Weekly StateVitals Update: Volume 19 (May 12, 2025)

National

• NASHP Launches Cell and Gene Therapy State Network. The National Academy of State Health Policy (NASHP) is hosting the inaugural meeting for its newly developed Cell and Gene Therapy State Network on May 15th. The network is intended only for state officials who have responsibility for implementing programming and policies pertaining to coverage and payment for cell and gene therapies (CGTs), with a focus on sickle cell CGT. The network is being launched as a result of the Center for Medicare and Medicaid Innovation’s Cell and Gene Therapy Access Model which has already been initiated. NASHP is convening the State Network to provide a platform for state officials to promote identification of challenges, solutions and sharing of lessons learned in state efforts to provide coverage for CGT. 

Alabama

• Governor Signs Bill Authorizing Farmers Federation’s Association Health Plan. Governor Kay Ivey (R) has signed into law HB 477 this past week. As enacted, the bill authorizes the Alabama Farmers Federation to sell an association health plan to its membership. authorize the Federation to sell this type of coverage but not be recognized or regulated as an insurer which enables them to skirt around meeting certain federal requirements. For instance, the health coverage product would allow them to deny coverage based on pre-existing conditions, not cover essential health benefits, and have prohibitive out-of-pocket amounts. Approximately 10 other states have passed similar legislation via their own state farm bureau organizations. Unique to Alabama, the bill would require minimum coverage, if eligible, to provide ambulatory patient services, inpatient hospitalization services, emergency services, lab services, mental health care, substance use treatment, and prescription drugs. The bill would also establish a 1.3 percent tax on premiums. The bill goes into effect June 1, 2025. 

Colorado

• 340B Senate Bill Clears the General Assembly. This past week, the House of Representatives voted to approve SB 71 without amendment. As enrolled, the bill prohibits drug manufacturers, wholesalers, third-party logistics providers or repackagers from limiting the ability of a pharmacy contracted with a 340B covered entity to acquire a 340B drug. It also prohibits a manufacturers’ ability to require a 340B covered entity or a contracted pharmacy from submitting any health information, claims or utilization data unrelated to claims. Finally, the measure required 340B hospitals to publish their annual total financial benefit from participating in the program and indicate how those savings are utilized. The bill is now set to head to the Governor’s desk. 

Florida

• Legislature Enrolls Mental Health Reform Vehicle. Following nearly two days of floor debate and consideration recently, the House opted to pass SB 1620 as the Senate amended and sent it to the Governor for consideration. The bill encompasses recommendations from Florida’s Commission on Mental Health and Substance Use Disorder, including but not limited to:

  • Requires the state to biennially review school-based behavioral health access via telehealth, with an emphasis on underserved and rural communities. 

  • Requires the state to biennially review the need for new short-term residential treatment facilities and additional beds in existing short-term residential treatment facilities. 

  • Requires the Florida Mental Health Institute to submit a report analyzing substance abuse and mental health services provided in the state through publicly funded programs, including Medicare. 

  The measure originally included funding for a Substance Abuse and Mental Health Research Center at the University of South Florida’s Florida Mental Health Institute but that funding and authorization was stripped from the bill by the House. The bill now goes to the Governor who is expected to sign it into law. 

• Medicaid Expansion Supporters Files Suit Against the State for New Constitutional Amendment Requirements. Following enactment of HB 1205, Florida Decides Healthcare has filed suit against the state arguing the state has changed the rules for how constitutional amendments may be passed by voters in the middle of their process to do so. Currently, they’re requesting a temporary restraining order to stop the law from being enforced while their ballot initiative is still pending. HB 1205 was enacted and includes numerous restrictive provisions on how ballot initiatives may be performed, such as a shorter timeline for when signed petitions must be submitted to the supervisor of elections office, who can actively solicit petition signatures, and enhanced penalties tied with existing violations of ballot initiatives. Florida Decides Healthcare claims that it would by default impose a moratorium on its petition activities, mitigating its ability to get on the 2026 general election ballot. 

Georgia

• State Submits 1115 Pathways to Coverage Demonstration Extension Application to CMS. Following a state public comment period, Georgia has now submitted their 1115 demonstration extension application to the Centers for Medicare & Medicaid Services (CMS) for consideration. As proposed in the application, Georgia wants to scale back its reporting requirements for qualifying work hours and activities required under the Medicaid expansion program from monthly to annually to reduce churn. It would also add additional qualifying activities to meet the required hours to retain eligibility, inclusive of compliance with SNAP requirements, Adults Without Dependents Program, or if the enrollee is caregiving for a child under six years of age. Further, the amendment would propose to remove premiums as an element of the Pathways program. The federal public comment period is open from May 2 through June 1.

Illinois

• Governor Signs EO Prohibiting Data Sharing of Individuals with Autism. Governor JB Pritzker (D) has signed Executive Order 2025-02 this past week which will prohibit state agencies from sharing data on Illinois residents without their informed consent. The order intends to protect individuals with Autism from having their data shared should the state receive any request from the federal government to do so as part of the U.S. Department of Health and Human Services’ efforts on studying Autism. Specifically, the order prohibits state agencies from collecting or disclosing personally identifiable autism-related data unless it is required for care, legal reasons, or program eligibility. Contractors, vendors and grantees of state dollars are also subject to the executive order. 

