) is amending specific license requirements for advanced registered nurse practitioners (ARNPs). These amendments are necessary in response to the coronavirus disease 2019 (COVID-19) pandemic and the critical demand for health care professionals. The rules in chapter 246-840 WAC provide regulatory requirements for registered nurses, licensed practical nurses, advanced registered nurse practitioners, and nurse technicians. See 2022 WA REG TEXT 554944 (NS). ¢ The department is extending the amendment of the rules listed below to ensure nursing homes are not significantly impeded from admitting and caring for residents during the COVID-19 outbreak. These amendments will continue to align state nursing home rules with federal rules that were suspended or amended to help facilitate care during the COVID-19 pandemic. See 2022 WA REG TEXT 554950 (NS). ¢ WAC 246-840-930 and 246-841-405, amending specific training requirements for nursing assistants-registered (NARs) and home care aides (HCAs). These rules continue the initial emergency rules filed as WSR 22-07-046 on March 14, 2022, and later on July 12, 2022, as WSR 22-15-020. The nursing care quality assurance commission (commission) is refiling these emergency rules to continue THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. to allow a registered nurse delegator to delegate nursing tasks to NARs or HCAs based on requirements established by the department of social and health services (DSHS). See 2022 WA REG TEXT 559815 (NS). ¢ This rule makes temporary allowances necessary to address the health and safety of waiver recipients and help control the spread of COVID-19. The allowances in this rule were approved by the Centers for Medicare and Medicaid Services (CMS) in an Appendix K waiver, the purpose of which is to address the effects of the COVID-19 public health emergency. These temporary allowances will end according to direction from CMS. This permanent rule supersedes the emergency filed under WSR 22-12-024 on May 23, 2022. See 2022 WA REG TEXT 561760 (NS). ¢ The department is extending the suspension of the rules listed below to ensure long-term care facilities and providers are not significantly impeded during the hiring process due to an inability to access required tuberculosis (TB) testing as a result of the COVID-19 pandemic. Clinics providing TB testing continue to be short of staff and have limited availability throughout the state. These clinics are unable to provide the TB testing required as a part of the hiring process in many long-term care programs. See 2022 WA REG TEXT 562837 (NS). e WAC 246-101-017 Novel coronavirus (SARS-CoV-2), coronavirus disease 2019 (COVID-19) reporting. The Washington state board of health has adopted a seventh emergency rule to continue to designate COVID-19 as a notifiable condition and establishes reporting requirements for health care providers, health care facilities, laboratories, local health jurisdictions, and the department of agriculture (WSDA) to report certain data with COVID-19 test results, including relevant demographic details (e.g., patient's age, race, ethnicity, sex), and testing information. See 2022 WA REG TEXT 562840 (NS). ¢ The department is extending the amendment of the rule listed below to ensure certified community residential services and supports (CCRSS) providers are not significantly impeded from providing services and support to clients during the COVID-19 pandemic. Governor Inslee's Proclamation 20-18 and subsequent extensions identified that the pandemic has resulted in disruptions of long-term care systems, including the ability to safely conduct inspections. See 2022 WA REG TEXT 563896 (NS). ¢ The department is extending the amendment of the rules listed below to ensure nursing homes are not significantly impeded from admitting and caring for residents during the COVID-19 outbreak. This rule making extends emergency rules filed consecutively since April 13, 2020, to maintain compliance with blanket waivers issued by the Centers for Medicare and Medicaid Services (CMS). The amendments will continue to align state nursing home rules with federal rules that are suspended or amended to help facilitate care during the COVID-19 pandemic until such time as CMS reinstates their rules. See 2022 WA REG TEXT 563902. * The department is extending the amendment of the rule listed below to ensure nursing homes are not significantly impeded from admitting and caring for residents during the COVID-19 pandemic. These amendments align state nursing home rules with federal rules that were suspended or amended to help facilitate care during the COVID-19 pandemic. The federal rules were amended to allow nursing facilities to provide clinical records to residents and resident representatives in 10 working days instead of two working days. See 2022 WA REG TEXT 566934 (NS). * WAC 246-338-020 and 246-338-026, medical test site licensure and notification requirements. The department of health (department) is adopting an emergency rule to amend WAC 246-338-026 mandating reporting of test results intended to detect SARS-CoV-2 or diagnose a possible case of the coronavirus disease 2019 (COVID-19) in alignment with federal changes published in 85 F.R. 54820 on September 2, 2020. See 2022 WA REG TEXT 569064 (NS). ¢ The health care authority is revising this section to allow for payment of office visits for clients under the alien emergency medical (AEM) program when the visit is specifically for the assessment and treatment of the COVID-19 virus. See 2022 WA REG TEXT 571418 (NS). « WAC 246-945-171 Retired active pharmacist license status, establishing a new section of rule. This emergency rule will extend WSR 22-12-066 filed on May 27, 2022, without change. On March 26, 2020, Governor Inslee signed Proclamation 20-32 to help increase the number of health care workers available to meet the needs of patients during the coronavirus disease 2019 (COVID-19) pandemic. See 2022 WA REG TEXT 577063 (NS). * WAC 246-817-581 Novel coronavirus disease 2019 vaccination by licensed dental hygienist. The dental quality assurance commission adopted rules allowing dentists to delegate administration of novel coronavirus disease 2019 (COVID-19) vaccination to licensed dental hygienists with close supervision and demonstration of competency. The adopted rule also provides for acceptance