REGULATORY INTELLIGENCE

YEAR-END REPORT - 2022

Health Policy Tracking Service - Issue Briefs
Healthcare Providers & Facilities
Quality of Healthcare

This Issue Brief was written by Sydney Brude , a contributing writer, compliance attorney and member of the Minnesota bar.
12/19/2022
I]. NEWS

Many OB-GYNS Residents Miss Out on Trans Care Instruction
Of 100 OB-GYN programs surveyed in the United States, 61 responded and only half of those programs provide specialized training

for providing care and health issues relating to LGBTQ patients. IFN2] The issues facing this community are different from the typical
community and providing the proper training for compassionate care will improve the quality. The study was in part a response to the
rollback in protections from the current administration and the hope that the industry will provide the protections being removed.

Penalties Not Lowering Hospital-Acquired Infection Rates

A program created by the Affordable Healthcare Act that penalizes hospitals for having higher infection rates has come under recent

scrutiny. [FNS] 9 study taking place during the first two years after the establishment of the program has indicated that hospitals that
have lower quality of care scores regarding readmittance and patient death do not tend to improve their scores the next year. This
penalty for a lower score seems to disproportionally effect hospitals that provide care to individuals with lower incomes. With the
penalties on the rise, and the patients served at these hospitals, the program may be increasing inequity of care given. This study was
not created to determine the effects of penalties on the quality of care.

HHS Announces Quality Summit to Streamline and Improve Quality Programs Across Government
The administration recently announced the creation of a summit related to the executive action to simplify and streamline current

healthcare quality programs. IFN4] [FNS] The goal of this simplification is to allow healthcare professionals to spend less time filling out
the existing quality measures and find a core set that most accurately depict the activities of the hospital and their effect on care. The
summit hopes to assist HHS in fulfilling the administration's executive order regarding healthcare transparency.

CMS is Bringing Health Plan Quality Ratings to All Exchanges for the First Time

The Trump Administration, in accordance with their goals of increasing the transparency in healthcare, has required that all health

plans involved in the exchange display the five-star Quality Rating System score. IFN6] This will allow insureds to directly compare
plans before purchase. The Quality Rating System score is based on three categories, medical care, member experience, and plan
administration. This method was piloted in 5 states previously before opening it up to the entire exchange.

What Do We Know About Prices and Hospital Quality?

A study reviews the relationship between cost of care, quality of care, and bonus payments. The study suggests that believing that an
increase in funding will increase the quality of care given is simplistic and false. The article reviews the relationship between the use of
the money and where it provides the greatest return on quality. Ultimately researchers determined that there are too many variables to
determine the true relationship between cost and quality.

Telehealth Innovation Bill Heads to Capital Hill for a Third Try

The Telehealth Innovation and Improvement Act has been introduced for a third time to encourage healthcare providers to utilize
telehealth programs to increase effectiveness, reduce costs, and provide an improvement in the quality of care provided using the

 
  

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Center for Medicare and Medicaid Innovation (CMI) program. IFN7] The Act also hopes to promote CMI to find the most effective model
for telehealth services and focus on reducing healthcare costs for patients.

CMS Considers the Value of Hospitals Displaying Quality Data

Information regarding hospitals costs and quality scores is already accessible, but CMS is mulling the idea of requiring the hospitals

to display this information on the hospital's site. [FN8] The current administration is focusing on healthcare transparency and this step
seems like a clear next move. Hospitals are reluctant to this move, fearing the consequences of sharing this information publicly.

CMS Delays Funding Renewal for Quality Improvement Organizations

CMS' quality improvement organizations have had to stop operations and lay off staff due to a failure to renew their contracts until

September and November. [FNS] Funding for these projects has been delayed before, but not for this long. CMS is stating that some of
the work performed by these agencies does not expire until mid-October and this is just a normal part of the transition process.

Top State Official was Warned Two Years Ago About 'Grave Risk' to Disabled lowans at Glenwood Resource Center, Emails
Show

Two years ago, officials were warned that clients were at serious risk due to the conditions at the facility. [FN10] This email was sent
directly to a top state official regarding the conditions at a facility for people with disabilities. A lawsuit has been initiated regarding the
quality of care following an increase in deaths of patients.

Changes Coming to Nursing Home Preadmission Resident Screening Regulations

For the first time since the 1990's the Preadmission Screening and Resident Review regulations are being revised. IFN11] The proposed
changes include changes in definitions and the improved usage of telemedicine. These regulations provide screening for mental illness
and intellectual disability to allow for the proper treatment and services to be provided.

CDC Coronavirus Testing Decision Likely to Haunt Nation for Months to Come

At the beginning of the COVID-19 pandemic, the CDC distributed 200 test kits, each containing 300-400 tests to 100 public health labs

across the nation. "N"2! These kits were distributed equally across the nation which lead to problems. Areas that were the hardest hit
by the virus were unable to test individuals who were presenting symptoms while others who were only mildly ill were able to be readily
tested in more remote areas. This system of test distribution likely allowed the spread of to accelerate and cause a higher fatality rate.

CMS Eases Quality, Other Reporting Demands Amid COVID-19 Crisis

With health care professionals being already strained treating individuals who have contracted coronavirus, CMS has relaxed reporting

requirements in an attempt to free up more time for health care professionals to focus on patients. [FN13] Opposition comes from
organizations participating in quality payment programs who feel that the lack of accountability will result in a decrease of quality of care
provided during this time. During this time clinicians participating in MIPS who have not submitted data by the end of April 2020 will
receive a neutral payment adjustment. CMS has acknowledged the need for the data collection, but believes that during this time, the
availability of providers is of greater need.

CDC Studies Show Drop in MDR Bacteria, C Diff in US Hospitals

The New England Journal of Medicine reports that the rates of multidrug-resistant organisms decreased in hospitals between 2012 and
2017. The rate decreased between 20% and 39%. A different study in the New England Journal of Medicine showed a drop of nearly a
quarter in the number of C diff infections between 2011 and 2017. While the cause for these reduction in rates, officials caution against
a belief that infection control is no longer an issue and provided statistics for rises in infection rates of other infections.

Providers Demand Piece of COVID-19 Stimulus Pie; "We're in a recession,' Economist Declares

Long-term care facilities have received a boost from the stimulus bill, but with the recession on the horizon, facilities feel that they

may need more help. The bill provided for medical leave for employees of facilities with under 500 residents and a boost to Medicaid
matching of 6.2 percentage points. With the strain on resources and the large number of employees expected to face the virus facilities
may fall apart without more support.

Lawmakers' $2T Stimulus Package Includes Nursing Homes Slice; COVID-Plagued SNF Stops Spread, Rebuffs Claims of
Staffing, Supply Shortages

The stimulus bill provides long term health care facilities with a boost in Medicaid matching at support of employees, however provided
no method of providing more supplies to these facilities. After an outbreak at a facility in Illinois, the facility claimed a shortage in
supplies, but the CEO of the supervising company was 'shocked' by the claims stating he had seen images of fully stocked inventory.
The outbreak has since been stopped, but not until 33 residents and 13 staff members fell ill. A former employee claims to have quit
due to insufficient safety supply and cleaning supply support.

CMS Guidance Bans Most Visitors, Communal Dining at Nursing Homes Over COVID-19

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Recent guidance from CMS states that visitors to long-term care facilities should be limited to compassionate care situations and

all other visitors should be prevented from entering. This is a stark acceleration from just one week ago when it was stated that only
visitors who are showing signs of COVID-19 should be prevented from visiting. With the close living quarters and care, the spread of
the virus is rapid in these environments, so it is of upmost importance that residents are protected.

Trump Administration Issues Key Recommendations to Nursing Homes, State and Local Governments

President Trump has issued key guidance for long-term care facilities to focus on their infection prevention protocols. Due to the
compromised nature of many residents and the enclosed environments the virus is spreading rapidly through these communities. CMS
has announced new infection control surveys to prevent further spread and to protect residents.

After Anonymous Tip, 17 Bodies Are Found at Nursing Home Hit by Virus
In a New Jersey nursing home, a morgue made for 4 bodies was found with 17 bodies inside due to an outbreak of COVID-19. [FN14] An

anonymous tip let officials know of the indiscretion. An outbreak at the nursing home had caused 68 deaths at the facility, of which the
17 bodies belonged. After the bodies were found, 76 more patients tested positive along with 41 staff members.

This outbreak has brought to the forefront long term facility's ability to deal with an outbreak at this magnitude.
Trump Wants Masks on All Nursing Home Workers, Temperature Checks for All, and Separate COVID-19 Units
The Trump Administration issued a set of 'critical recommendations' for long-term care facilities. [FN15] These recommendations

state that every single person working in a nursing home wear a mask while working for the duration of the pandemic. It is also
recommended that employees have their temperature checked prior to work and be checked for other symptoms.

These recommendations come alongside the finding that handwashing and infection control protocols continue to fall short of existing
standards.

CMS Announces Independent Commission to Address Safety and Quality in Nursing Homes

Going into the beginning of Older Americans Month CMS has announced an independent Commission that will head up a review of

the nursing home response to the coronavirus pandemic. IFN16] This Commission will be in charge of reviewing nursing homes and
providing reports to CMS providing recommendations to improve the current and future steps to protect seniors and facilities.

These Commissions will be headed up by industry experts, clinicians, family members, resident/patient advocates, medical ethicists,
administrators, academicians, infection control and prevention professionals, state and local authorities, and other selected experts.
The goal of the Commission is to provide recommendations on 3 tasks related to stopping the spread of COVID-19 in long-term care
facilities.

CMS Gives Therapy Providers the Green Light to Provide Medicare Telehealth Services

As of Thursday April 30, CMS has decided to waive limitations on the times of clinical practitioners that can provide Medicare telehealth

services, allowing at risk patients to avoid going to health care facilities for services that don't need to be provided in person. IFN17] The
health care professionals most greatly affected by this waiver are rehabilitative therapists. The goal of this waiver is to provide services
to patients in nursing homes without exposing them to greater risk.

New York Reportedly Allows COVID-19-positive Staff to Continue Working in Nursing Home

The New York Health Department recently signed off on a measure that would allow nursing home staff to return to work after testing

positive for COVID-19. IFN'18] This action comes under extreme scrutiny after the state had told nursing homes to readmit patients who
tested positive for COVID-19 but no longer need intensive care.

HCR ManorCare: 70 percent of COVID-19 Infected Employees Asymptomatic

In a large long-term care facility chain, consisting of 22 facilities there have been 1,500 positive cases of COVID-19, resulting in a

15% mortality rate. [FN19] However, the scariest part is that 70% of heath care providers who have tested positive were asymptomatic
when tested and 30%-50% of positive patients were also asymptomatic. The spread of the virus is frustrating with the number of
asymptomatic individuals and the lack of PPE. Facilities are operating with 10% of the necessary supplies according to ManorCare
Medical Director.

BREAKING NEWS: CMS Orders Resumption of Nursing Home Staffing Data Collection, Updates Star-Rating Plans

After a blanket waiver, CMS will begin requiring Nursing Facilities to submit staffing data again beginning August 14. [FN20] The waiver
was previously in place to allow facilities to focus on the treatment of patients with COVID-19.

CDC: Elderly May Get Top Priority for Eventual Coronavirus Vaccine

Due to the increased risk of complications due to COVID-19, the elderly, essential workers, and those at high risk may be the first
to receive a vaccine. '"N2"! There was also discussion of Black and Latinx patients receiving the vaccine first, but this is a more

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controversial provision. While these patients may receive the first vaccines, there will still be a large gap between the first vaccines and
widespread vaccinations.

Facilities Lack Sufficient Tests to Meet COVID-19 Recommendations, Senate Report Finds

President Trump has called for universal weekly testing in long-term care facilities, however the limits on the number of tests have

made it nearly impossible to meet the federal recommendations. FN22] Only one state has stated that they feel they are in a good place
to meet the testing requirements. Officials believe that until the time comes where the testing capacity can be met, facilities should
implement procedures that meet the test supply and the needs of the facilities.

Preliminary Medicare COVID-19 Data Snapshot

CMS has released information related to the spread of COVID-19 in long-term care facilities. [FN23] The information contained includes
the average length of hospital stay for COVID-19 cases and the distribution of cases per state.

Testing, More PPE Lead to 90% Drop in Nursing Home COVID-19 Cases

Minnesota has shown a 90% decrease in the number of COVID-19 deaths per day since May of 2020. [FN24] The number of facilities
with at least one new case of COVID-19 has dropped from 23 facilities per day to 6 facilities per day. This reduction in cases has been
attributed to Governor Walz's 5-point plan for ensuring safety in long-term care facilities and the securement of more PPE for facility
workers.

Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-
COVID-19 Healthcare

CMS has released Phase II guidelines for reopening clinics. IFN25] These guidelines are very specific to regions who are not showing
sides of a rebound and that satisfy the required gating criteria.
Provider COVID-19 Relief Funds Now to be Based on 2018 Patient Revenue

Originally, the Department of Health and Human Services had stated that the distribution of the $50 Billion COVID-19 relief fund

would be distributed according to the 2019 Medicare revenues, but has since reversed course. [FN26] The reason for this change was
determined that a focus on Medicare disbursement would alienate those facilities that relied on Medicaid payments. Focusing on the
net patient revenues for 2018 would level the playing field and allow a more equitable distribution of the funds.

New Study Links Facility Staffing Levels, Quality to Number of COVID-19 Cases

A new study published in the Journal of the American Geriatrics Society showed a correlation between low staffing levels and quality

scores and high rates of COVID-19 deaths. IFN27] The data showed that nursing homes with more staffed RNs had 22% fewer cases
and facilities with a 4 or 5 star rating at 13% fewer cases. The study also showed that facilities with more Medicaid residents and
patients of color had more confirmed cases. Yue Li, a professor in the University of Rochester Medical Center commented on the socio-
economic disparities and how these disparities are now reflecting in death rates during this pandemic.

CMS Issues 'Long Overdue' Visitation Guidelines for Nursing Homes
The emotional toll of isolation due to the Coronavirus pandemic is clear and felt hardest by those in long-term care facilities. IFN28] Cs

is working to create guidelines to ensure the safe opening of facilities during Phase 3 of opening. In addition to creating guidelines to
ensure that visitors can safely visit but want to encourage solutions to enriching clients lives without the need for physical contact.

As Telehealth Becomes the New Normal, NCQA Updates Quality Measures

As the world continues to worth through a health crisis, the NCQA has updated their quality measures to reflect the increasing role of
telemedicine in health care. "N2*! These updates 40 different measures are being updated to include telehealth specific measures.
CMS Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare

As a part of Phase II of reopening, CMS has provided new guidelines for opening non-emergent non-COVID-19 care. [FNS0] These
guidelines focus on the changing environment of the area the clinic is in and the facilities involved. The guidelines require the limitation

of visitors and procedures for allowing visitors into the building. Guidelines also lay down procedures when staff or patients test positive
for COVID-19.

COVID-19 Pushes Skilled Nursing Occupancy Down 10%, Analysis Finds
Since the end of 2019, nursing home occupancy has decreased by 100,000 caused by the complications of COVID-19. [FNS1] Beginning
in May, CMS required long-term care facilities to submit data related to coronavirus including suspected and confirmed deaths. This

data will allow CMS to look at facilities that have contained outbreaks and review their procedures to try and produce similar results at
other facilities.

CMS Will Pay More to Labs That Process COVID-19 Tests Quicker Starting Jan 1

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CMS has announced that beginning on January 1, 2021, they will pay out $100 for tests that are completed within two days and $75

for tests that take longer. [FNS2] 1, April of this year CMS stated that they would pay $100 for every test that was given, meaning that
this new standard would levy a $25 fine against facilities who take longer than 2 days to return results. The goal of this is to ensure that
individuals are able to self-isolate and receive care if needed sooner into a diagnosis in hopes of a more positive outcome. The base
rate for testing payout will be dropped to $75 dollars meaning that at that time it will turn into a $25 dollar bonus rather than a penalty.
The qualifications for meeting this standard include that the test is completed within two calendar days or less and that the majority

of the test results are put through high technology outputs in the last month, meaning that all patients using that facility receive their
results within the two day window.

Purdue Will Plead Guilty to Federal Charges, Reaches $8.3 Billion Deal Over Opioid Crisis

The maker of the drug OxyContin has agreed to plead guilty to three felony charges and pay a multi-billion-dollar penalty that will

ultimately result in the company becoming a public benefit company. [FN33] Part of these settlement includes the admission by Purdue
of wrongdoing including lying to the DEA, providing kickbacks for physicians who wrote more prescriptions and involving an electronic
health monitoring company by paying them to influence prescribing. A settlement regarding against the health record company was
reached earlier this year. It has been made clear that this settlement would not absolve those involved from criminal charges.

