State News

Connecticut and Pennsylvania have developed value-based payment models for Medicaid providers that are focused on maternity care, according to the NASHP. Connecticut uses a voluntary pay-for-performance model where providers are eligible for bonus payments if certain quality metrics are met, including receipt of a comprehensive postpartum visit, self-measured blood pressure, and low-dose aspiring for certain patients. Pennsylvania uses a bundled payment where providers receive bonus payments determined by quality metrics, such as postpartum depression screenings and follow-up, substance use disorder treatment, and well-child visits, as well as decreased cost of care. To address racial disparities in maternal mortality, providers that meet these metrics for Black patients in Medicaid can receive additional incentives.

Texas has passed a law prohibiting anti-steering and anti-tiering plans effective 2024, reported by ALM Benefits Pro. Anti-tiering provisions compel insurers to place favored providers in higher tiers even if they don’t meet cost or quality standards, and anti-steering provisions restrict insurer’s ability to direct patients to higher value care from competing providers, respectively. Under HB 711, employers will be allowed to steer workers toward higher-performing health centers and tier hospitals based on performance.

Connecticut has implemented significant changes to its Medicaid program, reports the Connecticut Mirror. During the most recent legislative session, the state: expanded Medicaid coverage eligibility to undocumented children fifteen years of age and younger; increased the income limit to qualify for HUSKY part C for the elderly, blind, and disabled to 105% of FPL; and will require the Department of Social Services to design and implement Medicaid reimbursement policies to compensate community health workers.

Colorado has passed a law limiting the use of copay accumulators, reported by the Lupus Foundation of America. Copay accumulators prevent third-party financial assistance from counting toward a patient's deductible and out-of-pocket maximum, which can increase patient costs and limit access to care. Colorado's SB23-195 ensures that financial assistance can be used toward a patient's deductible and other cost-sharing requirements.

Texas have passed laws limiting the use of copay accumulators, reported by the Lupus Foundation of America. Copay accumulators prevent third-party financial assistance from counting toward a patient's deductible and out-of-pocket maximum, which can increase patient costs and limit access to care. Texas's HB 999 ensure that financial assistance can be used toward a patient's deductible and other cost-sharing requirements.

Communities of color in Massachusetts experience nearly $6 billion in avoidable annual health care spending and lost labor productivity due to poor health and the cost of premature death, according to a new study, reports Mass Live. The study, commissioned by the Blue Cross Blue Shield of Massachusetts Foundation and the Health Equity Compact found premature deaths among residents of color cost $3 billion dollars, avoidable health care spending costs $1.5 billion, and lost labor productivity costs another $1.4 billion across a variety of industries. Without action, authors warned that inequity costs will nearly double in a single generation, reaching $11.2 billion annually in today’s dollars by 2050.

Colorado passed legislation directing the Department of Health Care Policy and Financing to track hospital price transparency compliance and refer those in violation to the attorney general, reports CBS News Colorado. The state is aiming to enforce federal price transparency requirements, which advocates argue federal regulators have failed to do. It will be considered a deceptive trade practice if hospitals do not post their prices, with an accompanying fine of $20,000 per violation.

Colorado passed legislation capping the out-of-pocket cost for a two-pack of epinephrine auto-injectors at $60, reports The Denver Post. While the law only applies to state-regulated health insurance plans, residents who do not have a state-regulated plan or Medicaid or Medicare coverage will still be able to access epinephrine auto-injectors for $60 by applying for an affordability program, beginning next year.

Washington has passed a number of bills intended to lower out-of-pocket costs for routine screenings and equipment, according to The Lund Report. Senate Bill 5729 caps the cost of insulin at $35 for a 30-day supply but without the 2-year expiration date that previous legislation had. Senate Bill 5242 eliminates cost-sharing for abortions in health plans that cover the procedure, which includes all plans that cover maternity care. House Bill 1222 requires large group health plans and plans offered to public employees to include certain hearing-related coverage, including hearing aids and assessments. Senate Bill 5396 eliminates copays for breast examinations used to screen for cancer. Finally, House Bill 1626 requires the Health Care Authority to certain colorectal cancer tests under medical assistance programs, as well as colonoscopies if there is a positive result.