Lawmakers have introduced and advanced several high-impact measures directly targeting health plan operations and hospital compliance. Notably, new legislation would significantly tighten utilization review standards, proposing to compress the timeframe for prior authorization determinations from three business days to seventy-two hours and mandating the use of peer-reviewed clinical criteria. Concurrently, state legislators are advancing strict restrictions on medical debt collection, which would prohibit hospitals from enforcing money judgments against patients unless they comply with stringent price transparency mandates.

In the Medicaid space, proposed bills seek to broaden coverage and reduce administrative barriers. Legislation under committee review would require Medicaid managed care plans to cover FDA-approved chronic weight management drugs for eligible adults. Additionally, multiple bills aim to exempt behavioral health and substance use disorder treatments from the Medicaid Recipient Restriction Program, effectively bypassing prior authorization and coverage hurdles for these specific services.

Commercial health insurers also face a wave of new benefit mandates. Advanced measures would require large group plans to cover acupuncture services, while other bills seek to mandate coverage for doula services, pediatric hearing aids, and at-home diagnostic kits for sexually transmitted infections. If enacted, these coverage expansions would compel health plans to revise their actuarial models and update claims adjudication processes.