Feds Still 'Optimistic' Limited Supply of a COVID-19 Vaccine Will be Ready by Year's End

The Director of CMS has stated that he is optimistic that there will be a small supply of vaccine by the end of the year, but that it is

not quite ready. [FN34] The Director expects the small supply to be prioritized to those working on the front line and those who live in
assisted and long-term care facilities. CMS recently released a bulletin discussing an agreement that had been reached with CVS and
Walgreens about administering the vaccines without charge to these facilities once a vaccine was available.

2019 Quality Payment Program (QPP) Performance Results

CMS has released the QPP results for 2019. ""**! The blog post also discusses changes that were made between reporting years and
alterations that were made due to COVID-19.

Nursing Home Providers Sue Over Alleged Misallocation of $150M in COVID-19 Funding

The state of Pennsylvania has been accused of withholding $1.5 million in federal funding meant for long-term care facilities during the
COVID-19 crisis. A lawsuit has been filed to force the Department to distribute the funds which the plaintiffs state was given to the state
with the clear purpose of supporting nursing homes.

FDA Panel Recommends Emergency Use for Pfizer COVID Vaccine

The FDA voted in favor for the emergency use of the Pfizer vaccine in a 17-4 decision with one-member abstaining. The Pfizer
vaccine has also been approved in the UK and Canada, however due to severe reactions observed in Britain the vaccine is no longer
recommended for people who have a history of severe allergic reactions. This decision was made after the CDC determined that those
living and working in long-term care facilities should be among the first to be inoculated.

CMS Addresses Substance Use, Mental Health Crisis Care for Those with Medicaid

The American Rescue Plan has provided funding to states to put into their Medicaid programs. IFN36] States and territories must file
Letters of Intent by July 23, 2021. The purpose of these funds is to provide community support through the Coronavirus pandemic and
provide services for mental health support or substance abuse treatment.

Il. SELECTED LEGISLATION AND REGULATION

Federal

¢ 2021 FD S.B. 4169 (NS), referred to the Committee on Veterans' Affairs May 10, 2022, would require the Secretary of Veterans
Affairs to carry out a pilot program to provide assisted living services to eligible veterans, and for other purposes.

¢ 2021 CONG US HRES 886, introduced in House January 25, 2022, would recognize the roles and the contributions of America's
Certified Registered Nurse Anesthetists (CRNAs) and their critical role in providing quality health care for the public, especially during
the ongoing coronavirus pandemic.

* 2021 CONG US §S 4486, introduced in Senate June 23, 2022, would improve the health of minority individuals, and for other purposes.

* 2021 CONG US §S 4593, introduce in Senate July 21, 2022, would amend title XIX of the Social Security Act to require the Secretary
of Health and Human Services to make certain information available on a public website relating to intermediate care facilities for
individuals with intellectual disabilities certified for participation under the Medicaid program, and for other purposes.

«2021 CONG US S 4616, introduced in Senate July 26, 2022, would amend title XXVII of the Public Health Service Act, the Employee
Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to strengthen parity in mental health and substance
use disorder benefits.

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¢ 2021 CONG US §S 4375, introduced June 9, 2022, would amend titles 10 and 37, United States Code, to establish special pay and
allowances for members of the Armed Forces assigned to cold weather operations, and for other purposes.

¢ 2021 CONG US §S 4381, introduced June 13, 2022, would amend titles XVIII and XIX of the Social Security Act with respect to nursing
facility requirements, and for other purposes.

* 2021 CONG US § 5015, introduced in Senate, would amend titles XIX and XXI of the Social Security Act to improve maternal health
coverage under Medicaid and CHIP, and for other purposes.

* 2021 CONG US HR 6448, engrossed in House September 22, 2022, would direct the Director of the Office of Community Oriented
Policing Services of the Department of Justice to carry out a grant program to provide assistance to police departments with fewer than
200 law enforcement officers, and for other purposes.

¢ 2021 CONG US HR 7233, reported in House June 16, 2022, would amend title XIX of the Social Security Act to provide for
requirements under Medicaid State plans for health screenings and referrals for certain eligible juveniles in public institutions; and to
require the Secretary of Health and Human Services to issue clear and specific guidance under the Medicaid and Children's Health
Insurance programs to improve the delivery of health care services, including mental health services, in elementary and secondary
schools and school-based health centers.

«2021 CONG US HR 7666, referred in Senate June 23, 2022, would amend the Public Health Service Act to reauthorize certain
programs relating to mental health and substance use disorders, and for other purposes.

* 2021 CONG US HR 7864, introduced to House May 24, 2022, would authorize assistance to train and retain obstetrician-
gynecologists and sub-specialists in urogynecology and to help improve the quality of care to meet the health care needs of women in
least developed countries, and for other purposes.

«2021 CONG US HR 8078, introduced to House June 15, 2022, would ensure that prior authorization medical decisions under
Medicare are determined by physicians.

«2021 CONG US HR 8468, introduced in House July 21, 2022, would amend title XIX of the Social Security Act to require the
Secretary of Health and Human Services to make certain information available on a public website relating to intermediate care facilities
for individuals with intellectual disabilities certified for participation under the Medicaid program, and for other purposes.

¢ 2021 CONG US HR 8624, introduced in House July 29, 2022, would amend title XI of the Social Security Act to provide for additional
requirements for disclosing entities relating to the quality of care furnished at skilled nursing facilities and nursing facilities, and for other
purposes.

«2021 CONG US HR 9254, introduced to House October 28, 2022, would establish within the Department of Health and Human
Services an Ombuds for Reproductive and Sexual Health.

* 2021 FD S.B. 4169 (NS), referred to the Committee on Veterans' Affairs May 10, 2022, would require the Secretary of Veterans
Affairs to carry out a pilot program to provide assisted living services to eligible veterans, and for other purposes.

¢ 87 FR 25277-01, notice of renewal April 28, 2022, announcing the renewal of the Pharmaceutical Science and Clinical Pharmacology
Advisory Committee by the Commissioner of Food and Drugs (the Commissioner).

¢ 87 FR 28108-01, proposed May 10, 2022, would: Revise the Medicare hospital inpatient prospective payment systems (IPPS) for
operating and capital-related costs of acute care hospitals; make changes relating to Medicare graduate medical education (GME) for
teaching hospitals; update the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for
inpatient hospital services provided by long-term care hospitals (LTCHs). In addition it would establish new requirements and revise
existing requirements for eligible hospitals and critical access hospitals (CAHs) participating in the Medicare Promoting Interoperability
Program; provide estimated and newly established performance standards for the Hospital Value-Based Purchasing (VBP) Program;
and propose updated policies for the Hospital Readmissions Reduction Program, Hospital Inpatient Quality Reporting (IQR) Program,
Hospital VBP Program, Hospital-Acquired Condition (HAC) Reduction Program, PPS-Exempt Cancer Hospital Reporting (PCHQR)
Program, and the Long-Term Care Hospital Quality Reporting Program (LTCH QRP). It would also revise the hospital and critical
access hospital (CAH) conditions of participation (CoPs) for infection prevention and control and antibiotic stewardship programs; and
codify and clarify policies related to the costs incurred for qualified and non-qualified deferred compensation plans. Lastly, this proposed
rule would provide updates on the Rural Community Hospital Demonstration Program and the Frontier Community Health Integration
Project.

¢ 87 FR 47502-01, final rule issued August 3, 2022, effective October 1, 2022, updates payment rates; forecast error adjustments;
diagnosis code mappings; the Patient Driven Payment Model (PDPM) parity adjustment; the SNF Quality Reporting Program (QRP);
and the SNF Value-Based Purchasing (VBP) Program. It also establishes a permanent cap policy to smooth the impact of year-to-
year changes in SNF payments related to changes in the SNF wage index. We also announce the application of a risk adjustment for
the SNF Readmission Measure for COVID-19 beginning in FY 2023. We are finalizing changes to the long-term care facility fire safety
provisions referencing the National Fire Protection Association (NFPA)? Life Safety Code, and Director of Food and Nutrition Services
requirements.

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¢ 87 FR 64060-01, notice given October 21, 2022, provides for public comment on proposed data collection projects of the Paperwork
Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of
Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden
estimate, below, or any other aspect of the ICR.

¢ 87 FR 67136-01, final rule issued November 7, 2022, updates and revises the End-Stage Renal Disease (ESRD) Prospective
Payment System for calendar year 2023. This rule also updates the payment rate for renal dialysis services furnished by an ESRD
facility to individuals with acute kidney injury. In addition, this rule updates requirements for the ESRD Quality Incentive Program and
finalizes changes to the ESRD Treatment Choices Model.

Alabama

2022 AL REG TEXT 623515 (NS), proposed August 31, 2022, would improve the organization and clarity of existing rules while
clarifying and expanding the regulatory requirements of medical waste. Changes include permit and registration requirements and
opportunities for public participation in the permitting process. In addition, there are revisions to correct regulations citations and make
grammatical clarifications.

Alaska

¢ 2022 AK REG TEXT 599398 (NS), effective May 25, 2022, adopted regulation changes dealing with Medicaid Coverage and Payment
Rates, Behavioral Health Services Rates, Autism Services.

* 2022 AK REG TEXT 613714 (NS), effective November 25, 2022, relates to changes dealing with Preventive Medical Services and
Permitted Disclosures.

Arizona

¢ 2022 AZ S.R. 1001 (NS), introduced January 24, 2022, would support Medicare for all.

© 2022 AZ S.B. 1202 (NS), adopted March 18, 2022, is a continuation for regulations associated with nursing care in assisted living.
* 2022 AZ S.B. 1242 (NS), adopted March 18, 2022, creates regulation for nursing care in assisted living.

¢ 2022 AZ S.B. 1297 (NS), introduced January 24, 2022, would relate to visitation of religious counselors in healthcare facilities.

¢ 2022 AZ S.B. 1308 (NS), engrossed May 5, 2022, would relate to DHS licensure and group homes.

¢ 2022 AZ S.B. 1469 (NS), adopted June 8, 2022, relating to the controlled substances prescription monitoring program.

* 2022 AZ H.B. 2196 (NS), introduced June 23, 2022, would amend title 36, Arizona Revised Statutes, by adding chapter 33; relating to
health care providers.

* 2022 AZ H.B. 2449 (NS), adopted April 25, 2022, relates to care facilities and clergy visitation.
¢ 2022 AZ H.B. 2609 (NS), adopted July 6, 2022, relates to ambulance services and service areas.
Arkansas

2022 AZ H.B. 2486 (NS), introduced January 24, 2022, would provide information related to health providers, insurers, and estimated
costs.

California

¢ 2021 CA S.B. 57 (NS), enrolled August 5, 2022, would add and repeal Section 11376.6 of the Health and Safety Code, relating to
controlled substances.

¢ 2021 CAA.B. 498 (NS), adopted September 19, 2022, amends Section 14087.59 of the Welfare and Institutions Code, relating to
Medi-Cal.

* 2021 CAA.B. 895 (NS), adopted September 27, 2022, adds Section 1569.381 to, and to add and repeal Article 10 (commencing with
Section 1569.900) of Chapter 3.2 of Division 2 of, the Health and Safety Code, relating to residential care facilities.

¢ 2021 CA S.B. 1003 (NS), amended/substituted May 19, 2022, would add Chapter 4 (commencing with Section 131400) to Part 1 of
Division 112 of the Health and Safety Code, relating to public health.

¢ 2021 CA A.B. 1051 (NS), adopted September 18, 2022, amends Sections 14714 and 14717.1 of, and to add Sections 14717.2,
14717.25, and 14717.26 to, the Welfare and Institutions Code, relating to Medi-Cal.

¢ 2021 CA S.B. 1207 (NS), adopted September 27, 2022, amends Section 1367.625 of the Health and Safety Code, and to amend
Section 10123.867 of the Insurance Code, relating to health care coverage.

¢ 2021 CAS.B. 1338 (NS), adopted September 14, 2022, adds Section 1374.723 to the Health and Safety Code, to add Section
10144.54 to the Insurance Code, to amend Section 1370.01 of the Penal Code, and to amend Sections 5801 and 5813.5 of, and to add
Part 8 (commencing with Section 5970) to Division 5 of, the Welfare and Institutions Code, relating to courts.

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«2021 CA A.B. 1855 (NS), adopted September 27, 2022, would add Section 9718.5 to the Welfare and Institutions Code, relating to
seniors.

¢ 2021 CAA.B. 1907 (NS), adopted September 13, 2022, amends Sections 1279 and 1422 of the Health and Safety Code, relating to
long-term health care facilities.

* 2021 CAA.B. 2079 (NS), enrolled August 29, 2022, would add Section 1272.5 to the Health and Safety Code, relating to skilled
nursing facilities.

* 2021 CA A.B. 2080 (NS), amended/substituted May 19, 2022, would amend the Health and Safety Code, and to add Section
10123.149 to the Insurance Code, relating to health care.

«2021 CA A.B. 2091 (NS), adopted September 27, 2022, adds Section 56.108 to the Civil Code, to amend Sections 2029.200,
2029.300, and 2029.350 of the Code of Civil Procedure, to amend Section 123466 of the Health and Safety Code, to amend Section
791.29 of the Insurance Code, and to amend Section 3408 of the Penal Code, relating to information disclosure, and declaring the
urgency thereof, to take effect immediately.

¢ 2021 CAA.B. 2236 (NS), enrolled September 2, 2022, would amend Section 3041 of, and to add Section 3041.4 to, the Business and
Professions Code, relating to healing arts.

* 2021 CAA.B. 2338 (NS), adopted September 29, 2022, amends Section 4711 of, and to add Section 4712 to, the Probate Code,
relating to health care decisions.

* 2021 CA A.B. 2405 (NS), amended/substituted March 24, 2022, would amend Section 1250 of the Health and Safety Code, relating
to health facilities. An act to amend Section 1254.5 of, and to add Section 1250.12 to, the Health and Safety Code, and to add Article
3.5 (commencing with Section 4085.01) to Chapter 3 of Part 1 of Division 4 of the Welfare and Institutions Code, relating to behavioral
health facilities.

¢ 2021 CA A.B. 2511 (NS), adopted September 29, 2022, adds Section 1418.22 to the Health and Safety Code, relating to skilled
nursing facilities.

¢ 2022 CA REG TEXT 599079 (NS), effective October 1, 2022, adds three new definitions to their continuing education regulations,
'Experimental medical procedure or treatment,' 'Implicit bias,' and 'Direct patient care.' This action will require continuing education
courses to include the understanding of implicit bias unless the course is related solely to research or other non-direct patient care
components. This action also establishes that continuing education courses can include experimental medical procedures or treatments
if they meet certain benchmark requirements.

* 2022 CA REG TEXT 628011 (NS), proposed November 2, 2022, proposes to amend section 1426 of Title 16 of the California Code of
Regulations pertaining to Required Curriculum: Direct PT Care Course Hours (Conform to AB 2684).

Colorado

¢ 2022 CO S.B. 53 (NS), adopted June 8, 2022, concerns visitation rights at health-care facilities, and, in connection therewith, making
an appropriation.

¢ 2022 CO S.B. 79 (NS), adopted May 31, 2022, would relate to required dementia training for direct-care staff or specified facilities that
provide services to clients living with dementia.

* 2022 CO S.B. 147 (NS), adopted May 17, 2022, concerning behavioral health-care integration services for children, and, in connection
therewith, making an appropriation.

* 2022 CO S.B. 154 (NS), adopted June 2, 2022, concerns increasing safety in assisted living residences, and, in connection therewith,
making an appropriation.

¢ 2022 CO H.B. 1268 (NS), adopted June 3, 2022, would concem a reporting of Medicaid reimbursement rates paid to mental health
providers.

¢ 2022 CO H.B. 1302 (NS), adopted May 18, 2022, concerns health-care practice transformation to support whole-person health
through integrated care models, and, in connection therewith, making an appropriation.

* 2022 CO H.B. 1303 (NS), enrolled May 18, 2022, would concern an increase in the number of residential senate behavioral health
beds, and, in connection therewith, making an appropriation.

* 2022 CO H.B. 1325 (NS), enrolled May 18, 2022, would concern alternative payment models for primary care services, and, in
connection therewith, making an appropriation.

¢ 2022 CO REG TEXT 622959 (NS), effective November 30, 2022, aligns Colorado law with the federal 'No Surprises Act', Pub.
L. 116-260, as amended, pursuant to the Commissioner's rulemaking authority, and to increase price and quality transparency by
removing gag clauses on information for plan sponsors and group and individual consumers.

¢ 2022 CO REG TEXT 626932 (NS), adopted on an emergency basis October 14, 2022, provides temporary changes to regulatory
requirements in order to provide enhanced flexibility, reduction to programmatic limitations, and alignment with existing federal

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guidance related to processes under the COVID-19 pandemic is imperatively necessary for the preservation of public health safety, and
welfare.

