New Policy in the U.S in 2021: Newly COVID-19 and health care laws
Virus-related laws include those offering help to essential workers, boosting unemployment benefits, and requiring time off for sick employees. A resolution in Alabama formally encouraged fist-bumping over handshakes, Cbsnews reported.
While legislatures tackled some elements of the coronavirus outbreak this year, most sessions had ended before the current wave of cases, deaths, and renewed stay-at-home orders. Lawmakers of both major parties have vowed to make the pandemic response a centerpiece of their 2021 sessions, addressing issues ranging from school reopenings to governors’ emergency powers.
The virus also refocused attention on the nation’s uneven and expensive health care system. Tackling issues of coverage and costs were common themes in 2020.
Surprise medical billing protection law in Georgia takes effect on January 1
A law that stops Georgians from receiving unexpected medical bills becomes effective Friday.
The Surprise Billing Consumer Protection Act, House Bill 888, stops patients from being charged for out-of-network health care services, according to Gwinnettdailypost.
The legislation received bipartisan approval from the General Assembly in June and has been applauded by many in the medical community. It was signed into law by Gov. Brian Kemp in July.
Kemp called the legislation "a historic step forward for Georgia when it comes to health care."
Georgia is among 30 states that have enacted surprise billing legislation, according to data from the Commonwealth Fund.
|A radiology technician looks at a chest X-ray of a child suffering from flu symptoms at Upson Regional Medical Center in Thomaston, Ga. Photo: David Goldman / AP|
Surprise bills often are a result of the emergency room or urgent care visits when patients go to facilities that are covered by their insurance plans but are treated by a physician or medical professional who is not within the insurer's network.
The insurance company could opt out of paying for the services, and patients could end up being billed by the provider, oftentimes weeks later.
An average of 13% of emergency room visits in Georgia in 2017 resulted in at least one out-of-network charge, Kaiser Foundation researchers found.
The Surprise Billing Consumer Protection Act removes patients from the process and allows the medical provider to bill the insurance company directly. Insurance companies now have the option to negotiate the price through an arbitrator, a qualified third-party medical professional who will review the claim.
According to the Taxpayers Protection Alliance, blocking surprise bills also can reduce government spending on health care, especially on public-funded plans.
After examining data from a commercial insurance company, Yale University researchers estimated resolving the issue could have decreased health spending by $40 billion for the tens of millions of Americans the company covered.
Senate Bill 28 also secures pricing protection from Georgians and goes into effect Friday. It also was signed into law by Kemp in July after bipartisan support from the Georgia Legislature. It blocks certain insurers from charging excessive copayments. Copayments must serve as "an incentive rather than a barrier to access appropriate care" and "must not unfairly deny necessary health care services," according to the law.
New Law Requiring Emergency Insulin and Diabetes Prescription Supplies Taking Effect Jan. 1
New state law will take effect January 1 that will require pharmacists to dispense a 30-day emergency supply of diabetes-related drugs and devices, said Nbcconnecticut.
By 2022, the law will put a price cap on the dispensing of those supplies for diabetics with less than a one-week supply of medicine or equipment, according to the office of State Sen. Derek Slap.
The bill was first introduced in February 2020 and was passed into law in July 2020. The bill passed 142-4.
On January 1, 2021, patients will be able to inform their pharmacist if they have less than a week’s supplies of diabetes-related medication or supplies. The pharmacist can issue the drugs or supplies after checking with the state’s emergency drug monitoring program and using their professional judgment.
|Photo: NBC Connecticut|
"It's unconscionable that anyone should have to limit or go without a common and widely-available life-saving drug on an emergency basis in America in 2021, said State Sen. Slap said in a press release. “The Connecticut legislature stepped in to help resolve this crisis, and our residents will be better for it.”
According to the state public health department, nearly 10%, or about 275,000 Connecticut residents have diabetes, which is the seventh leading cause of death in the state.
The new law, Connecticut House Bill 6003, will also limit the cost for insulin to $25 for a 30-day supply to those with state-regulated health insurance and limit the cost for diabetes-related supplies, such as pumps, blood sugar meters, and syringes to $100 on January 1, 2022.
The Health Care Cost Institute reports that the annual insulin cost for diabetics has nearly doubled between 2012 to 2016 raising from $2,865 to $5,700.
A section of the bill capping out-of-pocket expenses at $100 per year takes effect on January 1, 2022.
Medicaid expansion initiative approved by voters will take effect by July 2021
Oklahoma is one of 14 states that continue to reject federal funding to expand Medicaid under the ACA. But in June 2020, voters in Oklahoma passed a Medicaid expansion ballot initiative, paving the way for Medicaid expansion to take effect in Oklahoma by July 2021. The measure passed by a slim margin, garnering 50.5 percent of the vote, Health insurance reported.