of approved vaccination protocols and screening to meet the dentist's requirement to diagnose and authorize treatment. See 2022 WA REG TEXT 580808 (NS). * The legislation addresses coverage of telemedicine services, including audio-only telemedicine services. Prior to passage of this legislation, audio-only telemedicine services were explicitly excluded from the definition of 'telemedicine'. Carriers were not required by statute to cover audio-only telemedicine services. During the COVID-19 public health emergency, the office of the insurance commissioner issued emergency orders requiring coverage of audio-only telemedicine services in order to ensure access to medical services. ESHB 1196 requires coverage of audio-only telemedicine services under specified conditions and amends the statutory language related to telemedicine payment parity. See 2021 WA REG TEXT 587381 (NS). ¢ The agency is filing this rule to avoid a gap in coverage between the time the public health emergency (PHE) ends and the time similar coverage is reinstated under Medicaid verification procedures that existed before the PHE. 2022 WA REG TEXT 589971 (NS). THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ WAC 246-840-533 and 246-840-930. The nursing care quality assurance commission (commission) is adopting amendments to WAC 246-840-533 that incorporates the practice/academic partnership model for nursing preceptors, interdisciplinary preceptors, and proctors in clinical or practice settings for nursing students located in Washington state. In response to the coronavirus disease 2019 (COVID-19), the commission approved the practice/academic partnership model in order to assist with the strain on clinical placement of nursing students during the pandemic. See 2022 WA REG TEXT 595396 (NS). ¢ The department is requiring long-term care workers (LTCW) to complete training requirements by certain dates that would potentially be before the suspension of the training requirements ends. The department is dividing the group of LTCWs, who are working now and started within 120 days of when the suspension went into place in early 2020, into cohorts based on length of time working. The rule would then require each cohort to complete the requirements by deadlines in rule with the 'oldest' LTCWs having the first deadline and then working through the groups chronologically. See 2022 WA REG TEXT 596734 (NS). ¢ The department is adding two new sections in chapters 388-71 and 388-112A WAC. The intent is to respond to the backlog of long-term care workers needing training and/or testing for certification caused by the COVID-19 pandemic. These rules will allow additional time for long-term care workers to be trained and certified by requiring them to complete training requirements by certain dates based on no further information supplied. Workers are also credited with continuing education hours for on-the-job training during the COVID-19 emergency and related provisions. See 2022 WA REG TEXT 597808 (NS). * WAC 246-300-001 Licensed health care facilities and coronavirus disease 2019 (COVID-19). Adopting an emergency rule to clarify that licensed facilities must comply with state and federal statutes, rules, lawful orders, and other legal requirements, including lawful orders issued to prevent the spread of COVID-19. This emergency rule establishes that all health care facilities licensed by the department of health must comply with state and federal statutes, administrative rules, lawful orders, and other legal requirements relating to the operation of the facility and the control or prevention of the spread of COVID-19, including orders issued by the governor, by the secretary of health, by a local board of health, and by a local health officer. See 2022 WA REG TEXT 604667 (NS). ¢ The department is amending WAC 388-97-0140 to waive and suspend the requirement for nursing homes to suspend transfers and discharges pending the outcome of a resident appeal of the nursing home transfer or discharge decision. The COVID-19 pandemic continues to require more rapid transfers and discharges than the rule permits. See 2021 WA REG TEXT 601349 (NS). ¢ Addressing the impact COVID-19 response measures are having on the podiatric physician profession with regard to meeting the continuing medical education requirements. The podiatric medical board is extending the expiration of this policy through June 30, 2022, or until the declared State of Emergency issued under Proclamation 20-05 is rescinded, whichever is later. See 2022 WA REG TEXT 603202 (NS). ¢ Use of advanced emergency medical technicians and paramedics to administer monoclonal antibodies for COVID-19 during a public health emergency. See 2022 WA REG TEXT 603221 (NS). ¢ The health care authority (HCA) intends to submit Medicaid SPA 21-0038 to implement policies and procedures that may be different from the policies and procedures otherwise applied under the Medicaid state plan, during the period of the presidential and secretarial emergency declarations related to the COVID-19 outbreak. See 2022 WA REG TEXT 603223 (NS). ¢« WAC 246-300-001 Licensed health care facilities and coronavirus disease 2019 (COVID-19). Extending the adoption of an emergency rule that establishes that all health care facilities licensed by the department of health must comply with state and federal statutes, administrative rules, lawful orders, and other legal requirements relating to the operation of the facility and the control or prevention of the spread of COVID-19, including orders issued by the governor, by the secretary of health, by a local board of health, and by a local health officer. See 2022 WA REG TEXT 604667 (NS). ¢ On January 26, 2022, the department filed emergency rules under WSR 22-04-038 to suspend requirements in WAC 388-97-1740 Disaster and emergency preparedness, 388-97-1760 Quality assessment and assurance, and 388-97-2400 Resident rooms. The filing was an extension of emergency rules filed consecutively since June 23, 2020, to maintain compliance with blanket waivers issued by the Centers for Medicare and Medicaid Services (CMS) to ensure nursing homes are not significantly impeded from caring for residents during the COVID-19 pandemic. See 2022 WA REG TEXT 607486 (NS). ¢ The purpose of this rule is to amend WAC 246-980-030, 246-980-040, and 246-980-065 in chapter 