Weekly StateVitals Update: Volume 17 (April 28, 2025)
Colorado
State EMTALA-model bill sails through Senate. The Colorado Senate this past week voted to approve SB 25-130 and send it over to the House for consideration. As has been amended, it provides for near verbatim protections as the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires hospital emergency departments, inclusive of labor and delivery, to render care for patients regardless of their ability to pay, regardless of documentation status, if they are pregnant or if they are in need of an abortion to protect the life of the mother. The rationale behind the bill is that following the overturn of Roe v. Wade, some hospitals are not rendering abortion care under the presumption that such is not required under the federal EMTALA law. Under a state-like EMTALA law, hospitals would be required to comply with rendering abortion care when necessary to save the life of the mother and other limited circumstances. This bill heads to the House just as the General Assembly is scheduled to adjourn on May 7.
Florida
Bill prohibiting providers from discriminating based on vaccination status clears procedural hurdle. The Senate Rules Committee voted this past week to approve SB 1270 for consideration by the full Senate. The measure includes numerous provisions related to healthcare, inclusive of healthcare occupational licensure, scope of practice, and medical marijuana oversight. Most importantly, the bill would prohibit healthcare providers and facilities from discriminating against a patient based solely on vaccination status and affirms a patient’s right to impartial access to treatment regardless of vaccination status. The bill goes a step further and reaffirms the state’s prohibition relative to governmental entities, businesses and educational institutions discriminating against individuals particularly if they have chosen not to receive a vaccination developed with mRNA technology. The bill is a priority for Governor Ron DeSantis (R) and the state’s Surgeon General, Dr. Joseph Ladapo, who testified in committee this past week encouraging passage of the bill. The bill now goes before the full Senate in the coming days.
Indiana
General Assembly adjourns with healthcare legislation crossing the finish line. In the final days of legislative session, the Indiana General Assembly sent a number of healthcare-related bills that stand to have significant impact across providers, payers and other industry stakeholders. Of the bills that were able to reach agreement in conference committee and were ultimately sent to the Governor’s desk :
SB 118: Requires 340B covered entities to annually report data to the Department of Health. That data includes aggregate acquisition costs for drugs obtained under the 340B program, aggregate payment amount for all drugs received and also paid to pharmacies, and how 340B savings are utilized, among other data categories.
HB 1666: Establishes new reporting requirements for hospitals, insurers and pharmacy benefits managers. Notably, the bill requires the Secretary of State’s office to share ownership information of healthcare entities with the Department of Health. The bill also requires the Department of Health to annually publish a report pertaining to that ownership information. Finally, the bill authorizes the Attorney General to investigate the market concentration of a health care entity involved in M&A activity.
HB 1004: Establishes a new State Directed Payment Program for hospitals and also establishes a managed care assessment fee with the intent to pull down additional federal Medicaid matching funds. The bill also establishes new reporting and transparency requirements for non-profit hospitals, requires a study to be conducted of commercial inpatient hospital prices and outpatient hospital prices, and requires a nonprofit hospital system's aggregate average inpatient and outpatient hospital prices to at least be equal to or less than the statewide average by 2029.
SB 475: Establishes a ban on non-compete agreements between a physician and hospital or their parent company.
Michigan
Senate passes prescription drug bill, inclusive of PDAB establishment. Democrats in the Senate opted to move SB 3 this past week and send it over to the House for consideration. The bill establishes a Prescription Drug Affordability Board (PDAB) and authorizes the PDAB to establish upper payment limits (UPLs) for selected drugs. Those UPLs would be applicable to both Medicaid health plans and other private insurers. Similar to other states, the bill would also establish a stakeholder advisory council. Notably, related to UPLs, the bill would provide the Board with a year and a half runway to pick which medications to focus on based on criteria defined in the bill. Those criteria do include the cost of a 30 day supply or how expansive a generic drug is compared to the brand name. The bill now heads to the House where it’s unlikely to receive as receptive an audience with Republicans in charge of the Chamber.
Mississippi
Governor vetoes certificate of need bill. Governor Tate Reeves (R) opted to veto HB 569 this past week. The bill was the subject of scrutiny throughout the legislative session and would have established a more nuanced approach to certificate of need (CON) reform. The enrolled measure had included a provision raising the threshold for a medical facility needing to file a CON application when purchasing medical equipment from $1.5 million to $3 million. The bill also would have increased the amount that healthcare stakeholders would need to seek a CON application for in building a new clinical building, from $5 million to $10 million and non-clinical building, from $10 million to $20 million. Finally, among other provisions, the bill would have had the Department of Health conduct a study on CON laws pertaining to small hospitals and their dialysis units, geriatric psychiatric units, and acute adult psychiatric units. Related to another provision in the bill, the Governor based his veto message on the idea that the Legislature was attempting to circumvent existing litigation by directly granting a CON to a single psychiatric hospital in Jackson.
Montana
Personhood constitutional amendment fails to advance. In the final days of session, HB 316 failed to advance through the Legislature. The measure would have nullified Constitutional Initiative 128 passed last year by voters and granted rights to embryos upon conception. Due to the measure calling for a constitutional amendment, the measure required 100 out of 150 votes in the Legislature to advance and get a vote on a statewide ballot. Instead the bill earned only 91 votes collectively. Given that Montana voted by an eight percent margin to enshrine a right to abortion services in their constitution in 2024, proponents knowingly faced a challenging path through the Legislature. It’s unknown if similar efforts will be taken up in future years.
