Weekly StateVitals Update: Volume 30 (July 28, 2025)

Alaska

Prior Authorization Reform Measure Enacted. Recently, SB 133 was enacted into law as a result of the Governor opting to take no action on the measure. SB 133 was a significant prior authorization reform effort by the Legislature, inclusive of the following elements: 

• Provide determinations on  prior authorization requests within 72 hours for a standard request and 24 hours for an expedited request. 

• Make prior authorization standards available on their website. 

• Establish a process to request a clinical peer review of a prior authorization request. 

• Require approval of prior authorization for a chronic condition to be valid for at least 12 months. 

• Require an exception process to be available from any step therapy requirements by insurers. 

• Establish transparency requirements for insurers, inclusive of an annual report that must be developed. 

Some elements of the enacted law are effective immediately with the majority of elements effective beginning January 1, 2027. 

California

Insurance Commissioner Announces New Parity Rules in Effect. California Insurance Commissioner Ricardo Lara announced this past week that new regulations implementing mental and behavioral health parity laws (SB 855 of 2020 and AB 988 of 2022) have now gone into effect. Under the new regulations, insurers are provided with detailed requirements as to how they are to provide coverage for medically necessary services to diagnose, prevent, and treat all mental health conditions, inclusive of substance use disorders, in parity with coverage for other medical conditions. The regulations also establish a consumer complaint process for claim denials or other instances of unequal service. Additionally, the new regulations highlight that health insurers are required to align with the World Professional Association of Transgender Health guidelines for the treatment of gender dysphoria. As part of the enacted laws, and under these new regulations, it cements a requirement that insurers must also use clinical practice guidelines from non-profit specialty associations. The regulations were effective as of June 26, 2025.

Delaware

Governors Signs Healthcare Measures into Law. This past week, Governor Matt Meyer (D) signed six bills into law with an emphasis on improving access and delivery of healthcare in the state. Notably, HB 205 was signed into law, which adds additional protections for healthcare providers who may be subject to lawsuits or investigations that arise from other states related to reproductive and gender affirming healthcare. SB 129 was also signed, which authorizes the state’s opioid settlement fund to accept money from individuals now, in addition to companies. The need arose after the personal claims against the Sackler family were allowed to be settled and Purdue Pharmaceuticals cleared bankruptcy proceedings. Those proceedings wrapped up in recent weeks and it’s expected for opioid settlement funds to begin adhering to regularly scheduled deposits. 

Florida

Section 1115 Demonstration Amendment to the Home Health Aide Program. Florida’s Agency for Health Care Administration announced its intent to submit  an 1115 demonstration amendment to its managed Medicaid program. Under the proposed amendment, the state is attempting to implement a program called the Family Home Health Aide Services Program. In doing so, the state is requesting an income disregard for member eligibility and is seeking to mitigate workforce shortages of trained home health aides by authorizing other qualified, licensed professionals (such as a private duty nursing service) to render similar services as home health aides. The intent is to expand access to medically necessary services for medically fragile children. The state is accepting public comments from interested parties through August 16, 2025. 

Montana

DPPH Releases Draft Section 1115 Demonstration to Implement Work Requirements. The Montana Department of Public Health and Human Services (DPHHS) has released a draft 1115 Demonstration application, known as the Health and Economic Livelihood Partnership for a state public comment period. DPHHS had released a concept proposal to the same effect to initiate a similar public comment process two weeks ago. The proposed five-year demonstration would seek to implement community engagement and cost sharing requirements for the state’s Medicaid expansion population. The draft application requires Medicaid expansion enrollees to complete 80 hours of community engagement activities each month if they are between the ages of 19 and 55, albeit with a broad exemption list from those requirements. For cost-sharing requirements, it would establish  a requirement of an annual premium that is capped at 2 percent of an enrollee’s income in the first two years and increased by 0.5% in each subsequent year to achieve a maximum of 4 percent. Interested parties have through August 20, 2025 to submit comments.

Nevada

Forty Year Old Parent Notification Law for Abortion Care of Minors is Now in Effect. This past week, a federal District Court issued a one-page order that authorizes implementation of a forty year old state law that requires minors obtaining an abortion in the state to first have their physicians notify their parents or guardians. The order follows a federal appellate judge order from earlier in the week which said the law could be implemented while the federal appeal of the constitutionality of the law proceeds. The law originally had an injunction applied to it back in 1985, arguing that it violated the Constitutional right to an abortion and it remained as such until the overturning of Roe v. Wade. Under the existing law, minors can also obtain court authorization to avoid the notification requirement. 

Tennessee

Federal Circuit Court Blocks Tennessee Abortion Trafficking Law From Implementation. Recently, a federal circuit court judge in Tennessee opted to permanently block a portion of a 2024 Tennessee state law from going into effect. The law would have made it a felony to intentionally recruit, harbor or transport a pregnant minor for an abortion without parental consent. In a June 2024 filed lawsuit, a state representative had argued that the law was unconstitutional and vague, noting that how it defines “recruit” is not specified in the law or any other applicable state code, which violates the First Amendment. The circuit court agreed noting that the state cannot criminalize disseminating information about an activity that is legal in another state.