¢ 2022 CO REG TEXT 628790 (NS), adopted on an Emergency Basis November 11, 2022, increases the number of available
providers in hospitals that are experiencing capacity and staffing shortages due to COVID-19 and other respiratory illnesses, including
Respiratory Syncytial Virus (RSV) and influenza, an associated decrease in pediatric intensive care unit capacity, and an anticipated
bed shortage across all hospitals in Colorado. It will increase the availability of providers for patient care by temporarily suspending
utilization review requirements and streamlining the approval process for transfers and discharges from hospitals.

Connecticut

* 2022 CT H.B. 5339 (NS), amended/substituted April 18, 2022, would expand access to the state-funded portion of the Connecticut
home-care program for the elderly by reducing copayments and increasing asset limits.

¢ 2022 CT S.B. 290 (NS), amended/substituted April 11, 2022, would modify the certificate of need process for long-term care facilities.
¢ 2022 CT H.B. 5396 (NS), amended/substituted March 31, 2022, would increase access to mental health medication.

* 2022 CT H.B. 5481 (NS), amended/substituted April 12, 2022, would (1) expand the circumstances in which a change in ownership of
a health care facility or institution requires approval by the Department of Public Health; and (2) establish an application process for the
approval of changes in ownership of health care facilities and institutions.

Delaware
¢ 2021 DE H.B. 344 (NS), adopted July 25, 2022, amends Title 16 of the Delaware Code relation to bias training for healthcare workers.

¢ 2021 DE H.B. 424 (NS), introduced May 13, 2022, would amend title 16 of the Delaware code relating to staffing in nursing facilities,
intermediate care facilities for persons with intellectual disabilities, assisted living facilities, and dementia care.

¢ 2021 DE H.B. 438 (NS), adopted October 26, 2022, amends Title 29 of the Delaware code relating to the Delaware Nursing Home
Residents Quality Assurance Commission.

¢ 2021 DE H.B. 442 (NS), adopted August 19, 2022, would amend title 16 of the Delaware code relating to the Delaware health care
commission and state of Delaware health care spending and quality benchmarks.

¢ 2022 DE REG TEXT 608839 (NS), effective August 11, 2022, proposes to implement Senate Substitute 1 for Senate Bill 120 (SS1 for
SB 120), which expanded the regulatory authority of Department's Office of Value Based Health Care Delivery (OVBHCD) as described
in Proposal 1.

District of Columbia

* 2021 DC L.B. 714 (NS), adopted July 25, 2022, enacts and amends provisions of law necessary to support the Fiscal Year 2023
budget

* 2022 DC REG TEXT 456605 (NS), effective September 30, 2022, adopts the following amendments to Chapter 9 (Medicaid Program)
of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR) and of the intent to adopt the amendments as a
final rulemaking in not less than thirty (30) days after the date of publication of this notice in the District of Columbia Register.

¢ 2022 DC REG TEXT 510104 (NS), proposed July 29, 2022, notice of intent to adopt a new Chapter 47 (Health Benefit Plan Network
Access and Adequacy), of Title 26 (Insurance, Securities, and Banking), Subtitle A (Insurance), of the District of Columbia Municipal
Regulations (DCMR) in not less than thirty (30) days from the date of publication of this notice in the District of Columbia Register.

¢ 2022 DC REG TEXT 620619 (NS), effective September 30, 2022, gives notice of the adoption of a new Chapter 57 (Enrollment
and Disenrollment Requirements and Procedures for Medicaid Beneficiaries in an Integrated Dual-Eligible Special Needs Plan), and
amendments to Chapter 97 (Adult Day Health Program (ADHP) Services) and Chapter 102 (My Health GPS Program) of Title 29
(Public Welfare) of the District of Columbia Municipal Regulations (DCMR).

* 2022 DC REG TEXT 629220 (NS), effective on an emergency basis November 8, 2022, adopts, on an emergency basis, of the
following amendments to Chapter 2 (Communicable and Reportable Diseases) of Subtitle B (Public Health and Medicine) of Title 22
(Health) of the District of Columbia Municipal Regulations (DCMR) and Chapter 40 (Health Occupations: General Rules) of Title 17
(Business, Occupations, and Professionals) of the DCMR.

Florida

¢ 2022 FL S.B. 252 (NS), introduced January 11, 2022, would relate to health care cost savings; amending s. 627.6387, F.S.; revising
the definition of the term 'shoppable health care service' to include certain items and services specified in federal regulation; providing
an effective date.

¢ 2022 FL S.B. 534 (NS), adopted April 6, 2022, would authorize the approval of drug products or certain medication prescribed for
the treatment of schizophrenia or schizotypal or delusional disorders for Medicaid recipients who have not met the step-therapy prior
authorization criteria, when the drug product or certain medication meets specified criteria, etc.

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¢ 2022 FL H.B. 2259 (NS), introduced January 11, 2022, would provide appropriation for the Substance Use and Mental Health
Treatment for Veterans.

¢ 2022 FL S.B. 594 (NS), introduced January 11, 2022, would prohibit governmental entities from requiring proof of COVID-19
vaccination or postinfection recovery status as a condition of licensure or certification in this state; prohibiting employers from requiring
COVID-19 vaccination or proof of COVID-19 vaccination or postinfection recovery as a condition of employment, promotion, or
continued employment or from discriminating against employees on the basis of such status unless certain conditions are met;
providing a right of action for aggrieved persons, etc.

* 2022 FL S.B. 646 (NS), introduced January 11, 2022, would delete provisions requiring that a portion of the punitive damages
awarded for claims brought under part II of ch. 400, F.S., relating to nursing homes, and part | of ch. 429, F.S., relating to assisted living
facilities, be deposited into the Quality of Long-Term Care Facility Improvement Trust Fund, etc.

¢ 2022 FL H.B. 1085 (NS), introduced January 11, 2022, would require notification of primary care physician if sickle cell trait is detected
in newborns & infants; requires DOH to develop & maintain registry for such newborns & infants; requires department to establish
Sickle Cell Disease Education & Grant Program; requires AHCA to conduct certain annual review & study; requires Medicaid managed
care plans to develop & implement sickle cell disease quality strategy plans; requires health insurance policies & health maintenance
contracts to provide coverage for fertility preservation services.

¢ 2022 FL H.B. 1361 (NS), introduced January 11, 2022, would require resident's attending health care provider to consult with
resident's personal physician under certain circumstances; requires resident's attending health care provider to document consultations
in resident's records; requires facilities to take certain measures before admitting residents; requires facilities to provide resident with
opportunity to select personal physician; provides requirements for residents' records; revises timeframe in which facilities must furnish
requested records; requires facilities to post specified information on their websites.

¢ 2022 FL H.B. 1459 (NS), introduced January 11, 2022, would provide requirements for initiation of mental health examination &
treatment of minors; provides monitoring duties for DCF & DOE relating to use of involuntary examinations & other mandatory mental
health treatments of minors; provides reporting duties for schools; requires school districts, charter school sponsors, & other entities to
develop & implement policies & procedures; requires school districts to submit policies & procedures to DOE.

¢ 2022 FL H.B. 1507 (NS), introduced January 11, 2022, would require DOEA or its designee to develop or approve education &
training regarding care for persons with Alzheimer's disease or related dementia; provides requirements for education, training, &
covered providers; revises dementia-related staff training requirements for nursing homes, home health agencies, facilities providing
special care for certain persons, assisted living facilities, adult family-care homes, adult day care centers, & specialized Alzheimer's
services adult day care centers.

¢ 2022 FL S.B. 1734 (NS), introduced January 18, 2022, would require a resident's attending health care provider in a nursing home
facility to consult with the resident's personal physician, if selected, in the provision of acute care to the resident and before ordering
or prescribing medication to the resident; requiring the resident's attending health care provider to document any such consultations in
the resident's records; requiring nursing home facilities to take certain measures before admitting a resident; requiring nursing home
facilities to provide each resident with the opportunity to select a personal physician; revising the timeframe in which nursing home
facilities must furnish requested records of a current or former resident, etc.

¢ 2022 FL S.B. 1950 (NS), adopted April 6, 2022, requires rather than authorizing, that the reimbursement method for provider service
networks be on a prepaid basis; deleting a requirement that the Agency for Health Care Administration provide the opportunity for
public feedback on a certain waiver application; revising requirements relating to the databook published by the agency consisting of
Medicaid utilization and spending data; deleting procedures for plan procurements when no provider service networks submit bids;
providing that cancer hospitals meeting certain criteria are statewide essential providers, etc.

¢ 2022 FL REG TEXT 617459 (NS), effective November 9, 2022, provides requirements for Osteopathic Physician Office Surgery
Registration; Inspection or Accreditation; Approval of Osteopathic Physician Office Accrediting Organizations.

¢ 2022 FL REG TEXT 618652 (NS), proposed July 5, 2022, proposes to revise Rules 59A-36.019 and 59A-36.025 to align language
with statute regarding submission and approval of comprehensive emergency management plans (CEMP) and emergency
environmental control plans, remove obsolete language and update incorporated CEMP form for assisted living facilities.

Georgia
¢ 2021 GAH.B. 9 (NS), enrolled November 19, 2021, would develop guidelines for use of telehealth services in public schools.

¢ 2021 GA S.B. 342 (NS), engrossed February 7, 2022, would provide annual reporting regarding mental health parity in healthcare
plans.

* 2021 GAS.B. 645 (NS), filed April 1, 2022, would provide requirements for nurse staffing in hospitals and health care facilities.

* 2021 GAH.R. 652 (NS), introduced February 1, 2022, would urge the Department of Public Health to improve the quality of care of
those with HIV on the Medicaid program.

¢ 2021 GAH.B. 752 (NS), adopted May 8, 2022, enacts the Psychiatric Advance Directive Act.

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¢ 2021 GAH.B. 1013 (NS), adopted April 4, 2022, enacts the Mental Health Parity Act.
¢ 2021 GAH.B. 1609 (NS), introduced March 30, 2022, would provide requirements for nursing staffing hospitals.
Hawaii

¢ 2021 HI H.R. 96 (NS), introduced March 11, 2022, would urge the Department of Human Services to convene a working group to
explore creation of a sustainability fund for the community care foster family home and expanded adult residential care home programs.

¢ 2021 HI H.B. 1794 (NS), amended/substituted February 17, 2022, would require DOH to implement standardized quality metrics

to track and address health care processes or outcomes applicable to improving the quality of care for patients having opioid use
disorders and targeting through value-based purchasing improvements in outcomes for patients having opioid use disorders by
1/1/2024. Requires DOH to implement value-based purchasing based on the standardized quality metrics by 7/1/2024. Directs DOH
to collect certain data regarding opioid use. Requires annual reports to the legislature. Establishes a working group to determine major
shifts in operations and clinical models that substance use disorder treatment providers need to make before adjusting to efforts to
incentivize new demands for higher quality care. Effective 7/1/2112.

¢ 2021 HI H.B. 2205 (NS), introduced January 26, 2022, would eliminate the certificate of need requirement for all health care facilities
and health care services except for nursing homes, hospices, intermediate care facilities for the intellectually disabled, and ambulance
service providers.

¢ 2021 HI S.B. 2467 (NS), amended/substituted March 3, 2022, would require that one annual mental health screening be included in
health insurance coverage for diagnosis and treatment of mental disorders. Effective 1/1/2050.

* 2021 HI S.B. 2624 (NS), adopted June 27, 2022, requires the Department of Health to implement a telehealth pilot project and
publish an evaluation report on the telehealth pilot project outcomes. Exempts the telehealth pilot project from the Hawall Public
Procurement Code for a period of 12 months. Clarifies that the period of performance of all procurements made during this temporary
exemption shall not exceed the term of the telehealth pilot project. Requires the Department of Health to implement and administer a
rural healthcare pilot project to provide physicians serving selected rural areas with an availability fee and reimbursements for certain
expenses.

¢ 2021 HI S.B. 2875 (NS), amended/substituted February 17, 2022, would establish employment first as a state policy with respect

to persons with disabilities. Requires state and county agencies to implement this policy in hiring and all programs and services
administered or funded by the State or counties. Applies employment first principles to Medicaid home- and community-based waiver
programs.

¢ 2021 HI S.B. 3113 (NS), adopted June 27, 2022, incorporates the kupuna caregivers program into the kupuna care program and adds
services for care recipients, caregivers, and employed caregivers.

Idaho

¢ 2022 ID H.B. 613 (NS), introduced February 14, 2022, would add to existing law to provide for occupational licensing protection with
respect to coronavirus.

* 2022 ID S.B. 1327 (NS), adopted March 21, 2022, amends existing law to clarify cost coverage for hospitalization of mentally ill
individuals and to revise other provisions regarding such hospitalizations.

Illinois

¢ 2021 IL S.B. 2978 (NS), introduced January 5, 2022, would amend the Medical Patient Rights Act. Provides that each patient has the
right to: (1) receive current health care facility policies, inspection findings of State and local health authorities, and further explanation
of a written statement of rights to be available to the patient, his or her guardian, or his or her chosen representative; (2) be treated
with courtesy and respect for his or her individuality by employees or persons providing medical services or care and to have his

or her human and civil rights maintained in all aspects of medical care; (3) have his or her basic human needs accommodated in a
timely manner; (4) continuity and coordination of care among and between all disciplines serving the patient's medical diagnoses and
needs; (5) be told the identity of his or her health care provider upon request; (6) be provided, digitally or in writing, current information
concerning the patient's diagnosis, treatment, alternatives, risks, and prognosis upon request; and (7) be informed, prior to or at the
time of admission and during his or her stay, of services that are included in the health care facility's basic per diem or daily room rate
and that other services are available at additional charge. Provides that hospitals' patient advocates or ombudsmen shall be notified

of patient grievances. Provides that a health care facility shall make every effort to assist patients in obtaining information regarding
whether the Medicare or Medical Assistance program will pay for any or all of the services provided by the health care facility. Provides
that hospitals shall have a written internal grievance procedure that conforms with specified requirements. Makes other changes.
Effective immediately.

¢ 2021 IL S.B. 3490 (NS), adopted May 16, 2022, amends the Illinois Act on the Aging. In provisions concerning the Council on Aging,
provides that at least 7 citizen members shall represent underrepresented communities, including, but no limited to: one member who
is a lesbian, gay, bisexual, or queer individual; one member who is a transgender or gender-expansive individual; one member who is
an African-American or Black individual; and one member who is an Asian-American or Pacific Islander individual. Creates the Illinois
Commission on LGBTQ Aging to investigate, analyze, and study the health, housing, financial, psychosocial, home-and-community-

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based services, assisted living, and long-term care needs of LGBTQ older adults and their caregivers. Requires the Commission

to make recommendations to improve access to benefits, services, and supports for LGBTQ older adults and their caregivers.

Requires the Commission to: examine the impact of State and local laws, policies, and regulations on LGBTQ older adults and make
recommendations to ensure equitable access, treatment, care and benefits, and overall quality of life; and examine strategies to
increase provider awareness of the needs of LGBTQ older adults and their caregivers and to improve the competence of and access to
treatment, services, and ongoing care, including preventive care; and carry out other duties. Contains provisions concerning: members
appointed to the Commission; Commission meetings and reports; an LGBTQ Older Adult Advocate to advocate for LGBTQ older adults
and older adults living with HIV who experience barriers to accessing and utilizing services; an LGBTQ Older Adult Curriculum and
Training Program; and other matters. Effective immediately.

¢ 2021 IL S.B. 4024 (NS), adopted May 27, 2022, amends the Illinois Act on the Aging. In a provision requiring the Department on Aging
to make certain long term care consumer choice information available to the public on the Internet, removes a reference to the name of
the hyperlink 'Resident's Right to Know'.

¢ 2021 IL H.B. 4465 (NS), introduced January 21, 2022, would amend the Assisted Living and Shared Housing Act, the Community
Living Facilities Licensing Act, the Life Care Facilities Act, the Nursing Home Care Act, the MC/DD Act, and the ID/DD Community Care
Act. Provides that, on and after 36 months after the amendatory Act's effective date, facilities or establishments licensed under the Acts
are prohibited from: (1) being owned by and leased or rented to related business entities; and (2) employing a service provider that

is a related business entity of the owner of the facility or establishment. Provides that a facility or establishment shall not charge any
over-market rate for a resident's rent or for services provided to a resident. Provides that the provisions do not apply to any facility or
establishment that does not receive State or federal funds through Medicaid or Medicare. Contains other provisions.

¢ 2021 IL H.B. 4549 (NS), introduced January 21, 2022, would amend the Perinatal Mental Health Disorders Prevention and Treatment
Act. Makes a technical change in a Section concerning the short title.

¢ 2021 IL H.B. 4645 (NS), adopted May 27, 2022, 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. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or
behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified
requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department.
Contains other provisions.