246-980 WAC, Home care aides, and adopting new WAC 246-980-011. Due to impacts from the coronavirus disease 2019 (COVID-19) pandemic, many uncertified home care aides are unable to obtain training and certification within statutory timeframes. Establishing alternate timeframes under ESHB 1120 will allow additional time for uncertified home care aides to complete certification requirements while training, testing, and certification capacity issues are being resolved. See 2022 WA REG TEXT 608640 (NS). ¢ The department is extending the amendment of the rules listed below. Because of the ongoing COVID-19 public health emergency, on January 18, 2022, home and community services (HCS) temporarily suspended conducting ongoing assessments for HCS clients living in adult family homes, assisted living facilities, and enhanced services facilities. This suspension allows HCS staff to focus on conducting assessments for patients staying in hospitals to facilitate their discharge to long-term care facilities and improve the current surge capacity in hospitals. See 2022 WA REG TEXT 609578 (NS). ¢ The health care authority (HCA) previously filed notice under WSR 22-06-027 of its intent to submit CHIP SPA 22-0001 in order to provide coverage for COVID-19 vaccines, testing, and treatment, including treatment of a condition that may seriously complicate THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. COVID-19, without cost-sharing in CHIP. States are required to provide such coverage by the American Rescue Plan Act, retroactive to March 11, 2021. See 2022 WA REG TEXT 609596 (NS). ¢ The department is amending WAC 388-97-0120 and 388-97-0140 to waive and suspend the requirement for nursing homes to suspend certain transfers and discharges pending the outcome of a resident appeal of the nursing home transfer or discharge decision. The COVID-19 pandemic continues to require more rapid transfers and discharges than the rule permits. The rule in place by emergency waives the requirement for nursing homes to suspend certain transfer and discharges pending the outcome of a resident appeal hearing and improves resident safety by allowing faster grouping of COVID-19 positive residents in one facility or grouping of asymptomatic residents together. See 2022 WA REG TEXT 612429 (NS). ¢ The department is amending WAC 388-97-0140 and 388-97-0120 to waive and suspend the requirement for nursing homes to suspend certain transfers and discharges pending the outcome of a resident appeal of the nursing home transfer or discharge decision. The COVID-19 pandemic continues to require more rapid transfers and discharges than the rule permits. See 2022 WA REG TEXT 621918 (NS). * WAC 246-980-025 in chapter 246-980 WAC, Home care aides; and adopting new WAC 246-980-012. Due to impacts from the coronavirus disease 2019 (COVID-19) pandemic, long-term care workers experience significant delays when completing training, testing, and certification as a nursing assistant-certified (NAC). See 2022 WA REG TEXT 625521 (NS). ¢ Addressing the impact COVID-19 response measures are having on the podiatric physician profession with regard to meeting the continuing medical education requirements. The podiatric medical board is extending the expiration of this policy through December 31, 2022. See 2022 WA REG TEXT 626706 (NS). ¢« WAC 246-980-100 (5)(c) requires that home care aide certification testing occur within two years of training. This emergency rule removes the two-year limit on the validity of training. Lasting impacts from the coronavirus disease 2019 (COVID-19) pandemic have increased home care aide workforce shortages by creating backlogs that limit access to training and testing. Continuing to require testing within two years of training would require many uncertified individuals to repeat training, delaying and possibly preventing them from becoming credentialed as home care aides. See 2022 WA REG TEXT 627742 (NS). * WAC 388-71-0876 When must long-term care workers who were working or hired during the COVID-19 public health emergency complete training, including required specialty training? and 388-112A-0081 When must long-term care workers who were working or hired during the COVID-19 public health emergency complete training, including required specialty training?. The department of social and health services (department) is requiring that long-term care workers (LTCWs) complete training and certification by certain dates in response to the COVID-19 public health emergency. See 2022 WA REG TEXT 628809 (NS). lli. MEDICAID EXPANSION Medicaid Eligibility Illinois 2021 IL S.B. 3062 (NS), introduced January 5, provides that beginning on January 1, 2024, the Department of Healthcare and Family Services shall raise the income eligibility standard for all of its medical assistance programs to include persons whose income is equal to or less than 276% of the federal poverty level (or any higher percentage determined by the Department) plus 5% for the applicable family size as determined under federal law and applicable federal regulations. Kansas 2021 KS H.C.R. 5024 (NS), introduced January 20, proposing to amend the constitution of the state of Kansas to provide medical assistance eligibility to the extent authorized under federal law. Mississippi ¢ 2022 MS H.B. 108 (NS), introduced January 4, to expand Medicaid eligibility under federal Affordable Care Act. ¢ 2022 MS H.B. 387 (NS), introduced January 5, to expand Medicaid eligibility under federal Affordable Care Act. * 2022 MS H.B. 760 (NS), introduced January 17, to provide Medicaid coverage for individuals who are under 65 years of age, are not pregnant, are not entitled to or enrolled for Medicare benefits and whose income is not more than 133% of the Federal Poverty Level, as authorized under the federal Patient Protection and Affordable Care Act; and for related purposes. * 2022 MS H.B. 1000 (NS), introduced January 17, to provide Medicaid coverage for individuals who are at least 19 years of age but under 65 years of age and whose income does not exceed 138% of the Federal Poverty Level, who satisfy the criteria of a waiver approved by the Centers for Medicare and Medicaid Services to receive specific benefits including care coordination services provided by a provider sponsored health plan as defined by Mississippi law and related provisions. ¢ 