Michigan

• Attorney General Files Lawsuit Against PBMs. Michigan Attorney General Dana Nessel has filed a lawsuit against Express Scripts, Inc. and Prime Therapeutics, LLC, two pharmacy benefit managers (PBMs). The state contends that the two PBMs engage in anticompetitive conduct that has resulted in pharmacy deserts in the state due to suppressed reimbursement rates to independent pharmacies. Specifically, the lawsuit alleges an agreement was signed in 2019 between the two PBMs for Prime Therapeutics to adopt Express Scripts’ lower reimbursement rates in exchange for accessing Express Scripts’ buying power and pharmacy network. The result, the state claims, is that independent pharmacies received less reimbursement and at a level that failed to make up the cost of dispensing the drug to consumers. The lawsuit seeks to terminate the 2019 agreement between the two companies. 

Minnesota

• House Passes Human Services Omnibus. This past week, the Minnesota House of Representatives passed HF 2115, which is the chamber’s version of the state’s human services policy omnibus bill for the year. Passed in the House by a 121 to 13 margin, the bill would provide for the following:

  • Codify the existing school district behavioral health grant program.

  • Establishes a review process upon notice of agency denial, reduction, suspension or termination of long-term services and supports.

  • Provides an exemption for assisted living providers from adhering to direct care staff compensation requirements under the state’s Disability Waiver Rate System.

  • Adds post-traumatic stress disorder to serious and persistent mental illness for purposes of case management and community support services. 

  • Prohibits insurers from requiring cost-sharing for mobile crisis intervention or assessment services. 

  • Expands the state’s Health Care Bill of Rights to include patient access to children’s residential and nonresidential substance use disorder treatment, intensive residential treatment services or residential crisis stabilization, and withdrawal management programs. 

  While a myriad of other provisions were included in the bill, it now heads to the Senate for consideration. The Legislature is scheduled to adjourn on May 19th.  

North Carolina

• House Passes Surprise Billing Protections for Ambulance Services.  This past week, the House of Representatives passed HB 489, which establishes protections for consumers from surprise bills as a result of out-of-network ambulance services. Under the House-passed bill, insurers are required to provide coverage to transport an enrollee to a medically appropriate location for screening and stabilization in emergencies. Insurers are also required to cover services for an out-of-network provider if the enrollee did not have a choice in the ground ambulance transportation service provider due to the emergency. The bill also requires insurers to pay a minimum allowable rate to ambulance providers at either 100% of the rate set by a local government entity or, in the absence of that government set rate, the lesser of 400% of Medicare or the out-of-network ambulance service provider’s billed charges. Finally, insurers would be prohibited from charging a covered person any cost-sharing requirement for emergency transportation services that exceeds the lesser of $100 or 10 percent of the minimum allowable reimbursement rate. Currently, at least 18 states have some limited protections for surprise bills from ground ambulance services. This need arose as a result of the federal No Surprises Act, which opted not to regulate out-of-network bills received by consumers for ground ambulance services. 

New York

• Governor Hochul Signs Budget With Key Healthcare Provisions. This past week, Governor Kathy Hochul (D) signed the state’s FY26 Budget into law which included a myriad of key investments in healthcare. As noted by the Governor’s office, the budget includes $1 billion in capital and $300 million in operating funds to expand access and use of the state’s Safety Net Transformation Program, also including funding to increase Medicaid rates for hospitals, nursing homes, assisted living programs, physician services, and FQHCs. Also, similar to Colorado who recently enrolled similar legislation, 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. Additional investments specific to sites of care and other state-related programs are highlighted by the Governor’s office. 

Texas

• Texas House Committee Advances 340B Bill. The Texas House Insurance Committee voted by a 5 to 2 margin to advance a substitute for HB 3265 out of committee. As substituted, the first section of the bill prohibits a manufacturer, wholesaler and other entities from discriminating against a 340B covered entity or contract pharmacy, denying or limiting acquisition of a 340B drug, or requiring a covered entity or contract pharmacy to submit any claim or utilization data as a condition for acquisition of a 340B drug. The prohibition on claim or utilization data does not extend to a manufacturer’s authorized audit of the covered entity. Similar to other bills advanced this year and in recent years, the enforcement provision of the bill establishes a violation of the new statutory section as a false, misleading or deceptive act. 

  The second part of the bill prohibits insurers and pharmacy benefits managers (PBMs) from reimbursing a 340B covered entity or contract pharmacy at a rate lower than the rate paid to a non-covered entity for the same drug, if both sites of care are in network or imposing other terms that differs from terms of a network contract applied to non-covered entities, among other provisions. The committee approved substitute has now been sent to the Calendars Committee who will determine when it receives consideration on the House floor. 

Virginia

• Governor Vetoes Bills Pertaining to Contraception. Following passage by the General Assembly earlier this year, Governor Glenn Youngkin (R) made the recent decision to veto HB 1716 / SB 1105. The bills were an effort to protect access to contraceptives, inclusive of birth control pills and emergency contraception. In his veto statement, Gov. Youngkin argued that the right to contraception is already established and protected under law and the bills as passed create concern due to the absence of a conscience clause or provision that would allow providers to not provide contraception on religious or moral grounds. The decision to veto the measures came nearly a year ago to the same date that Gov. Youngkin vetoed nearly identical bills.