¢ 2021 IL H.B. 4656 (NS), engrossed February 22, 2022, would amend the Illinois Act on the Aging. In provisions concerning the
Council on Aging, provides that at least 7 citizen members shall represent underrepresented communities, including, but no limited to:
one member who is a lesbian, gay, bisexual, or queer individual; one member who is a transgender or gender-expansive individual;
one member who is an African-American or Black individual; and one member who is an Asian-American or Pacific Islander individual.
Creates the Illinois Commission on LGBTQ Aging to investigate, analyze, and study the health, housing, financial, psychosocial,
home-and-community-based services, assisted living, and long-term care needs of LGBTQ older adults and their caregivers. Requires
the Commission to make recommendations to improve access to benefits, services, and supports for LGBTQ older adults and their
caregivers. Requires the Commission to: examine the impact of State and local laws, policies, and regulations on LGBTQ older

adults and make recommendations to ensure equitable access, treatment, care and benefits, and overall quality of life; and examine
strategies to increase provider awareness of the needs of LGBTQ older adults and their caregivers and to improve the competence

of and access to treatment, services, and ongoing care, including preventive care; and carry out other duties. Contains provisions
concerning: members appointed to the Commission; Commission meetings and reports; an LGBTQ Older Adult Advocate to advocate
for LGBTQ older adults and older adults living with HIV who experience barriers to accessing and utilizing services; an LGBTQ Older
Adult Curriculum and Training Program; and other matters. Effective immediately.

¢ 2021 IL H.B. 4763 (NS), engrossed March 4, 2022, would amend the Assisted Living and Shared Housing Act, the Community Living
Facilities Licensing Act, the Life Care Facilities Act, the Nursing Home Care Act, the MC/DD Act, and the ID/DD Community Care

Act. Provides that establishments or facilities licensed under the Acts shall post on the establishment's or facility's website specified
information about the Department on Aging's Long Term Care Ombudsman Program. Provides that an establishment or facility may
comply with the provisions by posting the required information on the website of its parent company if the establishment does not
maintain a unique website and is not required to comply with the provisions if the establishment or facility and any parent company do
not maintain a website. Effective January 1, 2023.

¢ 2021 IL H.B. 4678 (NS), introduced January 21, 2022, would prohibit nurse agencies from entering into covenants not to compete
with nurses and certified nurse aides who are employed by the agencies. Provides that a supplemental healthcare staffing agency
must not bill nor receive payments from a licensed health care facility at a rate higher than 130% of the sum of total compensation
plus associated payroll taxes for applicable employee classifications. Provides that the maximum charge must include all charges
for administrative fees, contract fees, or other special charges in addition to compensation for the temporary nursing pool personnel
supplied to a health care facility. Amends the Illinois Public Aid Code. Provides that is shall be a matter of State policy that the
Department of Healthcare and Family Services shall set nursing facility rates, by rule, utilizing an evidence-based methodology

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that rewards appropriate staffing, quality-of-life improvements for nursing facility residents, and the reduction of racial inequities

and health disparities for nursing facility residents enrolled in Medicaid. Contains provisions concerning the Patient Driven Payment
Model for nursing services reimbursements; utilization of the Staff Time and Resource Intensity Verification study; the statewide base
rate for certain dates of service; the establishment of a variable per diem add-on for nursing facilities with specified staffing levels;
directed payments to improve the quality of care delivered by nursing facilities; occupied bed tax amounts beginning January 1, 2022,
emergency rules; and other matters. Schedules for repeal on July 1, 2024 the Nursing Home License Fee Article of the Code. Amends
the Illinois Administrative Procedure Act. Permits the Department of Healthcare and Family Services to adopt emergency rules to
implement certain changes made by the amendatory Act. Effective immediately.

¢ 2021 IL H.B. 5222 (NS), introduced January 31, 2022, would amend the Illinois Act on the Aging. Provides that each long term care
facility, supportive living facility, assisted living establishment, and shared housing establishment shall display, in an easily readable
format and in a manner prescribed by the Office of the Long Term Care Ombudsman, the address and phone number of the Office in a
conspicuous place next to the facility's main entrances for exterior viewing and in multiple, conspicuous public places within the facility
accessible to both visitors and residents.

¢ 2021 IL H.B. 5223 (NS), introduced January 31, 2022, would require each assisted living or shared housing establishment in the
State, as a condition of establishment licensure, to adopt and implement written policies, provide for the availability of technology

to establishment residents, and ensure that appropriate staff and other capabilities are in place to prevent the social isolation of
establishment residents. Contains specified requirements for the social isolation prevention policies. Provides that the social isolation
prevention policies shall not be interpreted as a substitute for in person visitation but shall be wholly in addition to the existing in person
visitation policies. Provides that an assisted living or shared housing establishment may apply to the Department for civil monetary
penalty fund grants and may request other available federal and State funds. Provides that whenever the Department conducts an
inspection of an assisted living or shared housing establishment, the Department shall determine whether the establishment is in
compliance with the provisions and the policies, protocols, and procedures adopted pursuant to the provisions. Provides that an
establishment that fails to comply with the provisions or properly implement the policies, protocols, and procedures required shall

be liable to pay an administrative penalty as a Type 3 violation on and after January 1, 2023. Contains other provisions. Effective
immediately.

¢ 2021 IL H.B. 5541 (NS), introduced January 31, 2022, would require long-term care facilities to conduct regular universal testing for all
facility residents and staff and disclose all COVID-19 cases and deaths to facility residents, residents' family members, the Department
of Public Health, and the federal Centers for Disease Control and Prevention. Provides that the Department of Public Health shall
coordinate with local, State, and federal governments to establish COVID-19 alternate care sites with staffing. Requires the Department
to establish a commission to implement increased State oversight of facilities, provide additional staff resources and personal protective
equipment (PPE) for workers, and consider receivership for facilities with chronic public health violations. Effective immediately.

¢ 2021 IL H.B. 5779 (NS), introduced November 16, 2022, would amend the Reproductive Health Act. Specifies that every individual
has certain fundamental rights with respect to the use of assisted reproductive technology. Prohibits the State from taking certain
actions that would restrict or interfere with those rights. Defines 'assisted reproductive technology'. Makes conforming changes.

¢ 2022 IL H.B. 1208 (NS), adopted May 27, 2022, relates to employment.

¢ 2021 IL H.B. 4645 (NS), adopted May 27, 2022, 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. Provides that, in order to be eligible for loan repayment under the Act, the health care professional or
behavioral health provider shall comply with specified requirements. Requires the Department to submit an annual report with specified
requirements to the General Assembly and the Governor. Contains provisions regarding the adoption of rules by the Department.
Contains other provisions.

¢ 2021 IL H.B. 5779 (NS), introduced November 16, 2022, would amend the Reproductive Health Act. Specifies that every individual
has certain fundamental rights with respect to the use of assisted reproductive technology. Prohibits the State from taking certain
actions that would restrict or interfere with those rights. Defines 'assisted reproductive technology'. Makes conforming changes.

Indiana
¢ 2022 IN S.E.A. 298 (NS), effective March 10, 2022, relates to agreements between hospitals

* 2022 IN S.B. 330 (NS), introduced January 11, 2022, would provide that certain acts by a person, an employer, or a governmental
entity concerning an individual's vaccination status or whether an individual has an immunization passport are against public policy.
Provides that the Indiana department of labor may investigate and issue administrative orders for violations or threatened violations.

lowa

2021 IA H.F. 2578 (NS), adopted June 14, 2022, relates to appropriations for health and human services and veterans and including
other related provisions and appropriations, providing penalties, and including effective date and retroactive and other applicability date
provisions.

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Kansas

¢ 2021 KS S.B. 2 (NS), adopted April 18, 2022, prohibits certain acts by business entities, governmental entities or public officials
based upon a person's vaccination status or possession of an immunity passport; ensuring a right to in-person visitation at medical
care facilities and adult care homes; allowing patients to sign a liability waiver to be prescribed off-label use drugs; prohibiting certain
public health orders related to isolation and quarantine, stay-at-home orders, curfews and face masks; limiting isolation or quarantine
orders to recommendations and providing criminal penalties for certain violations; amending the employment security law to provide
exceptions to benefit eligibility conditions and disqualification conditions based on an employee's unwillingness to receive a vaccination;
amending the Kansas act against discrimination to define unlawful employment practices related to vaccination status or possession

of an immunity passport; limiting state of disaster emergency powers of the governor related to stay-at-home orders, curfews and

face masks; and amending provisions related to childhood immunizations required for attendance at a child care facility or school and
exemptions from such requirements.

¢ 2021 KS S.B. 453 (NS), adopted April 18, 2022, requires unlicensed employees of adult care homes who take training courses to
demonstrate certain skills to successfully complete such training courses, requiring licensed nurses to teach and evaluate such training
courses and allowing simulation experiences to be used as part of such training courses.

¢ 2021 KS S.B. 453 (NS), adopted April 18, 2022, requires adult care home certified aides who take training courses to demonstrate
certain skills to successfully complete such training courses and requiring licensed nurses to teach and evaluate such training courses.

¢ 2021 KS H.B. 2109 (NS), adopted April 14, 2022, prohibits the disclosure of personal information about a person's affiliation with an
entity that is exempt from federal income taxation under section 501 of the federal internal revenue code and continuing in existence
certain exceptions to the disclosure of public records under the open records act.

¢ 2021 KS H.B. 2678 (NS), introduced February 9, 2022, would ensure a right to in-person visitation at medical care facilities and

adult care homes, prohibiting certain public health orders related to isolation and quarantine, stay-at-home orders, curfews and face
masks, limiting isolation or quarantine orders to recommendations and providing criminal penalties for certain violations, limiting state of
disaster emergency powers of the governor and state of local disaster emergency powers of counties and cities related to stay-at-home
orders, curfews and face masks and limiting powers of the secretary of health and environment and local health officers.

* 2021 KS H.B. 2699 (NS), introduced February 11, 2022, would exempt any skilled nursing care facility for which the secretary for
aging and disability services is appointed as receiver from the quality care assessment.

¢ 2021 KS H.B. 2748 (NS), introduced April 1, 2022, would enact the no patient left alone act to require certain healthcare facilities to
allow in-person visitation of patients or residents.

¢ 2022 KY H.B. 149 (NS), introduced January 4, 2022, would create new sections of KRS Chapter 311 to define terms; establish a
qualified terminally ill individual's right to voluntarily request medication to self-administer to cause death; require conditions for making
request; permit individual to rescind request at any time; permit an attending health care provider to provide medication; establish
requirements for attending health care provider to inform individuals and document request; require disposal of unused medications;
establish residency requirements for qualified individuals; require report by the Cabinet for Health and Family Services; establish
provisions for contracts, insurance policies, and beneficiaries; state that a health care provider is not required to provide medication

to a qualified individual; permit health care providers to prohibit persons or entities from participating in a qualified individual's request
during or on the premises of employment; prohibit reporting a health care provider to a licensing board for participating in a qualified
individual's request; state that actions do not constitute suicide or homicide; create a form for a qualified individual to make a request;
create a new section of Subchapter 12 of KRS Chapter 304 to establish provisions for insurance policies and beneficiaries of qualified
individuals; amend KRS 507.020 and KRS 507.030 to create an affirmative defense to a charge of murder and manslaughter in the first
degree; provide a severability clause; create the short title, the 'Kentucky Our Care, Our Options Act.'

Kentucky

¢ 2022 KY S.B. 55 (NS), adopted March 25, 2022, amends KRS 216B.0425 to change 'primary stroke center' to 'certified stroke center';
add thrombectomy capable stroke centers to the required list of certified acute stroke ready hospitals; amend KRS 211.575 to change
'primary stroke center' to 'certified stroke center.'

* 2022 KY H.B. 149 (NS), introduced January 4, 2022, would create new sections of KRS Chapter 311 to define terms; establish a
qualified terminally ill individual's right to voluntarily request medication to self-administer to cause death; require conditions for making
request; permit individual to rescind request at any time; permit an attending health care provider to provide medication; establish
requirements for attending health care provider to inform individuals and document request; require disposal of unused medications;
establish residency requirements for qualified individuals; require report by the Cabinet for Health and Family Services; establish
provisions for contracts, insurance policies, and beneficiaries; state that a health care provider is not required to provide medication

to a qualified individual; permit health care providers to prohibit persons or entities from participating in a qualified individual's request
during or on the premises of employment; prohibit reporting a health care provider to a licensing board for participating in a qualified
individual's request; state that actions do not constitute suicide or homicide; create a form for a qualified individual to make a request;
create a new section of Subchapter 12 of KRS Chapter 304 to establish provisions for insurance policies and beneficiaries of qualified

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individuals; amend KRS 507.020 and KRS 507.030 to create an affirmative defense to a charge of murder and manslaughter in the first
degree; provide a severability clause; create the short title, the 'Kentucky Our Care, Our Options Act.'

¢ 2022 KY S.J.R. 150 (NS), adopted March 22, 2022, terminates the declaration of emergency regarding the SARS-COV-2 virus in
2020 Executive Order 2020-215 and all subsequent actions directives based upon the declaration of emergency in 2020 Executive
Order 2020-215; EMERGENCY.

¢ 2022 KY S.B. 173 (NS), adopted April 8, 2022, requires an electronically-fillable version of the MOST form to be accessed online;
allow for an electronic signature; require a Spanish translation of the MOST form; allow the MOST form to be printed on any color of
paper.

* 2022 KY H.B. 512 (NS), adopted April 8, 2022, creates new sections of KRS Chapter 211 to require the Department for Public Health
to establish and implement a plan for achieving continuous quality improvement in the quality of care provided under a statewide
system for heart attack response and treatment; require the department to designate licensed hospitals as Comprehensive Cardiac
Centers, Primary Heart Attack Centers, or Acute Heart Attack Ready hospitals; amend KRS 311A.180 to expand the protocols of
emergency medical services providers to include trauma, cardiac arrest, and heart attack.

¢ 2022 KY REG TEXT 600923 (NS), effective March 1, 2022, complies with a requirement that may be imposed or opportunity
presented by federal law to qualify for federal Medicaid funds. 42 U.S.C. 1396n(b) and 42 C.F.R. Part 438 require specific standards
relating to managed care. This administrative regulation establishes the managed care organization requirements and policies relating
to individuals enrolled with a Medicaid managed care organization.

¢ 2022 KY REG TEXT 616128 (NS), effective November 1, 2022, authorizes the Commissioner of Insurance to promulgate
administrative regulations necessary for or as an aid to the effectuation of any provision of the Kentucky Insurance Code as defined

in KRS 304.1-010. KRS 304.17A-661 requires an insurer that issues or renews a health benefit plan to annually report to the
commissioner the self-compliance with the federal Mental Health Parity and Addiction Equity Act related to nonquantitative treatment
limitations between medical and surgical benefits and mental health substance use disorder benefits to demonstrate that such
treatment limitations are applied comparably. This administrative regulation sets forth the format and submission time frame for the data
reporting requirements in KRS 304.17A-661.

Louisiana

* 2022 LA S.B. 112 (NS), adopted June 16, 2022, provides for prior authorization for health insurance claims related to certain health
care procedures; to provide for the creation of programs for the selective application of prior authorization; to provide for definitions; to
provide for development and maintenance of programs seeking to reduce prior authorization requirements related to certain health care
services performed by certain health care providers; to provide for the promulgation of rules; and to provide for related matters.

¢ 2022 LA S.B. 154 (NS), adopted June 16, 2022, enacts R.S. 22:1028.4 relative to health insurance coverage of genetic testing for
critically ill infants with no diagnosis; to require health insurance coverage of genetic testing for critically ill infants with no diagnosis; to
provide for definitions; and to provide for related matters.

¢ 2022 LA S.B. 167 (NS), adopted June 18, 2022, amends and reenact R.S. 40:2009.25(A), (C) through (E), and (I) and to enact R.S.
40:1563(N), relative to emergency preparedness plans for nursing homes; to provide for the duties of the state fire marshal; to provide
for the duties of the Louisiana Department of Health; to provide for an effective date; and to provide for related matters.

¢ 2022 LA H.B. 278 (NS), adopted June 15, 2022, requires reimbursement for mental health and substance abuse benefits provided
through the Psychiatric Collaborative Care Model service delivery method; to provide for applicability; to provide for definitions; and to
provide for related matters.

* 2022 LA H.B. 291 (NS), adopted June 16, 2022, amends and reenacts R.S. 40:2009.25(A), (B), (C)(introductory paragraph), (D),
(E), (F){introductory paragraph), (9), and (12), and (H), relative to regulation of nursing homes; to revise laws pertaining to emergency
preparedness among nursing homes; to require that all nursing homes maintain in effect emergency preparedness plans approved
by the Louisiana Department of Health; to repeal a geographic limitation pertaining to nursing home emergency preparedness plan
requirements; and to provide for related matters.