2022 MS S.B. 2315 (NS), introduced January 17, to expand eligibility to include individuals entitled to benefits under federal Patient Protection and Affordable Care Act. THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. ¢ 2022 MS S.B. 2331 (NS), introduced January 17, to expand eligibility to include individuals entitled to benefits under federal Patient Protection and Affordable Care Act. ¢ 2022 MS S.B. 2447 (NS), introduced January 17, to expand eligibility to include individuals entitled to benefits under federal Patient Protection and Affordable Care Act. Missouri GOP Plan to Hamper Medicaid Expansion Reaches House Floor A Missouri legislative budget panel has approved a constitutional amendment proposal that would subject Medicaid expansion to annual appropriations by the General Assembly, which could defund it. [FN2] The proposal passed by a 22-9 vote and next heads to the full House for a vote. Expansion was approved by a voter referendum in 2020 and the state Supreme Court ruled last year that the legislature must provide money for expansion. Democrats say the latest end-around by Republicans is just another effort to hurt poor people who need health coverage. 'All we're doing is kicking off people who qualify," said Rep. Peter Merideth, D-St. Louis, who is the ranking member of the House Budget Committee. House Budget Committee Chairman Rep. Cody Smith, R-Carthage, argued that his proposed constitutional change wouldn't necessarily cut all expansion costs. Rather, he said, it would allow lawmakers more flexibility to manage Medicaid spending. In addition to making expansion an optional funding line in the budget, the proposed referendum also would institute a requirement for Medicaid recipients to work or do qualified community engagement for 80 hours a month. The proposed work requirements would apply to applicants between ages 19 and 65 and allow for some exemptions. If the proposal is approved by the House, it would then go to the state Senate for further deliberations. The proposal also would have to win approval from President Joe Biden's administration, which announced in February 2021 that it would remove all work waivers the government granted during the Trump administration. New Jersey 2022 NJ A.B. 4113 (NS), introduced June 2, codifies and expands Medicaid coverage for certain school-based services. Possible Medicaid Expansion Vote in North Carolina Later This Year An up-or-down vote on broad Medicaid expansion in North Carolina could occur before the November elections, key Republican legislators recently said. [FNS] A joint House-Senate panel created in the current budget law has been tasked with studying health care access and possible expansion. The committee could submit proposed legislation to the full General Assembly before this year's session ends, the budget law says. While there's no guarantee that North Carolina will accept expansion - many House Republicans still oppose the idea - more Senate Republicans have warmed to the concept in 2021. Support has grown in part because of a financial sweetener from the federal government above and beyond what it already pays to cover conventional recipients. Hundreds of thousands of additional people would be anticipated to join the Medicaid rolls, which is already at 2.7 million in the state. Democrats led by Gov. Roy Cooper are strong expansion supporters, with Cooper pitching the idea since taking office in 2017. North Carolina Tries Again to Expand Medicaid Another attempt to expand Medicaid to nearly 600,000 North Carolinians is being made. [FN4] Republicans in the state House of Representatives are not ready to embrace the policy whole hog. Instead, there will be one more study and more planning, while the lawmakers campaign for elections in November. The proposal to create a legislative committee with members from both chambers that will hear a Medicaid Modernization Plan to be developed by the state Department of Health and Human Services comes out of negotiations between state House and Senate leaders over a spending plan for the coming fiscal year. The new way forward toward embracing Medicaid expansion, according to SB 408, would add Medicaid coverage for adults with annual incomes up to 133% of the federal poverty level, or slightly more than $17,000 in earings for an individual. If negotiations with federal regulators produces a plan that the General Assembly is happy with, lawmakers have said they would return to Raleigh no later than Dec. 15 to have the actual, final vote on the plan. 'In December, should this go into law, there will be a vote," Tim Moore, the Republican from Kings Mountain who's speaker of the state House of Representatives, told the House Rules committee on Tuesday. In the past, bills to expand Medicaid have made it through the House committee hearing process only to never reach a vote on that chamber's floor. As a plan is developed to bring back to lawmakers, it will be learned from the federal government and teams of lawyers if the state can add a work requirement to the expansion rules, something that has failed in every other state that has proposed it. It can also figure out a parachute for the state to opt out if the federal government tries to cut back on its funding share of 90% for every new Medicaid expansion beneficiary. Oklahoma THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -10- These emergency revisions are necessary to protect the public health, safety or welfare by expanding Medicaid eligibility for individuals defined by 42 C.F.R. s. 435.119 (Expansion Adults). Additionally, the proposed changes will define Expansion Adult benefits, prior authorization requirements, and/or medically necessity criteria. See 2022 OK REG TEXT 606758 (NS). Medicaid Expansion to Appear on November South Dakota Ballot The South Dakota Secretary of State's office has announced that a proposal to expand Medicaid eligibility in the state will appear on the ballot in November. '""5! the measure, known as Constitutional Amendment D, was validated after a requisite number of signatures were collected. South Dakota is one of 12 states that has yet to expand Medicaid. So far, Medicaid expansion initiatives put on the ballot have only failed once in Montana (but the state legislature later approved it). If expansion is approved in South Dakota, it would provide an additional 42,500 residents with access in the first year. There is an additional sticking point. If a different ballot measure passes in June, the November expansion measure could require 60% approval, instead of the usual 50%, since it would raise taxes or spending by at least $10 million. South Dakota Senate Rejects Medicaid Expansion A proposal to expand Medicaid health coverage eligibility was recently defeated in the South Dakota Senate, leaving the decision to voters in the November election. "N®! The Republican-controlled Senate rejected the bill on a 12 to 23 vote. However, a campaign backed by the state's major health care systems is trying to get voters to pass a constitutional amendment to expand Medicaid eligibility on the November ballot. 