New Jersey
Department of Health proposes new rules to establish integrated care licensure standards. The New Jersey Department of Health has proposed new rules which would establish a manual of standards for the licensure of outpatient and integrated care facilities. Notably, the licensure of facilities that would be required if those facilities provide outpatient physical health care services (e.g., primary, reproductive health, and pediatric), outpatient behavioral health treatment (e.g., mental health, substance use disorder, and addiction), opioid treatment program services, and any combination of these services. The intent of the proposed rule would allow any entity that renders multiple services as described to apply for only one license as opposed to a license for each type of treatment or services provided. Any interested party wishing to comment on the proposed rules has until June 20 to do so.
New Mexico
Governor signs measure authorizing state to review healthcare M&A deals. This past week, Governor Michelle Lujan Grisham (D) signed HB 586 into law. The bill would provide the state’s Health Care Authority with oversight responsibility to review proposed mergers and acquisitions of hospitals and acquisitions of provider organizations by hospitals, insurers and independent health care practices. Specifically, the bill would require the Health Care Authority to determine whether the transactional activity will either negatively impact quality of patient care or providers’ working conditions. The Health Care Authority has authorization to determine whether or not the activity may proceed or if specific conditions are required of the transacting parties. Notably, New Mexico has a higher proportion of private equity-backed ownership of hospitals and physician practices compared to other states, which has proven to be a larger driver of this action. The law goes into effect on July 1.
North Dakota
Senate passes measure to limit out of pocket costs for certain prescription drugs. This past week, the Senate adopted HB 1216 by a 29 to 18 margin, which would limit the maximum amount that an enrollee can be charged for out-of-pocket expenses related to prescription drugs that lack a generic alternative. Specifically, the measure would require an insurer to include any amount paid by an enrollee or on behalf of an enrollee when calculating an enrollee’s overall contribution to any cost-sharing requirement for a prescription drug. The bill would prohibit insurers from varying the out-of-pocket maximum or cost-sharing requirement based on the availability of a cost-sharing assistance program. As defined in the bill, a qualifying prescription drug would be a drug without a generic equivalent or with a generic equivalent, if the enrollee has obtained access to the drug through prior authorization or a step therapy protocol. The bill is now back in the House for concurrence because it can be sent to the Governor’s desk for signature.
Ohio
Department of Medicaid releases a study on savings from moving to single PBM. The Ohio Department of Medicaid released findings to the Medicaid Oversight Committee this past month indicating that the state saved $140 million over two years when it moved to a single pharmacy benefits manager (PBM) model for its Medicaid program. The SPBM model was implemented beginning in 2022 and in addition to net cost drug savings, the initial findings report suggested the state saved over $333 million in its first two years in administrative costs compared to the previous model where Medicaid managed care organizations leveraged their own contracted PBMs. Moving to a single PBM model for Medicaid has been discussed in a multitude of states in recent years, with Kentucky, Louisiana, Mississippi and West Virginia all moving to similar albeit nuanced models.
Oklahoma
Senate committee advances bill to criminalize delivery of abortion-inducing drugs. The Senate Health and Human Services Committee recommended adoption of HB 1168 this past week. The bill would make any intentional act to deliver abortion-inducing drugs within the state a felony, inclusive of mifepristone, if the purpose of that drug is to cause an unlawful abortion. Additionally, the measure would prevent abortion-inducing drugs from being shipped directly into the state through carriers. Finally, the bill does exempt pharmacists, manufacturers and distributors of drugs who lawfully manufactures, possesses, offers, sells or distributes in their usual course of business provided such action is done for a lawful medical purpose. The bill will now head to the full Senate for consideration.
Tennessee
Compromise reached on 340B bill. The House and Senate have voted to move SB 1414 along and send it to the Governor’s desk for signature. In its final form, the bill would prohibit drug manufacturers or their agents from denying, restricting, prohibiting, discriminating, or limiting in any way a 340B contract pharmacy or covered entity from acquiring drugs at the discounted rate. The bill also prohibits manufacturers from imposing additional requirements or limitations on 340B covered entities due to their 340B status, inclusive of the submission of certain claims and utilization, purchasing and payment data. Notably, the bill also grants the Attorney General authority to provide oversight and ensure 340B entities have access to program discounts. If the Governor opts to sign the bill into law, it would take effect July 1, 2025.
Texas
House committee considers bill relating to hospital costs for uncompensated care. This past week, the House Public Health Committee held a hearing on HB 2587, which would codify Governor Greg Abbott’s (R) executive order to require annual reporting each year by hospitals on the amount of uncompensated care spent on immigrants that lack documentation. During the hearing last week, the Health and Human Services Commission testified on the initial round of annual reporting from this past year. Staff from the Commission testified that the number of encounters was in the tens of thousands and the costs tied to the 500 plus hospitals in Texas were in the millions. The Commission released the first year’s full set of data this past Friday. The bill was left pending in committee but may receive consideration next week when the House Public Health Committee reconvenes.
Vermont
Legislature enrolls bill to erase medical debt. The Vermont Senate concurred on amendments from the House and sent SB 27 this week to the Governor’s desk for signature. As enrolled, the bill would authorize the Treasurer’s office to utilize $1 million in appropriated funds to erase up to $100 million in state residents’ medical debt. As seen in other state, the bill would also prohibit credit reporting agencies from including medical debt in determining credit scores for state residents. It’s been reported that the bill will likely eliminate medical debt for up to 60,000 residents and would prioritize individuals whose debts are 18 months or older and the individuals holding the debt have income at or below 400 percent of the federal poverty level of their total amount of debt is at least 5 percent of the household’s annual income.
