Healthcare (Insurance)

The bill adds to the list of impermissible collection actions that a medical creditor is prohibited from using when collecting on a medical debt. Current law requires a medical creditor to comply with certain conditions and notify a patient with medical debt 30 days before taking any permissible extraordinary collection actions. In addition to providing notice before taking any permissible extraordinary collection actions, the bill requires a medical creditor to notify a patient 30 days before collecting, transferring, selling, or assigning a medical debt, and to verify the patient has been screened for public health insurance programs and discounted care. The bill requires a medical creditor to offer a reasonable payment plan to each patient with medical debt. If the medical creditor violates the requirements for selling, transferring, or assigning medical debt, or undertaking collection activities, the patient is entitled to damages in the amount of $3,000 or actual damages, whichever is greater.(Note: This summary applies to this bill as introduced.)

The bill creates an income tax credit for a resident individual's contributions to a health savings account that supports a high deductible health plan, as defined pursuant to federal law (credit). The credit is an amount equal to 25% of the amount of the contribution, limited to:$500 for a single filer;$1,000 for joint filers; and$1,500 for contributions to a family health plan.The credit is available beginning January 1, 2027, through December 31, 2032.If the credit exceeds the income taxes due on the resident individual's income, the amount of the credit not used to offset income taxes is not carried forward as tax credits against the resident individual's subsequent years' income tax liability and is not refunded to the individual.(Note: This summary applies to this bill as introduced.)

The act adds kidney function screening services as mandated preventive health-care services for which insurance policies or contracts in the state must provide total-cost coverage. Coverage for kidney function screening services will be implemented for all large employer health benefit policies or contracts issued or renewed in this state on or after January 1, 2027, and coverage will be implemented for all individual and small group health benefit plans issued or renewed in this state on or after January 1, 2028, as long as the state is not required to defray the cost of the coverage of the kidney function screening services.     The act permits the exclusion of the 'State Employees Group Benefits Act' from this mandate and exempts certain high deductible plans from having to provide total-cost coverage for such services.(Note: This summary applies to this bill as enacted.)

The act requires a health insurance carrier that provides prescription drug benefits to require that:The utilization review requirements, including prior authorization and step therapy, for a non-opioid drug prescribed and approved by the federal food and drug administration (FDA) for the treatment or management of chronic or acute pain (non-opioid pain management drug) are no more restrictive than the least restrictive utilization review requirements for opioid drugs prescribed for the treatment or management of chronic or acute pain; andThe cost-sharing, copayment, or deductible for a non-opioid pain management drug is not greater than the cost-sharing, copayment, or deductible for an opioid drug prescribed for the treatment or management of chronic or acute pain.     The act requires each individual and small group health benefit plan issued or renewed on or after January 1, 2027, and each large employer health benefit plan issued or renewed on and after January 1, 2028, to ensure there is at least one non-opioid pain management drug available as a clinically appropriate alternative for an opioid pain management drug. If the division of insurance determines that coverage for a non-opioid pain management drug offered by individual and small group health benefit plans requires state defrayal of the cost of coverage, the requirement to make a non-opioid pain management drug available is inoperative.     The state employee health benefit plan is excluded from the requirements of the act.     The act appropriates $15,415 to the department of regulatory agencies for use by the division of insurance to implement the act.(Note: This summary applies to this bill as enacted.)

If a mental health provider, substance use disorder provider, or psychiatric nurse (provider) has not submitted a claim for a period of at least 12 months, the act requires a commercial insurance carrier (carrier) to contact the provider to confirm the provider's participation in the carrier's provider network and to determine whether the provider is accepting new patients.     The act includes mental health providers, substance use disorder providers, and psychiatric nurses as providers who may participate in a carrier's provider network.     The act requires carriers to admit prelicensed providers into the carrier's network and to reimburse prelicensed providers for services rendered when provided under the supervision of a mental health provider, substance use disorder provider, or psychiatric nurse.     The act requires a clinical social worker to complete 3,000 hours of practice prior to licensure.(Note: This summary applies to this bill as enacted.)

The act makes changes to the dispute resolution process between health insurance carriers (carriers) and out-of-network health-care providers (providers) by requiring a carrier to provide, with each payment made to a provider, a remittance advice that: Identifies when the associated health benefit plan is regulated by the state and when the payment is made pursuant to services received from an out-of-network provider or at an out-of-network facility; andProvides the carrier's median in-network reimbursement rate for out-of-network claims.(Note: This summary applies to this bill as enacted.)