Oklahoma joins several other states — Maine, Utah, Idaho, Nebraska, and Missouri —where voters have approved Medicaid expansion ballot initiatives over the last few years after state lawmakers or governors had rejected Medicaid expansion for several prior years.
Once Oklahoma expands Medicaid, the state’s coverage gap will be eliminated (there are currently an estimated 111,000 adults stuck in the coverage gap in Oklahoma, earning too little to qualify for premium subsidies in the exchange, but also ineligible for Medicaid).
Estimates vary in terms of how many people will gain eligibility for Medicaid once expansion takes effect in Oklahoma. The Robert Wood Johnson Foundation estimates it would be at least 160,000 people. A study commissioned by the Oklahoma Health Care Authority (the agency that oversees Medicaid in the state) estimated that there would likely be more than 200,000 newly eligible residents.
The Center on Budget and Policy Priorities estimates 225,000. And the Oklahoma Hospital Association (which notes that rural hospital closures are due in part to the state’s failure to accept federal funding to expand Medicaid) estimates that 272,000 people would gain access to Medicaid in the first full year of expansion. All of those numbers were calculated before the COVID-19 pandemic, though, so it’s likely that the actual number of newly eligible people would be considerably higher if widespread unemployment is still a factor in the summer of 2021, when Medicaid expansion takes effect in Oklahoma.
|Amber England- who headed the campaign to put Medicaid expansion on the ballot in Oklahoma Photo: AP|
The process of getting a Medicaid expansion measure on the ballot and approved by voters took a substantial amount of work. Medicaid expansion supporters in Oklahoma gathered signatures in 2019 for Question 802, which calls for Medicaid expansion under the terms outlined in the ACA (i.e., to anyone earning up to 133 percent of the poverty level, plus the built-in 5 percent income disregard).
They needed 177,958 valid signatures by October 28, 2019, and reportedly submitted 313,000 — the most signatures that had ever been collected for a ballot initiative in the state. The Secretary of State’s office determined that 299,731 signatures were valid, and sent them to the Oklahoma Supreme Court to have the measure officially certified for the state’s 2020 ballot. In January 2020, Oklahoma’s secretary of state confirmed that the measure would appear on the ballot in 2020 (updates on the status of the initiative are available here, under Question 802).
However, it was up to Gov. Kevin Stitt — a Republican who opposes Medicaid expansion and has expressed opposition to the ballot initiative — to determine whether the Medicaid expansion question should be on the primary ballot in June, or on the general election ballot in November. Stitt ultimately determined that the measure would appear on the June 30, 2020, primary ballot. It’s rare for a governor to opt to put a ballot initiative on the primary ballot, although former Gov. Mary Fallin did so with a medical marijuana initiative in 2018.
Stitt had previously said that he would not sign legislation calling for unaltered Medicaid expansion as outlined in the ACA, and he does not support the ballot initiative as it also calls for the ACA’s expansion of Medicaid, without any modifications. But the Stitt administration had also proposed an alternative approach to Medicaid expansion — dubbed SoonerCare 2.0 — that would eventually include premiums, a work requirement, and a per-capita spending cap. And as described below, Oklahoma is also awaiting CMS approval for a proposed Medicaid work requirement for the state’s existing Medicaid population, although Medicaid work requirements nationwide are facing a dubious legal future.
New healthcare law in Minnesota
The new law modifies statutes on health care services utilization and prior authorization requirements to modify timelines for determinations and appeals, provide for continuity of care and improve public access to information.
Sponsored by Rep. Kelly Morrison (DFL-Deephaven) and Sen. Julie Rosen (R-Vernon Center), the law is – except where otherwise noted – effective Jan. 1, 2021, and applies to health plans offered, sold, issued or renewed on or after that date, said Crookstontimes.
Under the law, if a person switches health plan companies, their new provider will be required to comply with previous prior authorizations for health care services for the first 60 days after enrollment while a new utilization review is conducted.
The enrollee, or medical professional acting on their behalf, will be required to submit documentation to access this.
If a utilization review organization changes its coverage terms or clinical criteria during a plan year, those changes will not apply until the next year for any enrollee who received prior authorization for a health care service that would be affected, with some exceptions.
The law will also require utilization review organizations to submit their current requirements and restrictions for prior authorization determinations to the health plan companies for which they conduct reviews.
The health plan companies, in turn, will be required to post this information on their public websites in easy-to-understand language. Any changes to the prior authorization requirements will also need to be posted online.
In addition, health plan companies will be required to post certain data on their public websites, including the number of prior authorization requests for which an authorization was issued and the reasons for prior authorization denial. This will need to be available online by April 1, 2022, and updated by each following April 1.
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