¢ 2022 LA S.B. 411 (NS), adopted May 25, 2022, amends and reenacts R.S. 40:2841, 2842(3), 2843(A), 2844(B)(3), (15), (16),

(17), (20), and (23), (C), and (D), and 2845(A)(1) and (2)(b) and (C)(1), relative to the Louisiana Emergency Response Network; to
provide for legislative purpose; to provide for definitions; to provide for the Louisiana Emergency Response Network; to provide for the
governing board; to provide for an annual report; and to provide for related matters.

¢ 2022 LA H.B. 933 (NS), adopted June 16, 2022, amends and reenact R.S. 40:2009.25 and to repeal R.S. 36:259(B)(28) and R.S.
40:2009.1, relative to nursing homes licensed by the Louisiana Department of Health; to provide relative to emergency preparedness
among nursing homes; to provide requirements and standards for nursing home emergency preparedness plans; to provide procedures
for and schedules by which nursing homes shall develop and submit such plans; to provide for duties of the Louisiana Department

of Health and local offices of emergency preparedness with respect to nursing home emergency preparedness; to provide relative

to sites to which nursing home residents may be evacuated; to revise laws creating and providing for the Nursing Home Emergency
Preparedness Review Committee within the Louisiana Department of Health; to repeal laws creating and providing for a nursing

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home advisory committee within the Louisiana Department of Health; to provide for limitation of liability; to require promulgation of
administrative rules; to provide for an effective date; and to provide for related matters.

¢ 2022 LA H.B. 958 (NS), adopted June 17, 2022, enacts Part Il-E of Chapter 11 of Title 40 of the Louisiana Revised Statutes of 1950,
to be comprised of R.S. 40:2120.11 through 2120.22, relative to the licensure and regulation of nurse staffing agencies by the Louisiana
Department of Health; to provide for definitions; to provide for the licensure and registration of nurse staffing agencies; to provide for the
protection of public rights to health care; to provide for licensed and certified personnel in healthcare facilities; to provide for applicability
provisions for prospective agencies; to provide for regulations and grounds for issuance, renewal, and denial of a license; to establish
standards for the operation of nurse staffing agencies; to provide for penalty provisions; to provide for rulemaking requirements; and to
provide for related matters.

Maine
2021 ME H.P. 1370 (NS), adopted March 31, 2022, clarifies inspection requirements for hospitals and certain nursing facilities.
Maryland

¢ 2022 MD REG TEXT 620763 (NS), effective November 14, 2022, updates the budget adjustment factors for Fiscal Years 2021
and 2022, extend the sunset date for the Interim Working Capital Fund for 1 year, and to clarify cost reporting and field verification
requirements for out-of-State nursing facilities. The proposal also corrects the percentage of the budget allocation for nursing facility
services based on the pay-for-performance scores.

Massachusetts
¢ 2021 MA S.B. 1287 (NS), introduced January 20, 2022, would increase investment in behavioral health care in the Commonwealth.

¢ 2021 MA S.B. 1311 (NS), introduced January 21, 2022, would create a pilot program to transfer high acuity behavioral health and dual
diagnosis patients away from overcrowded emergency departments.

¢ 2021 MA S.B. 1458 (NS), introduced January 26, 2022, would relate to the practice of acupuncture.

¢ 2021 MA H.B. 2078 (NS), introduced February 9, 2022, would promote high value and evidence-based behavioral health care.
* 2021 MA H.B. 2084 (NS), introduced February 19, 2022, would create a thriving public health response for adolescents.

¢ 2021 MA H.B. 2115 (NS), introduced February 19, 2022, would protect children's mental health services.

¢ 2021 MAS.B. 3056 (NS), introduced July 26, 2022, would relate to step therapy and patient safety.

¢ 2021 MA H.B. 4700 (NS), introduced April 14, 2022, would make appropriations for the fiscal year 2023 for the maintenance of the
departments.

* 2021 MA H.B. 4929 (NS), adopted November 2, 2022, amends and inserts a new section relating to step therapy and patient safety.
¢ 2021 MA H.B. 5050 (NS), adopted July 28, 2022, makes appropriations for the fiscal year 2023.

¢ 2022 MD S.B. 720 (NS), adopted May 29, 2022, renames the State Board of Examiners of Nursing Home Administrators to be the
State Board of Long-Term Care Administrators and establishing a licensing and regulatory system for assisted living managers under
the Board; and generally relating to the licensing of assisted living managers and the State Board of Long-Term Care Administrators.

¢ 2022 MD S.B. 840 (NS), introduced February 7, 2022, would establish and alter certain requirements related to COVID-19, including
requirements related to planning by institutions of higher education, home health agencies, nursing homes, and assisted living
programs, the provision of coverage by the Maryland Medical Assistance Program, the Maryland MyIR Mobile immunization record
service, and reporting by the Maryland Department of Health; establishing that certain urgent care centers are not subject to the rate-
setting jurisdiction of the Health Services Cost Review Commission; requiring the State Board of Nursing to establish an apprentice
geriatric nursing assistant program; altering the authority of pharmacists to refill prescriptions, administer certain vaccines, and delegate
certain functions to pharmacy technicians; and generally relating to public health, the provision of health care services, and responding
to COVID-19 in the State.

¢ 2022 MA REG TEXT 615395 (NS), effective November 11, 2022, adopts substantive changes for substance use disorder treatment
programs including general Modernizing, Reorganization, and Alignment with Federal Standards. This includes the following: - OTPs
will now participate in a Central Registry database which will serve as both an electronic verification system and disaster assistance tool
to ensure the uninterrupted delivery of medications in case of emergency.

¢ 2022 MA REG TEXT 625583 (NS), proposed September 30, 2022, would relate to the adoption of 101 CMR 315.00: Vision Care
Services and Ophthalmic Materials (to be renamed as 'Rates for Vision Care Services and Ophthalmic Materials').

¢ 2022 MA REG TEXT 626781, proposed October 14, 2022, would adopted 101 CMR 305.00 related to the rates of payment for
Behavioral Health Services Provided in Community Behavioral Health Centers

¢ 2022 MA REG TEXT 627636 (NS), proposed October 28, 2022, provides a remote public hearing will be held on November 4, 2022,
at 2 p.m. relative to the adoption of: 101 CMR 306.00: Rates for Mental Health Services Provided in Community Health Centers and
Mental Health Centers.

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¢ 2022 MA REG TEXT 627637 (NS), proposed October 28, 2022, provides a remote public hearing will be held on November 4, 2022,
at 1:00 p.m. relative to the adoption of: 101 CMR 329.00: Psychological Testing, Treatment, and Related Services (to be renamed as
'Rates for Psychological and Independent Clinical Social Work Services').

Michigan

¢ 2021 MI S.B. 247 (NS), adopted April 7, 2022, amends 1956 PA 218, entitled 'The insurance code of 1956,' by amending section
2212c (MCL 500.2212c), as added by 2013 PA 30, and by adding section 2212e.

¢ 2021 MI S.B. 412 (NS), adopted March 10, 2022, amends 1939 PA 280, entitled 'The social welfare act,' by amending section 109h
(MCL 400.109h), as added by 2004 PA 248.

* 2021 MI S.B. 641 (NS), engrossed September 28, 2022, would amend 1939 PA 280, entitled 'The social welfare act,' (MCL 400.1 to
400.119b) by adding section 106c.

¢ 2021 MI H.B. 5609 (NS), adopted July 25, 2022, amends 1978 PA 368, entitled 'Public health code,' by amending sections 20155,
20155a, 20161, 21734, 21771, 21794, and 21799b (IMCL 333.20155, 333.20155a, 333.20161, 333.21734, 333.21771, 333.21794, and
333.21799b), sections 20155, 20155a, and 21734 as amended by 2015 PA 155, section 20161 as amended by 2020 PA 169, section
21771 as amended by 2012 PA 174, section 21794 as added by 2014 PA 529, and section 21799b as amended by 2000 PA 437, and
by adding section 21771a.

Minnesota

¢ 2021 MN S.R. 105 (NS), introduced March 3, 2022, would be a resolution relating to opposition of the criminalization of physicians
providing care within their scope of training and accepted standard of medical care for their specialty.

¢ 2021 MN H.F. 1200 (NS), engrossed April 19, 2022, would provide for paid family, pregnancy, bonding and applicant's serious
medical condition benefits, regulate and require employment leaves, classify data, and appropriate money.

¢ 2021 MN S.F. 1257 (NS), engrossed May 17, 2022, would provide background studies requirement exemption for licensed persons.

* 2021 MN H.F. 3854 (NS), engrossed March 28, 2022, would authorize pharmacists to prescribe, dispense, and administer drugs to
prevent the acquisition of human immunodeficiency virus; and pharmacists authorized to order, conduct, and interpret laboratory tests
necessary for therapy that uses drugs to prevent the acquisition of human immunodeficiency virus.

* 2021 MN S.F. 4165 (NS), engrossed May 10, 2022, would forecast adjustments authorization and appropriation.

¢ 2021 MN S.F. 4410 (NS), engrossed May 3, 2022, would be an omnibus health and human services policy and make supplemental
appropriations.

¢ 2021 MN H.F. 4430 (NS), introduced March 21, 2022, would establish Health Care Affordability Board and Health Care Affordability
Advisory Council.

¢ 2021 MN H.F. 4533 (NS), introduced March 23, 2022, would direct the Commissioner of Human Services to conduct statewide
behavioral health treatment capacity and needs, and report required.

* 2021 MN H.F. 4579 (NS), engrossed April 19, 2022, would relate to community supports, behavioral health, continuing care for older
adults, children and vulnerable adult protection, economic assistance, direct care and treatment, homelessness prevention, human
services licensing and operations, and modify opioid litigation settlement provisions.

Mississippi

¢ 2022 MS H.B. 83 (NS), introduced January 4, 2022, would amend section 43-13-117, Mississippi code of 1972, to revise the
calculation of Medicaid reimbursement for durable medical equipment; and for related purposes.

* 2022 MS H.B. 300 (NS), introduced January 4, 2022, would amend section 43-13-117, Mississippi code of 1972, to provide Medicaid
coverage for substance abuse and mental health services for pregnant and postpartum women in a community-based, telehealth or
faith-based setting; and for related purposes.

* 2022 MS H.B. 602 (NS), introduced January 13, 2022, would amend section 43-13-117, Mississippi code of 1972, to prohibit a
managed care organization under any managed care program implemented by the division of Medicaid from transferring a beneficiary
who is enrolled with the managed care organization to another managed care organization or to a fee-for-service Medicaid provider
more often than one time in a period of twelve months unless there is a significant medical reason for making another transfer within the
twelve-month period, as determined by the division; and for related purposes.

¢ 2022 MS H.B. 657 (NS), adopted April 19, 2022, would amend section 43-13-117, Mississippi code of 1972, to delete the provision
that prohibits the division of Medicaid's rates of reimbursement, services, charges and fees from being increased, decreased or
otherwise changed unless they are authorized by an amendment to this section by the legislature, et al.

¢ 2022 MS S.B. 2314 (NS), introduced January 17, 2022, would amend section 43-13-117, Mississippi code of 1972, to authorize
Medicaid reimbursement for community-based home-visitation, pregnancy, and postpartum support services to eligible mothers and
children under the age of one year; and for related purposes.

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Missouri

¢ 2022 MO H.B. 1555 (NS), engrossed February 8, 2022, would modify provisions relating to the scope of practice for physical
therapists.

¢ 2022 MO H.B. 2097 (NS), introduced January 5, 2022, would create provisions relating to visitation rights in hospitals and long-term
care facilities.

* 2022 MO H.B. 2012 (NS), amended/substituted April 27, 2022, would modify provisions relating to health care.
Montana

2022 MT REG TEXT 621364 (NS), effective September 24, 2022, amends and repeals statutes related to communicable disease
control.

Nebraska

2021 NE L.B. 752 (NS), adopted April 18, 2022, adopts the Alzheimer's Disease and Other Dementia Support Act, the Licensed
Professional Counselors Interstate Compact, and the Occupational Therapy Practice Interstate Compact, require notifications regarding
stem cell therapy, and redefine respiratory care under the Respiratory Care Practice Act

Nevada

¢ 2022 NV REG TEXT 559350 (NS), adopted September 20, 2022, relates to industrial insurance; authorizing the purchase of an
annuity by a private carrier to provide compensation for an industrial injury or occupational disease; prohibiting reimbursement

from certain accounts for certain claim expenditures which are reimbursable to self-insured employers, associations of self-insured
employers and private carriers from other sources; requiring certain information to be provided to the Administrator of the Division of
Industrial Relations of the Department of Business and Industry and the Commissioner of Insurance.

¢ 2022 NV REG TEXT 612627 (NS), revised draft June 23, 2022, would relate 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.

New Hampshire

¢ 2021 NH S.B. 281 (NS), adopted July 8, 2022, prohibits a private nursing home or assisted living facility from enforcing a 30-day
notice of vacancy policy in the event of a resident's death and provides that, in such cases, the month in which the resident passes shall
be the last month for which payment is due.

¢ 2021 NH H.B. 1019 (NS), introduced January 5, 2022, would relate to health insurance; amending O.S. 2011, Section 6060.2,
which relates to treatment of diabetes; requiring health insurers to cap copayments for insulin at a certain amount; authorizing
insurers to reduce copayments below cap; authorizing Insurance Commissioner to enforce cap on copayments; authorizing Insurance
Commissioner to promulgate rules; and providing an effective date.

¢ 2021 NH REG TEXT 598921 (NS), effective January 25, 2022, sets forth the classification of and licensing requirements for supported
residential health care facilities (SRHCF) pursuant to RSA 151:2, I(e)(2) and as described in RSA 151:9, VIl(a)(2). Groups affected by
this rule include any individual, agency, partnership, corporation, government entity, association or, or other legal entity operating a
SRHCF pursuant to RSA 151:9, VIl(a)(2).

¢ 2022 NH REG TEXT 615417 (NS), adopted November 10, 2022, defines the process for involuntary emergency admission (IEA) to a
designated receiving facility or New Hampshire Hospital (NHH).

¢ 2022 NH REG TEXT 616560 (NS), final proposal October 13, 2022, would prescribe the requirements of the New Hampshire
Medicaid care management program as they pertain to Medicaid recipients, including individuals determined eligible for Medicaid
coverage through the granite advantage health care program (granite advantage) in accordance with RSA 126-AA:2.

New Jersey

* 2020 NJ A.B. 4139 (NS), adopted January 10, 2022, establishes requirements for copies of medical and billing records to be provided
without charge to Social Security Disability benefits applicants and recipients.

* 2022 NJ S.B. 311 (NS), adopted June 30, 2022, establishes a Statewide behavioral health crisis system of care.

* 2022 NJ S.B. 558 (NS), introduced January 11, 2022, would require health insurers to cover treatment ordered by health care provider
for covered person based on generally accepted standards of health care practice, subject to appeal; creates Carrier Appeals Program.

¢ 2022 NJ S.B. 710 (NS), introduced January 11, 2022, would require nursing homes to permit use of electronic monitoring devise at
request of resident.

¢ 2022 NJ S.B. 846 (NS), introduced January 18, 2022, would revise requirements for health insurers to cover telemedicine and
telehealth; requires telemedicine and telehealth systems to include accessible communication features for individuals with disabilities.

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¢ 2022 NJ S.B. 1040 (NS), introduced January 31, 2022, would require each nursing home to employ a patient advocate.

¢ 2022 NJ S.B. 1164 (NS), introduced January 31, 2022, would establish remote medical consultation assistance grant program in
DOH.

* 2022 NJ S.B. 2031 (NS), introduced March 3, 2022, would establish process to bar certain health care providers from receiving
reimbursement under PIP.

¢ 2022 NJ A.B. 2193 (NS), amended/substituted October 27, 2022, would revise emergency care services referral standards for
providers of telemedicine and telehealth.

* 2022 NJ S.B. 2253 (NS), adopted September 22, 2022, limits fees charged for copies of medical and billing records.

¢ 2022 NJ S.B. 2305 (NS), introduced March 21, 2022, would require health insurers to cover colorectal cancer screenings
recommended by United States Preventive Services Task Force and eliminates cost-sharing requirements for certain colonoscopies.

* 2022 NJ S.B. 2331 (NS), introduced March 21, 2022, would require health insurers, SHBP and SEHBP to provide coverage for
diagnosis, evaluation and treatment of lymphedema.

* 2022 NJ A.B. 2335 (NS), introduced February 7, 2022, would require nursing homes to permit use of electronic monitoring devices at
request of resident.

¢ 2022 NJ S.B. 2466 (NS), introduced May 9, 2022, would require long-term care facilities to provide certain disability protection and
advocacy agencies access to residents.