'It's clear that the only path to expanding Medicaid in South Dakota is by letting the people vote on it directly," said Zach Marcus, the manager for the campaign, in a statement. The proposal would allow 42,500 more people to access health care coverage and bring $1.3 billion in federal money to the state. Virginia This regulatory action adds the alternative benefit plan (ABP), which is available to individuals who are covered by Medicaid expansion, to the Virginia State Plan for Medical Assistance in order to implement Medicaid expansion. The Centers for Medicare and Medicaid Services (CMS) requires state Medicaid agencies to create an ABP for expansion populations. The changes included in this regulatory action have already been reviewed and approved by CMS. See 2022 VA REG TEXT 530408 (NS). Medicaid Buy-In Florida ¢ 2022 FL S.B. 1692 (NS), introduced January 18, requiring the Agency for Health Care Administration to establish and implement a Medicaid buy-in program for certain individuals with disabilities; providing requirements for the program; requiring the agency to seek federal waiver approval or submit any state plan amendments necessary to implement the program by a specified date; requiring the agency to implement the program upon receiving federal approval, etc. * 2022 FL S.B. 1822 (NS), introduced January 18, requiring the Agency for Health Care Administration to establish and implement a Medicaid buy-in program for certain individuals with disabilities; providing requirements for the program; requiring the agency to seek federal waiver approval or submit any state plan amendments necessary to implement the program by a specified date; requiring the agency to implement the program upon receiving federal approval, etc. Indiana 2022 IN S.B. 384 (NS), introduced January 11, removes consideration of countable resources in determining an individual's eligibility for participation in the Medicaid buy-in program (program). Prohibits the office of the secretary of family and social services (office of the secretary) from considering resources and whether the individual participated in a specified program in determining the individual's eligibility or continuous eligibility for the program. New York 2021 NY S.B. 95-8 (NS), introduced July 22, enacts the 'health equity, affordability, and reform act'; relates to the basic health program; permits a person or eligible small group to purchase coverage from a basic health plan on behalf of an individual, spouse, and any qualified dependents through the basic health program buy-in as long as the individual, spouse, and any qualified dependents otherwise meet certain eligibility requirements (Part A) and related provisions. West Virginia 2022 WV S.B. 688 (NS), introduced February 21, creating the Affordable Medicaid Buy-in Program. Medicaid Initiatives HHS Approves Medicaid Initiatives in Massachusetts and Oregon On September 28, the Centers for Medicare & Medicaid Services (CMS), approved groundbreaking Medicaid section 1115 demonstration initiatives in Massachusetts and Oregon. Both demonstrations aim to test improvements in coverage, access, and THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -11- quality with innovative approaches to ensure more eligible people retain their Medicaid coverage, including by approving Oregon's demonstration to keep children enrolled in Medicaid up to age six - preventing gaps in coverage that can cause children to lose access to needed care in their formative early years. The initiatives also take steps to address unmet health-related social needs, such as by giving Massachusetts and Oregon new authority to test coverage for evidenced-based nutritional assistance and medically tailored meals, clinically-tailored housing supports, and other interventions for certain beneficiaries where there is a clinical need. These efforts coincide with the White House Conference on Hunger, Nutrition, and Health, where the Biden-Harris Administration released its national strategy to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities ? all goals supported by the initiatives approved today. 'This is an historic moment in our nation's fight to end hunger and improve health equity, particularly in states like Oregon and Massachusetts," said HHS Secretary Xavier Becerra. 'Groundbreaking action in each state will ensure children and youth remain connected to health care, and that we double down on tackling social needs impacting health, such as nutrition. Everyone should get the access to care they need to live safe and healthy lives." Both demonstrations will work to improve enrollment and continuity of coverage. In Oregon, children determined eligible for Medicaid will be able to stay continuously enrolled until they turn six years old, without their families needing to renew their coverage. This will minimize red tape for both families and the state, and help to ensure access to care throughout this critical period of early childhood. Individuals older than six will be able to keep their coverage for up to two years, even if their household income fluctuates. Massachusetts will provide up to 12 months of continuous coverage for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries upon release from correctional settings and 24-months of continuous eligibility for beneficiaries with a confirmed status of chronic homelessness, eliminating gaps in coverage for these vulnerable populations. Evidence indicates that health-related social needs, such as food insecurity and housing instability, are critical drivers of an individual's