State Healthcare Legislative Trends Emerge

Key Takeaways

• State healthcare legislation trends this year show lawmakers focusing on insurance reform, Medicaid program changes, and expanding provider practice authority as legislative sessions wind down.
• Prior authorization reform laws passed in Iowa, Utah, South Dakota, Washington, and New Mexico aim to streamline utilization management processes and reduce barriers to prescription drug coverage.
• Medicaid eligibility verification requirements are tightening in states like Indiana, Wyoming, and Utah in response to federal reforms, with new policies requiring more frequent redeterminations and enhanced data checks.
• Scope of practice expansion bills for pharmacists, physician assistants, and nurse practitioners are moving forward in North Dakota, Utah, and Virginia as states position themselves to qualify for Rural Health Transformation Program funding.

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Over the past couple of weeks, several states have adjourned for the year, and in the next few weeks, more will follow. As states wrap up sessions, lawmakers have enrolled, and governors have signed a number of significant pieces of healthcare legislation, which provides an opportunity to analyze emerging healthcare trends focused on insurance, Medicaid, and scope of practice reforms.

State Insurance Reform Legislation Targets Utilization Management and Claims Processing

States continue to take up legislation on insurer practices, particularly utilization management and claims processing.

Prior Authorization and Utilization Management Reforms

Of note, Iowa recently enrolled a comprehensive reform measure, HF 2635, to establish requirements for utilization management and claim payments. Furthermore, Utah, South Dakota, and Washington have enrolled notable prior authorization reforms, and New Mexico enacted SB 20 to establish limitations on prior authorizations for prescription drugs.

Anti-Downcoding Legislation Gains Momentum

In addition, several states took action on legislation to regulate the practice of downcoding by insurers, with Virginia recently enrolling and Indiana enacting legislation.

Medicaid Eligibility Verification Reforms Follow Federal Changes

A number of states have moved legislation related to Medicaid eligibility verification and program oversight in response to federal reforms enacted in the One Big Beautiful Bill Act. Indiana Governor Mike Braun (R) recently signed SB 1, which requires biannual Medicaid eligibility redeterminations and modifies immigration status and work requirements for the Medicaid expansion program. In addition, Wyoming Governor Mark Gordon (R) signed SF 106 to increase the frequency of eligibility verification for certain public assistance programs and mandate monthly data checks across varying platforms to ensure eligibility for enrollees. Before adjourning last week, Utah’s legislature passed similar policies with HB 471 that now await a signature from Governor Spencer Cox (R).

Scope of Practice Expansions Driven by Rural Health Transformation Program

Scope of practice policy, specifically for mid-level providers, is a factor that states are evaluated on as part of the Rural Health Transformation Program (RHTP), so several states have taken the opportunity to enact legislation in order to potentially draw in more funds.

Pharmacist Practice Authority Expansions Lead the Way

North Dakota led the way during its January special session focused on RHTP and enacted SB 2402 to authorize pharmacists to independently prescribe drugs and devices under certain conditions and make therapeutic substitutions. Utah and Virginia have followed, and recently enrolled bills to expand the scope of practice for pharmacists.

Multi-Professional Scope Expansions in Utah and Virginia

Both states have also passed bills on other health professionals. Virginia HB 746 authorizes physician assistants with at least three years of full-time clinical experience to practice without a written practice agreement, and Utah SB 31 expands the scope of practice for several professions, including physical therapists, nurse anesthetists, physician assistants, and advanced practice registered nurses.

Track Health Care Policy

The ever-evolving state health policy landscape will continue to influence how health care organizations make business decisions. MultiState’s team pulls from decades of expertise to help you effectively navigate and engage. MultiState’s team understands the issues, knows the key players and organizations, and we harness that expertise to help our clients effectively navigate and engage on their policy priorities. We offer customized strategic solutions to help you develop and execute a proactive multistate agenda focused on your company’s goals. Learn more about our Health Care Policy Practice.