¢ 2022 NJ S.B. 2520 (NS), introduced May 12, 2022, would establish the 'New Jersey No Patient Left Alone Act'; requires certain
facilities to establish policies guaranteeing visitation rights for facility residents.

¢ 2022 NJ S.B. 2528 (NS), introduced May 12, 2022, would require DOH to establish Community Health Center Integrated Care Loan
Program; appropriates funds for purpose of loan program.

¢ 2022 NJ S.B. 2541 (NS), introduced May 12, 2022, would establish a two-year pilot program for certain mental health care facilities to
treat additional juvenile patients.

¢ 2022 NJ A.B. 2573 (NS), introduced February 14, 2022, would expand Medicaid coverage regarding assistive devices for hearing
impaired under certain circumstances.

¢ 2022 NJ A.B. 2586 (NS), introduced February 14, 2022, would clarify DHS authority over sober living homes, and requires certain
sober living homes to be dedicated for use by persons in substance use recovery who have other mental health disorders.

¢ 2022 NJ S.B. 2601 (NS), introduced May 12, 2022, would establish the 'Planning for an Aging Population Task Force.'

* 2022 NJ S.B. 2621 (NS), introduced May 12, 2022, would establish a pilot program to refer certain emergency department patients for
development of coordinated behavioral health care treatment and support services plan.

¢ 2022 NJ A.B. 2655 (NS), introduced February 14, 2022, would establish requirements concerning the provision of postpartum care
information and the development of individualized postpartum care plans.

¢ 2022 NJ S.B. 2703 (NS), introduced May 19, 2022, would allow health care professionals located outside New Jersey to provide
services using telemedicine and telehealth to patients in New Jersey.

* 2022 NJ A.B. 2735 (NS), introduced February 14, 2022, would provide for Medicaid coverage and reimbursement for mental health
services provided through telepsychiatry.

¢ 2022 NJ S.B. 2821 (NS), introduced June 9, 2022, would require Medicaid and NJ FamilyCare managed care organizations to offer
patient-centered medical home model or other alternative payment model to primary care providers.

¢ 2022 NJ S.B. 2891 (NS), amended/substituted October 6, 2022, would expand the scope of Office of State Long-Term Care
Ombudsman; appropriates $1 million.

¢ 2022 NJ S.B. 2892 (NS), amended/substituted October 6, 2022, would establish requirements for sanctions and other actions
involving low-performing nursing homes.

¢ 2022 NJ A.B. 3210 (NS), introduced March 7, 2022, would establish the Working Group on End-of-Life Care and Palliative Care in
DOH.

* 2022 NJ A.B. 3245 (NS), introduced March 7, 2022, would establish prescription drug pricing disclosure requirements and measures
to reduce prescription drug costs.

¢ 2022 NJ S.B. 3259 (NS), introduced October 31, 2022, would require health insurance coverage for certain obesity treatments.

¢ 2022 NJ S.B. 3295 (NS), introduced November 3, 2022, requires State Health Benefits Plan Design Committee include certain first
responder titles in first responders primary care medical home program.

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¢ 2022 NJ A.B. 4024 (NS), introduced May 16, 2022, would establish a two-year pilot program for certain mental health care facilities to
treat additional juvenile patients.

¢ 2022 NJ A.B. 4420 (NS), introduced June 29, 2022, would require health insurance carriers to provide list of alternative drugs to
health care professionals, pharmacists, and covered persons under certain circumstances.

* 2022 NJ A.B. 4223 (NS), introduced June 9, 2022, would increase Medicaid reimbursement rates for primary care and mental health
services according to Medicare payment rates for same services.

* 2022 NJ A.B. 4428 (NS), introduced June 29, 2022, would establish cause of action for residents of assisted living facilities and
comprehensive personal care home providers.

¢ 2022 NJ A.B. 4536 (NS), introduced September 22, 2022, would establish minimum registered professional nurse staffing standards
for hospitals and ambulatory surgery facilities and certain DHS facilities.

¢ 2022 NJ A.B. 4542 (NS), introduced September 22, 2022, would require certain places of public assembly to have automated external
defibrillator on-site.

* 2022 NJ A.B. 4620 (NS), introduced September 22, 2022, would provide for enrollment as NJ FamilyCare provider in conjunction with
licensure application; Requires health insurance carriers to determine provider enrollment within six months of application.

* 2022 NJ A.B. 4627 (NS), introduced September 22, 2022, would require DOH to maintain emergency stockpile of insulin and
authorizes dispensing of emergency supply of insulin to certain patients.

¢ 2022 NJ A.B. 4781 (NS), introduced October 17, 2022, would require health insurance coverage for certain obesity treatments.
New Mexico

¢ 2022 NM H.B. 2 (NS), adopted April 8, 2022, makes general appropriations and authorizing expenditures by state agencies required
by law.

* 2022 NM REG TEXT 583147 (NS), effective January 1, 2023, relates to provider grievances.

¢ 2022 NM REG TEXT 621492 (NS), proposed August 9, 2022, would improve access to and quality of health care across the
geographic and economic spectrum of New Mexico the New Mexico Medical Board has drafted a new part to their rules that would
cover Telemedicine. The Board's intent is to facilitate the important use of Telemedicine and to streamline the practice of medicine that
does not involve direct patient contact, i.e. radiology, pathology and others where the goal is to process data to facilitate a diagnosis
and therefore care. This new part will outline what is expected when providing care via Telemedicine.

New York

¢ 2021 NY A.B. 289 (NS), amended/substituted January 10, 2022, would enhance coverage and care for medically fragile children;
requires that health plans adopt policies and procedures tailored to the unique healthcare needs of this population.

¢ 2021 NY S.B. 1576 (NS), amended/substituted May 17, 2022, would relate to violations of safety conditions in adult care facilities;
provides penalties for safety violations and operating without a valid license; prohibits reductions in fines in certain circumstances where
a patient is endangered or harmed.

¢ 2021 NY S.B. 2103 (NS), amended/substituted January 24, 2022, relates to the use of psychotropic medications in nursing homes
and adult care.

¢ 2021 NY S.B. 2121 (NS), amended/substituted January 6, 2022, relates to enhancing coverage and care for medically fragile children.

¢ 2021 NY A.B. 4656 (NS), amended/substituted April 29, 2022, would establish a residential demonstration program for persons with
advanced needs to provide medical, social, and residential care to persons with dementia, significant cognitive disease or behavior
disturbances.

¢ 2021 NY A.B. 7538 (NS), amended/substituted April 21, 2022, would create a veteran health care navigator program to employ people
with knowledge and skills to ensure veterans and their families have access to health and mental health treatment, including for post-
traumatic stress disorder, depression, and suicide prevention.

¢ 2021 NY S.B. 7706 (NS), adopted February 24, 2022, relates to veteran access to certain benefits regarding temporary shelter,
nursing homes, residential health care facilities, adult care facilities, etc.; requires the division to encourage all temporary shelter
providers to share information to increase veteran access to benefits.

¢ 2021 NY S.B. 7777 (NS), introduced January 11, 2022, would direct the commissioner of health, in consultation with the state long-
term care ombudsman, to establish policies and procedures for reporting, by staff and volunteers of the long-term care ombudsman
program, issues concerning the health, safety and welfare of residents at long-term care facilities.

¢ 2021 NY S.B. 7892 (NS), introduced January 18, 2022, would require nursing homes and assisted living facilities to provide and
maintain automated external defibrillators in quantities and types deemed by the commissioner to be adequate to ensure ready and
appropriate access for use during emergencies.

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¢ 2021 NY S.B. 8285 (NS), introduced February 9, 2022, would direct 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.

¢ 2021 NY S.B. 8813 (NS), introduced April 20, 2022, would require adult care facilities to include demographic information, including
race or ethnicity, in certain admission and discharge records maintained by the facility.

¢ 2021 NY A.B. 8920 (NS), introduced January 19, 2022, would require certain residential adult care facilities that house individuals with
traumatic brain injuries to hold a certification or professional license or employ a resident manager who holds a current professional

license as a physician, nurse practitioner, registered nurse, licensed rehabilitation professional, certified brain injury specialist (CBIS) or
licensed mental health professional who is trained and experienced in the care and rehabilitation of residents with traumatic brain injury.

* 2021 NY A.B. 9007 (NS), adopted April 9, 2022, amends the public health law, in relation to the implementation of the Nurses Across
New York (NANY) program (Part A); to amend the education law, in relation to enacting the interstate medical licensure compact;

and to amend the education law, in relation to enacting the nurse licensure compact (Part B); to amend the public health law and the
education law, in relation to allowing pharmacists to direct limited service laboratories and order waived tests and modernizing nurse
practitioners and, in relation to regulations for medication-related tasks provided by certified medical aides; to amend the education law,
in relation to allowing for certain individuals to administer tests to determine the presence of SARS-CoV-2 or its antibodies, influenza
virus or respiratory syncytial virus in certain situations; to amend part D of chapter 56 of the laws of 2014, amending the education

law relating to enacting the 'nurse practitioners modernization act', in relation to the effectiveness thereof; and providing for the repeal
of certain provisions upon the expiration thereof (Part C); to amend the social services law, in relation to establishing the health care
and mental hygiene worker bonuses (Part D); to amend the public health law, in relation to increasing general public health work base
grants for both full-service and partial-service counties and allow for local health departments to claim up to fifty percent of personnel
service costs (Part E); to amend the public health law, in relation to the modernization of the emergency medical system (Part F); to
repeal articles governing healthcare professions in the education law and adding such laws to the public health law and transferring

all functions, powers, duties and obligations relating thereto (Part G); to amend part H of chapter 59 of the laws of 2011, amending the
public

¢ 2021 NY A.B. 9290 (NS), adopted June 30, 2022, requires adult care facilities to include demographic information, including race or
ethnicity, in certain admission and discharge records maintained by the facility.

¢ 2021 NY A.B. 9984 (NS), introduced April 29, 2022, would create the Brooklyn health care commission.
¢ 2021 NY A.B. 10031 (NS), introduced April 29, 2022, would establish a quality incentive program for managed care providers.
¢ 2021 NY REG TEXT 597200 (NS), adopted January 26, 2022, updates language and confirm current State Plan Amendment.

¢ 2022 NY REG TEXT 599116 (NS), adopted December 7, 2022, requires every RHCF shall spend a minimum of 70% of revenue on
direct resident care and 40% of revenue on resident-facing staffing.

¢ 2021 NY REG TEXT 599117 (NS), adopted December 7, 2022, sets minimum staffing levels for nursing homes.
* 2022 NY REG TEXT 600117 (NS), adopted September 28, 2022, establishes regulations regarding the expansion of telehealth.

* 2022 NY REG TEXT 607453 (NS), effective January 26, 2022, requires nursing homes and adult care facilities to conduct ongoing
COVID-19 vaccinations of their residents and personnel.

¢ 2022 NY REG TEXT 609553 (NS), effective October 1, 2022, relate to general service standards for substance use disorder
outpatient programs.

¢ 2022 NY REG TEXT 613996 (NS), effective on an emergency basis May 11, 2022, requires nursing homes and adult care facilities to
conduct ongoing COVID-19 vaccinations of their residents and personnel.

* 2022 NY REG TEXT 616230 (NS), emergency rule effective July 22, 2022, requires nursing homes and adult care facilities to conduct
ongoing COVID-19 vaccinations of their residents and personnel.

North Carolina

¢ 2021 NC S.B. 105 (NS), adopted November 18, 2021, would make base budget appropriations for current operations of state
agencies, departments, and institutions and for other purposes.

¢ 2021 NC S.B. 792 (NS), introduced May 26, 2022, would modify the current operations appropriations act of 2021and to make other
changes in the budget operations of the state.

Ohio

* 2021 OH H.B. 431 (NS), engrossed March 30, 2022, would require the Department of Health to establish and maintain a stroke
registry database and to provide for the recognition of thrombectomy-capable stroke centers.

¢ 2022 OH REG TEXT 625085 (NS), effective December 11, 2022, reviews long-term care facilities and beds and bed review criteria;
state and county bed need.

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¢ 2022 OH REG TEXT 626633 (NS), proposed October 14, 2022, relates to the termination of enrollment in Medicaid.
Oklahoma

¢ 2021 OK S.B. 1156 (NS), introduced February 7, 2022, would relate to licensure requirements for adult day care centers; allowing
certain facilities to be licensed as adult day care centers; requiring State Department of Health to consider certain licensure as proof
of compliance with applicable standards; requiring application and fee; specifying applicability of Adult Day Care Act; and providing an
effective date.

* 2021 OK S.B. 1240 (NS), adopted May 2, 2022, updates statutory requirement; updating statutory reference; conforming language.
Effective date.

¢ 2021 OK S.B. 1413 (NS), adopted May 20, 2022, relates mental health coverage provisions; modifying contents to be reported in
analyses; updating statutory references to comply with federal law; requiring analysis findings include certain provisions; requiring
Insurance Commissioner issue guidance and standardized reporting materials; updating statutory references; updating statutory
language; and providing an effective date.

¢ 2021 OK S.B. 1668 (NS), amended/substituted February 14, 2022, would relate to qualifications for license or certification of long-
term care administrators; broadening types of administrators exempt from certain requirement; providing that certain experience shall
substitute for certain degree; requiring Oklahoma State Board of Examiners for Long-Term Care Administrators to grant assistant
administrator certification to applicants who meet certain criteria; providing for full licensure of certified assistant administrators;
requiring Board to grant provisional licensure to applicants who meet certain criteria; granting provisional licensee certain rights;
providing for licensure by endorsement; providing for revocation of provisional license; requiring Board to approve certain organizations
or agencies for certain training program under certain condition; requiring Board to ensure availability of at least two training programs;
authorizing Board to provide training; and providing an effective date.

* 2021 OK H.B. 3978 (NS), introduced February 7, 2022, would relate to health insurance; amending O.S. 2011, Section 6060.2, which
relates to treatment of diabetes; requiring actions taken by insurers providing certain coverage be consistent with certain standards; and
providing an effective date.

* 2021 OK H.B. 4294 (NS), introduced February 7, 2022, would relate 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

¢ 2021 OK S.B. 1369 (NS), adopted May 11, 2022, establishes the Office of the State Coordinator for Health Information Exchange;
data; penalty schedule. Effective date. Emergency.

* 2022 OR H.B. 4003 (NS), engrossed February 24, 2022, would direct Oregon State Board of Nursing to issue nurse internship
license to qualified applicant. Allows nurse intern to practice nursing subject to certain limitations and under supervision of registered
nurse. Directs Healthcare Workforce Advisory Committee to study nursing workforce shortage. Requires report to interim committee of
Legislative Assembly related to health care no later than November 15, 2022. Allows nonresident nurses to practice in Oregon for up to
90 days under certain circumstances at specified entities. Requires entities experiencing temporary staffing shortage to notify nurses'
exclusive bargaining representative of shortage and other information. Allows person other than applicant for licensure by indorsement
to pay application fee. Directs board to support Oregon nonprofit organization that promotes well-being of Oregon health professionals
in order to ensure nurses may access program. Declares emergency, effective on passage.

* 2021 OR REG TEXT 599976 (NS), effective February 15, 2022, would provide clarity to the form and manner for carriers offering
individual and group health benefit plans to report on behavioral health benefits. Specifically, the rules clarify certain definitions and
expectations for the reporting to be submitted to the department. Data elements are further expanded upon when additional clarity was
determined to be necessary and helpful for vague terminology or information required by Oregon Laws 2021, chapter 629.

¢ 2021 OR REG TEXT 602981 (NS), effective January 1, 2022, amending rules addressing long-term care settings, to control the
virus in these settings. Additionally, fire and life safety for new construction and newly licensed adult foster homes is crucial to the
health and safety of adult foster home residents. The Department of Building Code Services has implemented new OARs through
Oregon Residential Specialty Code (ORSC) requiring sprinkler systems or an alternative. To ensure the health and safety of residents,
create guidance for licensed providers and the local licensing authority, the Department has amended program language to reflect the
changes to State of Oregon Building Codes Division OARs that became effective April 1, 2021.

* 2022 OR REG TEXT 613826 (NS), effective July 11, 2022, would add language indicating the Department may impose a $250 daily
penalty if weekly reporting of vaccination data is not submitted timely. Other changes may be made to OAR 411-061-0010 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.

* 2022 OR REG TEXT 620554 (NS), effective November 4, 2022, would implement and administer the Paid Leave Oregon program,
the Oregon Employment Department is promulgating permanent administrative rules in accordance with ORS chapter 657B.

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¢ 2022 OR REG TEXT 620975 (NS), proposed July 29, 2022, would add requirement for QMHAs and QMHPs to complete suicide
prevention training every two or three years. These changes describe the added requirements.

¢ 2022 OR REG TEXT 626317 (NS), effective October 13, 2022, establishes requirements and funding methodology for the Essential
Workforce Health Care Program. This Program will provide supplemental payments to participating facilities to support the funding of
Essential Workforce Health Care Fund.