health outcomes. With this demonstration, Massachusetts will receive expanded authority to provide certain time-limited housing supports, clinical nutrition education, and medically-tailored food assistance services when medically appropriate. These services will be available to a range of at-risk populations, including postpartum individuals for up to 12 months. Massachusetts will also provide additional meal support for certain households when an eligible beneficiary is a child or pregnant woman with special clinical needs. Oregon will expand health-related social needs coverage for certain food assistance, housing supports, and other interventions that are medically appropriate for individuals experiencing certain life transitions, including individuals who are homeless or at risk of homelessness. In both states, the time-limited housing and nutritional support services provided in the demonstration can be expected to stabilize the housing and nutritional circumstances of these Medicaid enrollees and thus ensure that they will keep receiving and benefiting from the Medicaid-covered services to which they are entitled. Massachusetts will also be implementing an innovative Hospital Quality and Equity Initiative for private acute hospitals and the Commonwealth's only non-state-owned public hospital, Cambridge Health Alliance. The initiative is expected to reduce health inequities by improving outcomes in populations that are likely to face barriers to quality health care. As such, the demonstration is likely to help improve the quality of care and is also likely to reduce health disparities through this value-based care approach. CMS will require both states to systematically monitor the demonstrations and conduct rigorous independent evaluations to determine the outcomes and impacts. Medicaid Work Requirements Supreme Court Tosses Arkansas/New Hampshire Medicaid Work Requirement Case The Supreme Court won't be rescheduling arguments in the fight over work requirements for Medicaid beneficiaries that had been sitting in limbo at the court for over a year. IFN7] The justices on Monday agreed the cases disputing the Trump administration's approval of work rules in Arkansas and New Hampshire are now moot, and sent them back to the trial court with instructions to wipe the decisions off the books and dismiss them. Though the Biden administration is opposed to Medicaid work rules, the Justice Department took the unusual step of asking the justices to vacate lower court rulings that invalidated them. Some health law scholars say the appeals court rulings could have been used in the future to limit the authority the Health and Human Services secretary has to test new policies for the Medicaid program. The HHS notified the states on March 17, 2021, that the agency was withdrawing the Trump administration's prior approvals of the rules that require Medicaid beneficiaries to work, go to school, or volunteer in their community to remain in the program. Michigan and Wisconsin's were also withdrawn shortly thereafter. Arizona and Indiana were notified theirs were being withdrawn in letters sent June 24, 2021. Each state was given 30 days to file a written notice of appeal. IV. OTHER STATE ACTIONS 2022 State Actions in Review A. Balance and Surprise Billing New Jersey 2022 NJ S.B. 1129 (NS), introduced January 31, requires certain disclosures to consumers regarding health care costs. THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -12- Vermont ¢ 2021 VT S.B. 160 (NS), introduced January 4, bill proposes to limit the amount a health care provider may charge for a diagnostic test for the coronavirus to twice the Medicare rate. It would prohibit a hospital from imposing a lien on a patient injured in an accident without first billing and accepting payment from the patient's health insurance and would prohibit the hospital from balance billing the patient or from filing a lien for sums charged in excess of the insurance reimbursement amounts. ¢ 2021 VT H.B. 489 (NS), enrolled May 18, proposes to amend certain health insurance laws to comply with the federal No Surprises Act. It would revise the statute defining group health insurance and would remove the Department of Financial Regulation as the co- author of a required annual report on the exercise of the Green Mountain Care Board's billback authority. The bill would also correct a reference to the frequency of license or registration renewal for entities administering certain tax-advantaged accounts for health- related expenses. Virginia ¢ 2022 VA S.B. 201 (NS), adopted April 11, requires hospitals to make reasonable efforts to screen every uninsured patient, defined in the bill, to determine whether the individual is eligible for medical assistance pursuant to the state plan for medical assistance or for financial assistance under the hospital's financial assistance policy and to inform every uninsured patient who receives services at the hospital and who is determined to be eligible for assistance under the hospital's financial assistance policy of the option to enter into a payment plan with the hospital. ¢ 2022 VA H.B. 1071 (NS), adopted April 11, requires hospitals to make reasonable efforts to screen every uninsured patient, defined in the bill, to determine whether the individual is eligible for medical assistance pursuant to the state plan for medical assistance or for financial assistance under the hospital's financial assistance policy and to inform every uninsured patient who receives services at the hospital and who is determined to be eligible for assistance under the hospital's financial assistance policy of the option to enter into a payment plan with the hospital. B. Cost Control and Transparency Colorado ¢ 2022 CO S.B. 68 (NS), engrossed May 10, concerning the creation of a tool to provide transparency in health claims data submitted to the Colorado all-payer health claims database and making and appropriation. ¢ 2022 CO H.B. 1285 (NS), engrossed May 3, concerning a prohibition against a hospital taking certain debt collection actions against a patient if the hospital is not in compliance with hospital price transparency laws. Illinois 2021 IL H.B. 5327 (NS), introduced January 31, creates the All Payer Claims Database Act. Provides that the Department of Insurance shall establish an All Payer Claims database