* 2022 OR REG TEXT 626602 (NS), effective October 13, 2022, making minor regulatory corrections.

* 2022 OR REG TEXT 627621 (NS), proposed October 27, 2022, would establish new requirements for individual and group health
benefit plans providing behavioral health benefits, including updating several provisions related to requirements for behavioral health
benefits and treatment which require rulemaking to amend existing rules.

Pennsylvania

¢ 2021 PA S.B. 225 (NS), adopted November 3, 2022, amends the act of May 17, 1921 (P.L.682, No.284), known as The Insurance
Company Law of 1921, in quality health care accountability and protection, further providing for definitions, for responsibilities of
managed care plans, for financial incentives prohibition, for medical gag clause prohibition, for emergency services, for continuity of
care, providing for medication assisted treatment, further providing for procedures, for confidentiality, for required disclosure, providing
for medical policy and clinical review criteria adopted by insurer, MCO or contractor, further providing for internal complaint process, for
appeal of complaint, for complaint resolution, for certification, for operational standards, providing for step therapy considerations, for
prior authorization review and for provider portal, further providing for internal grievances process, for records, for external grievance
process, for prompt payment of claims, for health care provider and managed care plan, for departmental powers and duties, for
penalties and sanctions, for compliance with National Accrediting Standards; and making editorial changes.

¢ 2021 PA 8.B. 1131 (NS), introduced March 7, 2022, would amend the act of April 27, 1905 (P.L.312, No.218), entitled 'An act creating
a Department of Health, and defining its powers and duties,' further providing for State health centers; and making editorial changes.
Increase access to mental health medication.

* 2021 PA S.B. 1269 (NS), introduced June 14, 2022, would amend the act of June 13, 1967 (P.L.31, No.21), known as the Human
Services Code, in children and youth, providing for Statewide children's mental health ombudsman.

¢ 2021 PA H.B. 2779 (NS), introduced August 22, 2022, would provide for long-term services and supports, establishing the Long-Term
Services and Supports Commission, the Long-Term Services and Supports Council and the Long-Term Services and Supports Trust
Fund, imposing duties on the Department of Human Services and the Department of Revenue and imposing a payroll premium.

¢ 2021 PA H.B. 2824 (NS), introduced September 16, 2022, would provide 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.

¢ 2021 PA H.B. 2884 (NS), introduced October 24, 2022, would require physician practices operating as part of an integrated delivery
network to meet certain requirements to ensure patient access and consumer choice; and imposing powers and duties on the
Insurance Department.

Rhode Island

¢ 2021 RI S.B. 2080 (NS), amended/substituted March 24, 2022, would require individual health insurers, large group health insurers
and small employer health insurers to provide coverage for ten (10) categories of essential health benefits listed in the act.

¢ 2021 RI S.B. 2695 (NS), introduced March 17, 2022, would allow an individual to exercise their right to consent to or refuse mental
health treatment through an advance instruction when the individual lacks sufficient understanding or capacity to make or communicate
mental health treatment decisions. A validly executed advance instruction would become effective upon its proper execution and remain
effective until revoked by the individual. This act would allow an attending physician or other mental health treatment provider to rely
upon such advance instruction, and act in accordance with the advance instruction, when an individual has been determined to be
incapable without fear of criminal prosecution, civil liability or professional disciplinary action.

¢ 2021 RI S.B. 2762 (NS), introduced March 24, 2022, would include licensed advanced practice registered nurses (APRN), certified in
psychiatric/mental health, as qualified to certify the need for mental health treatment in certain patients.

* 2021 RI S.B. 2769 (NS), introduced March 24, 2022, would establish a universal, comprehensive, affordable single-payer health

care insurance program and help control health care costs, which would be referred to as, 'the Rhode Island Comprehensive Health
Insurance Program' (RICHIP). The program would be paid for by consolidating government and private payments to multiple insurance
carriers into a more economical and efficient improved Medicare-for-all style single-payer program and substituting lower progressive
taxes for higher health insurance premiums, co-pays, deductibles and costs due to caps. This program would save Rhode Islanders
from the current overly expensive, inefficient and unsustainable multi-payer health insurance system that unnecessarily prevents
access to medically necessary health care.

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¢ 2021 RI S.B. 2948 (NS), introduced May 18, 2022, would establish a nursing service agency maximum rate of two hundred percent
(200%) of the regional average hourly wage for each position for services provided to a client, including, but not limited to, a health care
facility and assisted living residence, by a nurse or nurse aide. Additionally, this act would create employment prohibitions which would
not allow a nursing service agency to recruit and /or hire potential employees from a client to which it actively provides services under
contract. Also, this act would create annual reporting requirements for certain statistics to the department in order for the department to
enforce the provisions of this act.

¢ 2021 RI H.B. 7078 (NS), introduced January 12, 2022, would require a health plan to cover clinically appropriate and medically
necessary residential or inpatient services, including detoxification and stabilization services, for the treatment of mental health and
substance use disorders, including alcohol use disorders.

¢ 2021 RI H.B. 7446 (NS), introduced February 11, 2022, would provide for Medicaid home care, home nursing care and hospice
base rate adjustments for services delivered by professionals and paraprofessionals to meet the increasing demand for services for
medically-complex and rural patients and to meet the need to grow and sustain the workforce. This act would support the state's long-
term care rebalancing goals by keeping high-acuity or high medical necessity patients out of skilled nursing facilities and hospitals and
remain safe at home and in the community with highly trained and stable long-term services and support. This act would authorize the
executive office of health and human services (EOHHS) to develop a methodology for the compliance of United States Department of
Labor requirements for time and travel between patients' homes.

¢ 2021 RI H.B. 8119 (NS), introduced April 8, 2022, would establish a universal, comprehensive, affordable single-payer health care
insurance program and help control health care costs, which would be referred to as, 'the Rhode Island Comprehensive Health
Insurance Program' (RICHIP). The program would be paid for by consolidating government and private payments to multiple insurance
carriers into a more economical and efficient improved Medicare-for-all style single-payer program and substituting lower progressive
taxes for higher health insurance premiums, co-pays, deductibles and costs due to caps. This program would save Rhode Islanders
from the current overly expensive, inefficient and unsustainable multi-payer health insurance system that unnecessarily prevents
access to medically necessary health care.

¢ 2021 RI H.B. 8137 (NS), introduced April 13, 2022, would allow assisted living facilities ('ALFs') the ability to provide assisted living
flex care to better care for individuals whose health care needs progress over time. This act would allow ALFs to provide more intensive
medical and skilled nursing care services to residents in the assisted living setting, as their care needs change over time, rather than
requiring their transition to a skilled nursing facility when full-time skilled services are required for the resident. It would also remove

the forty-five (45) day limitation on medical or skilled care permitted for a resident of an ALF, whose condition may require longer daily
skilled care, because of that condition or illness.

¢ 2022 RI REG TEXT 604203 (NS), emergency rule effective January 10, 2022, provides COVID-19 procedures for long-term care
facilities regarding testing of residents and personnel; collecting vaccination status of personnel; and provide requirements for visitors
and essential caregivers to enter the facility.

* 2022 RI REG TEXT 627049 (NS), proposed October 20, 2022, proposing to amend existing regulations to adopt prevailing standards
for the licensure and operation of facilities and programs providing behavioral health services for adults who are not in the custody of
the Department of Children, Youth, and Families (DCYF), and/or substance use disorder services for children and adults.

South Carolina

¢ 2021 SC S.B. 150 (NS), amended/substituted April 20, 2022, would enact the 'South Carolina Compassionate Care Act'; to amend
chapter 53, title 44 of the 1976 code, relating to poisons, drugs, and other controlled substances, by adding article 20, to provide for
the sale of medical cannabis products and the conditions under which a sale can occur; to amend section 12-36-2120(69) of the 1976
code, relating to exemptions from the South Carolina sales and use tax, to provide that cannabis sold by a dispensary to a cardholder
is exempt from a certain sales tax; to repeal article 4, chapter 53, title 44 of the 1976 code, relating to controlled substances therapeutic
research; and to define necessary terms.

¢ 2021 SC H.B. 5161 (NS), introduced March 29, 2022, would amend the code of laws of South Carolina, 1976, to enact the 'South
Carolina Telehealth and Telemedicine Modernization Act' by adding article 23 to chapter 71, title 38 so as to define terms, establish
applicability, and to prohibit actions; to amend section 40-47-20, as amended, relating to definitions, so as to define telehealth and to
make conforming changes; to amend section 40-47-37, relating to the practice of telemedicine, so as to allow for the prescribing of
schedule II and schedule ill medications via telehealth in specific circumstances; and to amend section 40-33-34, as amended, relating
to the performance of medical acts, so as to make conforming changes.

South Dakota

2022 SD H.B. 1283 (NS), adopted March 9, 2022, would require the posting of laws regarding hospital, nursing facility, and assisted
living center visitation.

Texas

¢ 2023 TX H.B. 691 (NS), prefiled November 15, 2022, would relate to prevention of and safety requirements regarding sudden cardiac
arrest affecting public school students participating in interscholastic athletics.

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¢ 2021 TX REG TEXT 597114 (NS), effective February 18, 2022, would amend 28 TAC s.21.4901 and s.21.4903, concerning
disclosures by out-of-network providers, and 28 TAC s.21.5002 and s.21.5003, concerning out-of-network claim dispute resolution. The
amendments implement House Bill 3924, 87th Legislature, 2021.

¢ 2022 TX REG TEXT 604353 (NS), effective January 6, 2022, adopts on an emergency basis in Title 26 Texas Administrative

Code, Chapter 553, Licensing Standards for Assisted Living Facilities, new s.553.2004, concerning an emergency rule to track
vaccinations of staff and residents in long-term care facilities in Texas in response to COVID-19. As authorized by Texas Government
Code s.2001.034, HHSC may adopt an emergency rule without prior notice or hearing if it finds that an imminent peril to the public
health, safety, or welfare requires adoption on fewer than 30 days' notice. Emergency rules adopted under Texas Government Code
s.2001.034 may be effective for not longer than 120 days and may be renewed for not longer than 60 days.

¢ 2022 TX REG TEXT 604354 (NS), effective January 6, 2022, adopts on an emergency basis in Title 26, Texas Administrative Code,
Chapter 554, Nursing Facility Requirements for Licensure and Medicaid Certification, new s.554.2804, concerning an emergency rule
in response to COVID-19 in order to track vaccinations of staff and residents in nursing facilities in Texas and require enrollment for
the emergency communication system. As authorized by Texas Government Code, s.2001.034, HHSC may adopt an emergency rule
without prior notice or hearing if it finds that an imminent peril to the public health, safety, or welfare requires adoption on fewer than 30
days' notice. Emergency rules adopted under Texas Government Code, s.2001.034, may be effective for not longer than 120 days and
may be renewed for not longer than 60 days.

* 2022 TX REG TEXT 611706 (NS), adopted August 26, 2022, adopts amended 28 TAC s.19.1710 and new 28 TAC Chapter

19, Subchapter R, Division 2, s.s.19.1730 - 19.1733, concerning requirements prior to issuing an adverse determination and
preauthorization exemptions. These amended and new sections implement House Bill 3459, 87th Legislature, 2021. The Commissioner
adopts s.19.1710 without changes to the proposed text published in the April 8, 2022, issue of the Texas Register (47 Tex Reg 1856).
This section will not be republished. The Commissioner adopts s.s.19.1730 - 19.1733 with revisions made in response to public
comments. These sections will be republished.

¢ 2022 TX REG TEXT 611683 (NS), effective March 28, 2022, adopts on an emergency basis in Title 26, Texas Administrative
Code, Chapter 554, Nursing Facility Requirements for Licensure and Medicaid Certification, new s.554.2802. This emergency rule
is adopted in response to COVID-19 and requires nursing facilities to take certain actions to reduce the risk of spreading COVID-19.
The emergency rule also permits nursing facilities to request temporary increases in capacity and Medicaid bed allocations to aid in
preventing the transmission of COVID-19 or caring for residents with COVID-19.

¢ 2022 TX REG TEXT 611707 (NS), effective June 16, 2022, proposes new 28 TAC Chapter 21, Subchapter TT, consisting of
s.8.21.5401 - 21.5406, concerning the all-payor claims database. These sections implement House Bill 2090, 87th Legislature, 2021,
which amended the Texas Insurance Code by adding Chapter 38, Subchapter I, concerning Texas All-Payor Claims Database.

¢ 2022 TX REG TEXT 621215 (NS), effective December 6, 2022, would amendments to s.554.101, relating to Definitions; s.554.204,
relating to Application Requirements; s.554.403, relating to Notice of Rights and Services; s.554.1921, relating to General
Requirements for a Nursing Facility; s.554.1935, relating to Automated External Defibrillators; s.554.2002, relating to Procedural
Requirements-Licensure Inspections and Surveys; and s.554.2326, relating to Medicaid Swing Bed Program for Rural Hospitals. HHSC
proposes the repeal of s.554.1913, relating to Clinical Records Service Supervisor.

* 2022 TX REG TEXT 627124 (NS), proposed October 21, 2022, proposes the repeal of s.371.212, concerning Minimum Data

Set Assessments; s.371.214, concerning Resource Utilization Group Classification System; and s.371.216, concerning Waiver

of Extrapolation; and proposes new s.371.212, concerning Utilization Review of Nursing Facilities; s.371.214, concerning HHSC-
Approved Online RUG or Other HHSC-Required Training Course; s.371.216, concerning Nursing Facility Clinical Records; s.371.218,
concerning Onsite and Desk Utilization Reviews of Nursing Facilities; s.371.220, concerning Exit Conferences; s.371.222, concerning
Reconsideration of Utilization Review Results; s.371.224, concerning Appeals of Reconsideration Results; s.371.226, concerning
Calculation of Overpayments and Underpayments; s.371.228, concerning Recoveries; and s.371.230, concerning Waiver of
Extrapolation.

Vermont

¢ 2021 VT S.B. 244 (NS), introduced January 12, 2022, proposes to require health insurance plans and Medicaid to reimburse health
care providers the same amounts for care delivered in person and by audio-only telephone. It would require health insurers, the State
Employees' Health Benefit Plan, and the health plans offered to school employees to increase the percentage of total health care
spending they allocate to primary care to at least 12 percent and would require the next All-Payer Model agreement with the federal
government to include a provision requiring annual increases in primary care spending in Medicare. The bill would direct the Agency
of Human Services to increase primary care reimbursement rates in the Medicaid program to match Medicare levels and to implement
certain Medicare primary care coding changes. It would also create the position of Chief Clinical Officer for Primary Care at the Green
Mountain Care Board to coordinate efforts to evaluate, monitor, and implement solutions to strengthen primary care in Vermont.

¢ 2021 VT REG TEXT 598152 (NS), adopted March 10, 2022, amends Vermont rules governing therapeutic community residences
to require those facilities to contact any former resident, who had received treatment for serious mental illness, within 72 hours of the
resident's discharge.

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Virginia

¢ 2022 VA S.B. 40 (NS), enrolled April 27, 2022, would require that regulations of the Board of Social Services regarding involuntary
discharges of residents from assisted living facilities provide certain safeguards for residents, including a description of the reasons for
which a resident may be involuntarily discharged, certain notice requirements, a requirement that the facility make reasonable efforts
to resolve any issues upon which the discharge is based, and the provision of information regarding the resident's right to appeal the
facility's decision to discharge the resident.

* 2022 VA S.B. 60 (NS), adopted April 8, 2022, provides that all political subdivisions shall provide an annually updated emergency
management assessment and data related to emergency sheltering capabilities to the State Coordinator of Emergency Management
on or before August 1 of each year. Under current law, such assessment and data is due to the State Coordinator of Emergency
Management on or before May 1 of each year.

* 2022 VA H.B. 97 (NS), introduced January 12, 2022, would direct the Board of Health to include in regulations governing nursing
homes a provision prohibiting a nursing home from refusing to admit, transferring, or discharging a patient on the grounds that the
patient has implemented or requested to implement electronic monitoring, provided such request and electronic monitoring is in
accordance with regulations of the Board.

* 2022 VA S.B. 130 (NS), enrolled April 27, 2022, would provide for an exemption from the requirement for a certificate of public need,
for the duration of the State Health Commissioner's determination, emergency order of the State Board of Health, or Commissioner's
exercising of authority on behalf of the Board, plus a period of 30 days, for projects involving a temporary increase in the total number
of beds in an existing hospital or nursing home, which may include temporary structures or satellite locations that are operated by the
hospital or nursing home in response to a public health emergency, when the Commissioner has determined that a natural or man-
made disaster has caused the evacuation of a hospital or nursing home and that a public health emergency exists due to a shortage of
hospital or nursing home beds, or when the Board has made an emergency order or the Commissioner is exercising authority on behalf
of the Board for the purpose of suppressing nuisances dangerous to the public health and communicable, contagious, and infectious
diseases and other dangers to the public life and health.