for sharing limited use health care data. Provides that the All Payer Claims database shall not include or disclose any data that contains direct, primary, or obvious personal identifiers, and that the Department shall develop criteria and procedures to ensure that limited use health care data complies with the requirements of Health Insurance Portability and Accountability Act of 1996. Louisiana ¢ 2022 LA H.C.R. 83 (NS), engrossed May 5, to create the Louisiana All-Payer Claims Database Task Force to study and make recommendations regarding the implementation of an all-payer claims database to facilitate the aggregation and use of health insurance and government health benefits claims data in Louisiana. * 2022 LA H.B. 882 (NS), introduced March 28, to enact the Louisiana Right to Shop Act; to require a program with healthcare shopping capabilities and decision support services; to require an interactive marketplace disclosing the costs of certain healthcare services and procedures; to provide for definitions; to provide for incentives; to require reporting; to provide for rulemaking and related provisions. Rhode Island 2021 RI H.B. 8002 (NS), introduced March 18, would regulate pharmacy benefit managers' (PBMs) policies and practices relating to accurate costs and pricing reporting, restricting discriminatory practices and establishing consumer protections with enforcement of penalties for violations by the office of the attorney general. C. Healthcare Inequalities Colorado 2022 CO H.B. 1157 (NS), engrossed March 25, concerning the utilization of demographic health data by the Department of Public Health and Environment to address health inequities and making an appropriation. Hawaii THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -13- ¢ 2021 HI S.B. 141 (NS), adopted April 5, requesting the adoption of a state policy assuring that savings realized by the state through the extension of federal medical assistance percentage payments of 100 percent for native Hawaiian health care systems is used to address health disparities experienced by Hawaiian communities. ¢ 2021 HI H.R. 149 (NS), introduced March 11, requesting the adoption of a state policy assuring that savings realized by the state through the extension of federal medical assistance percentage payments of 100 percent for native Hawaiian health care systems is used to address health disparities experienced by Hawaiian communities. ¢ 2021 HI S.C.R. 240 (NS), amended/substituted April 4, requesting the adoption of a state policy assuring that savings realized by the state through the extension of federal medical assistance percentage payments of 100 percent for native Hawaiian health care systems is used to address health disparities experienced by Hawaiian communities. ¢ 2021 HI S.B. 2031 (NS), amended/substituted February 18, establishes the Office of Health Equity within the Department of Health. Appropriates funds. Effective 1/1/2050. Illinois 2021 IL H.B. 4645 (NS), engrossed March 4, creates the Equity and Representation in Health Care Act. Contains the findings of the General Assembly. Creates the Equity and Representation in Health Care Workforce Repayment Program and the Equity and Representation in Health Care Workforce Scholarship Program to be administered by the Department of Public Health. Provides that a health care professional, medical facility, or behavioral health provider may apply to the Department for loan repayment assistance under the Program and related provisions. Louisiana 2022 LA H.C.R. 44 (NS), adopted May 17, to create the Health Inequities and Disparities in Rural Areas Task Force, to provide for the composition and duties of the task force, and to require the task force to report findings and recommendations to the legislative committees on health and welfare. D. Insurance Exchanges/Marketplaces California 2021 CA A.B. 2530 (NS), adopted September 28, would require the Exchange to administer a program of financial assistance beginning July 1, 2023, to help Californians obtain and maintain health benefits through the Exchange if they lose employer-provided health care coverage as a result of a labor dispute. Under the bill, if specified eligibility requirements are met, an individual who has lost minimum essential coverage from an employer or joint labor management trust fund as a result of a strike, lockout, or other labor dispute would receive the same premium assistance and cost-sharing reductions as an individual with a household income of 138.1% of the federal poverty level, and, beginning January 1, 2024, would also not pay a deductible for any covered benefit if the standard benefit design for a household income of 138.1% of the federal poverty level has zero deductibles. New Jersey 2022 NJ A.B. 647 (NS), adopted June 30, requires the Department of Banking and Insurance to establish and operate the New Jersey Easy Enrollment Health Insurance Program (the program). The department is required to integrate the program with the State-based health insurance exchange, and may enter into an agreement with a third-party for operation of the program. The purpose of the program is to: {1} establish a State-based reporting system to provide information about the health insurance status of State residents through the use of State income tax returns to identify individuals and determine whether an individual is interested in obtaining minimum essential coverage; (2) determine whether an individual who is interested in obtaining minimum essential coverage qualifies for insurance affordability assistance; (3) proactively contact an individual who is interested in obtaining minimum essential coverage to assist in enrolling the individual in insurance affordability assistance and minimum essential coverage; and (4) maximize enrollment of eligible individuals in insurance affordability assistance and minimum essential coverage to improve access to care and reduce insurance costs for all residents of the State. Wisconsin ¢ 2021 WI S.B. 1089 (NS), introduced March 10, relating to BadgerCare purchase option, basic plan, state-based insurance exchange, and granting rule-making authority. ¢ 2021 WI A.B. 1118 (NS), introduced March 10, relating to BadgerCare purchase option, basic plan, state-based insurance exchange, and granting rule-making authority. E. Premium Assistance Oklahoma 2021 OK S.B. 1323 (NS), enrolled May 16, state Medicaid program; authorizing certain recognition of self-funded or self-insured health care plan; allowing participation in certain premium assistance program. Rhode Island THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -14- ¢ 2021 RI S.B. 2895 (NS), introduced April 26, would establish a premium payment program to help individuals and families transition from expired COVID-19 Medicaid coverage to commercial health insurance, thereby avoiding a gap in medical coverage. ¢ 2021 RI S.B. 2896 (NS), amended/substituted June 14, establishes a premium payment program to help individuals and families transition from expired COVID-19 Medicaid coverage to commercial health insurance, thereby avoiding a gap in medical coverage. F. Preserving ACA Coverage Rhode Island 2021 RI H.B. 7500 (NS), introduced February 16, requires individual health insurers, large group health insurers and small employer health insurers to provide coverage for essential health benefits listed in the act. G. Short-Term and Catastrophic Plans Kansas 2021 KS S.B. 199 (NS), amended/substituted February 22, providing for short-term, limited-duration health plans. H. Single Payer and Universal Insurance Hawaii 2021 HI S.C.R. 62 (NS), amended/substituted March 29, requesting the auditor to conduct a social and financial assessment of proposed mandatory health insurance coverage. Kansas 2021 KS H.B. 2459 (NS), introduced January 10, enacting the Kansas health act; creating a universal single-payer guaranteed healthcare coverage program; pertaining to eligibility and enrollment, benefits, board of trustees, healthcare providers, care coordination, program standards, rules and regulations, retraining of impacted employees, advisory council and revenue proposal; and related provisions. Michigan 2021 MI H.B. 5966 (NS), introduced March 23, to provide for the establishment of a universal and unified health care system and to reform the current payment system for health care coverage in this state; to create certain boards and committees and prescribe their powers and duties; to provide for the powers and duties of certain state and local governmental officers and agencies; to establish a fund; to provide for the promulgation of rules; and to prescribe penalties and provide remedies. New Jersey 2022 NJ A.B. 4538 (NS), introduced September 22, expands Medicare health care coverage to all New Jersey residents. Pennsylvania 2021 PA H.B. 2824 (NS), introduced September 16, providing for a Statewide comprehensive health care system; establishing the Pennsylvania Health Care Plan and providing for eligibility, services, coverages, subrogation, participating and nonparticipating providers, cost containment, quality assurance and for transitional support and training; establishing the Pennsylvania Health Care Board, the Pennsylvania Health Care Agency, the Office of Health Care Ombudsman and the Pennsylvania Health Care Trust Fund; and imposing a payroll tax and an additional personal income tax. Rhode Island ¢ 2021 RI S.B. 2769 (NS), introduced March 24, establishes a universal, comprehensive, affordable single-payer health care insurance program and helps control health care costs, which would be referred to as, 'the Rhode Island Comprehensive Health Insurance Program' (RICHIP). ¢ 2021 RI S.B. 2994 (NS), amended/substituted June 21, would establish 'The Rhode Island All-Payer Health Care Payment Reform Act.' This act would provide that the health insurance commissioner and the Medicaid director would convene an all-payer payment reform working group which would be charged with developing the structure and terms of advanced value-based payment models for use by all-payer. Annual reports are to be provided every March 1 to the general assembly. ¢ 2021 RI H.B. 8119 (NS), introduced April 8, establishes a universal, comprehensive, affordable single-payer health care insurance program and helps control health care costs, which would be referred to as, 'the Rhode Island Comprehensive Health Insurance Program' (RICHIP). Vermont 2021 VT H.B. 658 (NS), introduced January 18, proposes to provide Medicaid-equivalent coverage to all Vermonters by age bands over time, regardless of household income. It would direct the Agency of Human Services to seek approval for federal financial participation in the expanded coverage, with the State paying the full amount if the federal government does not approve the request. The bill would direct the Agency of Human Services and others to develop cost estimates for the Medicaid-equivalent coverage and a detailed implementation plan. THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -15- © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service [FN2] . Kurt Erickson, GOP plan to gut Medicaid advances to floor of Missouri House, St. Louis Dispatch (February 8, 2022) at: https:/Avww.stltoday.com/news/local/govt-and-politics/gop-plan-to-gut-medicaid-advances-to-floor-of-missouri-house/ article_26660c42-83c2-5efb-9e63-0c58cdab7c87.html. [FN3] . NC GOP: Medicaid expansion vote possible later this year, AP News (February 15, 2022) at: https://apnews.com/article/business- health-elections-north-carolina-election-2020-4817ab04225480101ac75001072ad771. [FN4] . Anne Blythe, Yet another attempt to expand Medicaid in NC, NC Health News (June 29, 2022) at: https:// www.northcarolinahealthnews.org/2022/06/29/yet-another-attempt-to-expand-medicaid-in-nc/. [FN5] . Medicaid expansion proposal OK'd for November ballot, South Dakota Public Broadcasting (Jan 3, 2022) at: https:// starherald.com/news/state-and-regional/govt-and-politics/medicaid-expansion-proposal-okd-for-november-ballot/ article_63fbfb45-377f-589a-9ba2-94c45fa88bdf.html. [FN6] . SD Senate rejects Medicaid expansion, leaving it to election, AP News (February 15, 2022) at: https://apnews.com/article/health- business-senate-elections-legislature-elections-a61dc3fa706c5bacf9ae8eb04 1703860. [FN7] . Lydia Wheeler, Supreme Court Tosses Out Dispute Over Medicaid Work Requirements, Bloomberg Law (April 18, 2022) at: https:// news.bloomberglaw.com/health-law-and-business/supreme-court-tosses-out-dispute-over-medicaid-work-requirements. Produced by Thomson Reuters Accelus Regulatory Intelligence 27-Jun-2023 THOMSON REUTERS © 2023 Thomson Reuters. No claim to original U.S. Government Works. -16-