¢ 2022 VA H.B. 234 (NS), adopted April 11, 2022, would direct the Secretary of Health and Human Resources to study the current
oversight and regulation of nursing homes, assisted living facilities, and other congregate living settings to improve efficiency and
effectiveness of regulation and oversight, provide better transparency for members of the public navigating the process of receiving
services from such facilities, and better protect the health and safety of the public and to report his findings and recommendations to
the Governor and the Chairmen of the Senate Committees on Education and Health and Finance and Appropriations and the House
Committees on Appropriations and Health, Welfare and Institutions by October 1, 2022.

* 2022 VA H.B. 277 (NS), enrolled April 27, 2022, would require every person who operates a recovery residence to disclose to
potential residents whether the recovery residence is a certified recovery residence and that no health care provider or behavioral
health service provider who receives public funds or state agency shall refer a person with substance abuse disorder to a recovery
residence unless the recovery residence has been certified by the Department of Behavioral Health and Developmental Services (the
Department) in accordance with regulations adopted by the Board of Behavioral Health and Developmental Services (the Board).

The bill also provides that credentialing agencies by which the Board may require accreditation or in which the Board may require
membership shall administer credentialing and certification programs in accordance with standards of the National Alliance for
Recovery Residences; requires the Board to adopt regulations requiring each certified recovery residence include one or more resident
or nonresident staff persons who is employed by the provider for compensation and who is responsible for oversight or management of
the recovery residence; and requires the Department to provide, for each certified recovery residence included on the list maintained on
the Department's website the level of support provided by the certified recovery residence. The bill also provides that certified recovery
residences shall constitute residential occupancy by a single family for zoning purposes, regardless of the number of persons residing
in the certified recovery residence, and exempts certified recovery residences from the provisions of the Virginia Landlord and Tenant
Act.

* 2022 VA H.B. 330 (NS), introduced January 12, 2022, would require nursing homes to meet a baseline staffing level based on
resident acuity in alignment with the Centers for Medicare and Medicaid Services staffing level recommendations. The bill requires
nursing homes to collect and submit to the Department of Health certain data related to staffing. The bill gives the Commissioner of
Health the power to impose administrative sanctions on nursing homes and directs the Board of Health to promulgate regulations
related to the criteria and procedures for imposition of administrative sanctions or initiation of court proceedings for violations of the
bill. The bill provides that nursing homes shall only be subject to administrative sanctions upon initial funding for the state share of the
cost to implement the provisions of the bill. The bill establishes the Long-Term Care Services Fund for the purpose of making grants to
assist in the provision of activities that protect or improve the quality of care or quality of life for residents, patients, and consumers of
long-term care services.

* 2022 VA S.B. 406 (NS), introduced January 12, 2022, would require nursing homes to meet a baseline staffing level based on
resident acuity in alignment with the Centers for Medicare and Medicaid Services staffing level recommendations. The bill requires
nursing homes to collect and submit to the Department of Health certain data related to staffing. The bill gives the Commissioner of
Health the power to impose administrative sanctions on nursing homes and directs the Board of Health to promulgate regulations
related to the criteria and procedures for imposition of administrative sanctions or initiation of court proceedings for violations of the

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bill. The bill provides that nursing homes shall only be subject to administrative sanctions upon initial funding for the state share of the
cost to implement the provisions of the bill. The bill establishes the Long-Term Care Services Fund for the purpose of making grants to
assist in the provision of activities that protect or improve the quality of care or quality of life for residents, patients, and consumers of
long-term care services.

¢ 2022 VA H.B. 537 (NS), adopted April 8, 2022, allows certain practitioners of professions regulated by the Boards of Medicine,
Counseling, Psychology, and Social Work who provide behavioral health services and who are licensed in another state, the District

of Columbia, or a United States territory or possession and in good standing with the applicable regulatory agency to engage in the
practice of that profession in the Commonwealth with a patient located in the Commonwealth when (i) such practice is for the purpose
of providing continuity of care through the use of telemedicine services and (ii) the practitioner has previously established a practitioner-
patient relationship with the patient. The bill provides that a practitioner who provides behavioral health services to a patient located

in the Commonwealth through use of telemedicine services may provide such services for a period of no more than one year from the
date on which the practitioner began providing such services to such patient.

* 2022 VA H.B. 634 (NS), adopted April 8, 2022, would require a guardian to visit an incapacitated person at least once every 90 days
and make certain observations and assessments during each visit. The bill provides that a guardian may utilize a person who is directly
employed and supervised by the guardian, or contract the services of a care manager who is a trained professional who specializes in
the field of life-care management, geriatrics, older adults and aging or adults with disabilities and who provides written reports to the
guardian regarding any such visits to satisfy the duties imposed upon such a guardian.

* 2022 VA H.B. 646 (NS), introduced January 12, 2022, would require the State Board of Health to establish staffing and care standards
in nursing homes to require a minimum of direct care services to each resident per 24-hour period as follows: (i) a minimum of 2.8
direct care hours provided by a nurse aide per resident, per day; (ii) a minimum of 1.3 direct care hours provided by a registered nurse
or licensed practical nurse per resident, per day; and (iii) a minimum of 0.75 hours out of total 4.1 required direct hours provided by

a registered nurse per resident, per day. The bill requires nursing homes to provide quarterly staff training on first aid, medication
administration, and compliance with nursing home policies and procedures. Additionally, the bill removes language requiring that each
hospital, nursing home, and certified nursing facility establish protocols for patient visits from a rabbi, priest, minister, or clergy of any
religious denomination or sect during a declared public health emergency related to a communicable disease of public health threat.

¢ 2022 VA H.B. 690 (NS), amended/substituted February 8, 2022, would provide that an assisted living facility shall not involuntary
discharge a patient except (i) in cases in which the resident's condition presents an immediate and serious risk to the health, safety,

or welfare of the resident or others and emergency discharge is necessary to protect the health, safety, or welfare of the resident or
others; (ii) for nonpayment of contracted charges; or (iii) for failure of the resident to substantially comply with the terms and conditions
of the lease agreement between the resident and the assisted living facility. The bill requires an assisted living facility to take steps to
prevent the involuntary discharge, requires an assisted living facility to provide at least 30 days' notice of the involuntary discharge, and
requires the assisted living facility to provide a discharge plan for the resident prior to involuntary discharge. The bill also requires the
Department of Social Services to establish a process by which a resident or the resident's representative may appeal the decision of
the assisted living facility to involuntarily discharge a resident to the Department and requires the Department to conduct a review to
determine whether the assisted living facility has complied with the requirements of the bill.

¢ 2022 VA H.B. 916 (NS), approved April 8, 2022, amends and reenacts ? 32.17127 of the Code of Virginia and to amend the Code
of Virginia by adding a section numbered 54.172404.1, relating to health care providers; health care records of minors; available via
secure website.

* 2022 VA REG TEXT 572686 (NS), proposed January 31, 2022, would add to the reporting requirements for physicians and directors
of medical care facilities for COVID-19 to (i) require physicians and directors of medical care facilities to report suspected or confirmed
COVID-19 cases and COVID-19 hospitalizations and intensive care unit admissions to the Virginia Department of Health (VDH) through
participation in the Emergency Department Care Coordination Program; (ii) require all suspected or confirmed COVID-19 case report
forms be submitted electronically to VDH; (iii) clarify that the category 'laboratory directors' includes pharmacies that hold Clinical
Laboratory Improvement Amendments Certificates of Waiver so that pharmacies testing for COVID-19 are required to report to VDH;
(iv) require laboratory directors report both positive and negative COVID-19 test results.

* 2022 VA REG TEXT 576104 (NS), proposed February 14, 2022, proposes to amend align Virginia provider licensing regulations

with the American Society of Addiction Medicine (ASAM) Levels of Care Criteria or an equivalent set of criteria to ensure the provision
of outcome-oriented and strengths-based care in the treatment of addiction to ensure individualized, clinically driven, participant-
directed, and outcome-informed treatment. Additionally, some proposed amendments align the regulation with 42 CFR Part 8 Subpart
C requirements for opioid treatment programs, including (i) staffing and programs, (ii) special services for pregnant individuals, (iii) drug
screening, and (iv) take-home medications and theft or diversion detection procedures for treatment providers.

¢ 2022 VA REG TEXT 604650 (NS), effective March 4, 2022, repeals the regulation associated with the Alzheimer's Assisted Living
Waiver, which was developed to provide care and support to help aging Virginia residents who have been diagnosed with Alzheimer's
disease or other related memory disorders and was ended effective June 30, 2017. Centers for Medicare and Medicaid Services home-
and-community based services Final Rule (79 FR 2958 through 79 FR 3039) established new reimbursement criteria with the goal of
enabling Medicaid members to receive services in settings that are integrated into the community rather than in skilled nursing facilities.

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Washington

¢ 2021 WA S.B. 5644 (NS), adopted March 30, 2022, relates to providing quality behavioral health co-response services; adding a new
section to chapter 71.24 RCW; and creating a new section.

¢ 2021 WA S.B. 5736 (NS), adopted March 17, 2022, relates to partial hospitalizations and intensive outpatient treatment services for
minors; reenacting and amending RCW 71.24.385; and creating a new section.

* 2022 WA REG TEXT 550632 (NS), effective January 27, 2022, amending sections of this chapter to implement SHB 1049 (chapter
62, Laws of 2019), codified in RCW 43.70.075, and to ensure the rules are clear, up-to-date, and align with best practices.

¢ 2022 WA REG TEXT 596805 (NS), proposed September 7, 2022, would expand the use of telemedicine for home health and hospice
supervisory visits. The proposed rule would give home health and hospice agencies the option to conduct supervisory visits either
on-site or via telemedicine. In an effort to align with recent telemedicine legislation, the proposed rule also amends the definition of
telemedicine to include supervision activities and creates new definitions for 'audio-only telemedicine' and 'established relationship.' In
addition to aligning with ESHB 1196 and 1821, the proposed rules would be consistent with the federal government's 'Patients Over
Paperwork' initiative.

¢ 2022 WA REG TEXT 604674 (NS), effective January 1, 2022, increases daily rates for assisted living facilities. SPA 22-0010 is
expected to increase the daily rate for assisted living facilities on average by two percent. The weighted average increase is expected
to be $1.70, though this amount will vary based on the comprehensive assessment reporting evaluation classification of each individual
client.

* 2022 WA REG TEXT 607486 (NS), effective February 3, 2022, extends 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 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.

* 2022 WA REG TEXT 609578 (NS), effective June 23, 2022, 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.
The intent of this suspension is to allow 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. This is a subsequent emergency rule filing
and suspends the regulatory requirement for these facilities to complete assessments for HCS clients while the HCS assessors are not
available. The centers for Medicare and Medicaid services approved this flexibility for Medicaid beneficiaries needing specific long-term
care services and supports whose assessments meet the requirements under 42 C.F.R. 441.720.

¢ 2022 WA REG TEXT 609596 (NS), effective March 11, 2022, provides coverage for COVID-19 vaccines, testing, and treatment,
including treatment of a condition that may seriously complicate 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.

West Virginia
¢ 2021 WV REG TEXT 587560 (NS), effective June 2, 2022, makes modifications to WV ADC Series 1B.

* 2022 WV REG TEXT 587583 (NS), effective May 1, 2022, creates a board and provides regulations for the licensing of osteopathic
physicians.

¢ 2022 WV REG TEXT 619036 (NS), effective July 1, 2022, relates to the general administration of the West Virginia Insurance Plan.

© Copyright Thomson/West - NETSCAN's Health Policy Tracking Service

 

[FN2]

https://newsroom.uw.edu/postscript/many-ob-gyn-residents-miss-out-trans-care-instruction

[FN3]

https:/Avww.reuters.com/article/us-health-hospitals-infections/penalties-not-lowering-hospital-acquired-infection-rates-id(USKCN1U528P

[FN4]

https:/Avww.hhs.gov/about/news/201 9/07/09/hhs-announces-quality-summit-streamline-improve-quality-programs-government.html

[FNS]
https:/Avww.hhs.gov/about/news/2019/07/09/hhs-quality-summit-fact-sheet.html

[FN6]

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https:/Avww.cms.gov/newsroom/press-releases/cms-bringing-health-plan-quality-ratings-all-exchanges-first-time

[FN7]
https://mhealthintelligence.com/news/telehealth-innovation-bill-heads-to-capital-hill-for-a-third-try

[FN8]
https:/Avww.modernhealthcare.com/safety-quality/cms-considers-value-hospitals-displaying-quality-data

[FN9]
https:/Avww.modernhealthcare.com/government/cms-delays-funding-renewal-quality-improvement-organizations

[FN10]

https:/Avww.desmoinesregister.com/story/news/health/2020/02/13/glenwood-administrator-warned-top-state-official-problems-state-run-
center-dhs-jerry-foxhoven/4750052002/

[FN11]
https:/Avww.mcknights.com/news/changes-coming-to-nursing-home-preadmission-resident-screening-regulations/
[FN12]

https://khn.org/news/cdc-coronavirus-testing-decision-likely-to-haunt-nation-for-months-to-come/

[FN13]

https:/Avww.modernhealthcare.com/safety-quality/cms-eases-quality-other-reporting-demands-amid-covid-1 9-crisis

[FN14]

https:/Avww.msn.com/en-us/news/us/after-anonymous-tip-1 7-bodies-are-found-at-nursing-home-hit-by-virus/ar-BB 12GNxV?
li=BBnb7Kz&ocid=U142DHP

[FN15]

https:/Avww.mcknights.com/news/trump-wants-masks-on-all-nursing-home-workers-temperature-checks-for-all-and-separate-covid-
units/

[FN16]
https:/Avww.cms.gov/newsroom/press-releases/cms-announces-independent-commission-address-safety-and-quality-nursing-homes

[FN17]
https:/Avww.mcknights.com/news/cms-gives-therapy-providers-the-green-light-to-provide-medicare-telehealth-services/

[FN13]
https:/Avww.mcknights.com/news/new-york-reportedly-allows-covid-19-positive-staff-to-continue-working-in-nursing-home/

[FN19]
https:/Avww.mcknights.com/news/hcr-manorcare-70-percent-of-covid-1 9-infected-employees-asymptomatic/

[FN20]

https:/Avww.mcknights.com/news/breaking-news-cms-orders-resumption-of-nursing-home-staffing-data-collection-updates-star-rating-
plans/

[FN21]
https:/Avww.mcknights.com/news/cdc-elderly-may-get-top-priority-for-eventual-coronavirus-vaccine/

[FN22]
https:/Avww.mcknights.com/news/facilities-lack-sufficient-tests-to-meet-covid-19-recommendations-senate-report-finds/

[FN23]
https:/Avww.cms.gov/research-statistics-data-systems/preliminary-medicare-covid-19-data-snapshot

[FN24]

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https:/Avww.mcknights.com/news/testing-more-ppe-lead-to-90-drop-in-nursing-home-covid-19-cases/

[FN25]
https:/Avww.cms.gov/files/document/covid-recommendations-reopening-facilities-provide-non-emergent-care. pdf

[FN26]
https:/Avww.mcknights.com/news/provider-covid-1 9-relief-funds-now-to-be-based-on-201 8-patient-revenue/

[FN27]
https:/Avww.mcknights.com/news/new-study-links-facility-staffing-levels-quality-to-number-of-covid-19-cases/

[FN28]
https:/Avww.mcknights.com/news/cms-issues-long-overdue-visitation-guidelines-for-nursing-homes/

[FN29]
https:/Avww.healthcareitnews.com/news/telehealth-becomes-new-normal-ncqa-updates-quality-measures

[FN30]
https:/Avww.cms.gov/files/document/covid-recommendations-reopening-facilities-provide-non-emergent-care. pdf

[FN31]
https:/Avww.mcknights.com/news/covid-1 9-pushes-skilled-nursing-occupancy-down-10-analysis-finds/

[FN32]
https:/Avww.mcknights.com/news/cms-will-pay-more-to-labs-that-process-covid-19-tests-quicker-starting-jan-1/

[FN33]
https:/Avww.statnews.com/pharmalot/2020/10/21/purdue-opioids-sacklers-guilty-oxycontin/

[FN34]
https:/Avww.mcknights.com/news/feds-still-optimistic-limited-supply-of-a-covid- 1 9-vaccine-will-be-ready-by-years-end/

[FN35]
https:/Avww.cms.gov/blog/201 9-quality-payment-program-qpp-performance-results

[FN36]
https:/Avww.cms.gov/newsroom/press-releases/cms-addresses-substance-use-mental-health-crisis-care-those-medicaid

Produced by Thomson Reuters Accelus Regulatory Intelligence 27-Jun-2023

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