Breakthrough Therapies for Veteran Suicide Prevention Act; fund and council established; report. Establishes the Breakthrough Therapies for Veteran Suicide Prevention Fund (the Fund) to provide funding to support clinical research and implementation of FDA Breakthrough Therapies, defined in the bill, for the treatment of post-traumatic stress disorder, treatment-resistant depression, major depressive disorder, and traumatic brain injury. Under the bill, the Fund shall be used to (i) establish public-private partnerships to jointly fund Phase III clinical trials of FDA Breakthrough Therapies; (ii) conduct investigator-initiated clinical trials; (iii) establish a compassionate use program; (iv) create education and training opportunities for mental health professionals; (v) begin patient access pilot programs; and (vi) conduct implementation studies for best practices, cost-effectiveness, and methods to reduce treatment costs. The bill also establishes the Breakthrough Therapies for Veteran Suicide Prevention Advisory Council to advise the Department of Health on administration of grant funding or contracting to carry out the purposes of the Fund. Finally, the bill requires the Board of Pharmacy to amend its regulations to designate, reschedule, or deschedule a controlled substance in accordance with federal law after the expiration of 30 days from the publication in the Federal Register of a final or interim final order or rule.
Department of Medical Assistance Services; community health worker expansion. Directs the Department of Medical Assistance Services, in coordination with the Department of Health, Department of Social Services, Department of Behavioral Health and Developmental Services, and Department for Aging and Rehabilitative Services, to (i) evaluate opportunities for Medicaid managed care organizations to embed certified community health workers into care coordination models, (ii) evaluate the implementation of 2024 Medicare Community Health Integration services codes, (iii) develop and implement statewide workforce pathways for community health worker training, and (iv) identify opportunities to expand the use of community health workers in programs supporting high-cost Medicaid populations. The bill directs the Department of Medical Assistance Services to submit a report of its findings and recommendations to the Joint Commission on Health Care and the Chairs of the House Committee on Appropriations and Senate Committee on Finance and Appropriations no later than December 1, 2026.
Department of Behavioral Health and Developmental Services; Early Intervention Program for Infants and Toddlers with Disabilities; program extension. Directs the Department of Behavioral Health and Developmental Services to take all steps necessary to implement the federal extension option for the federal Early Intervention Program for Infants and Toddlers with Disabilities to allow children five years of age or younger to receive services through such program.
State pharmacy benefits manager; contractual provisions; report. Requires the Department of Medical Assistance Services' contract with the state pharmacy benefits manager to (i) require that that ingredient-cost reimbursement is based on the national average drug acquisition cost, or if unavailable, the wholesale acquisition cost minus a discount set by the Department, plus a professional dispensing fee, determined by the Department; (ii) require real-time or near real-time transparency in drug costs, rebates collected and paid, dispensing fees paid, administrative fees, and all other charges, fees, costs, and holdbacks, claim denials appeals, and network participation; (iii) prohibit the state pharmacy benefits manager from steering Medicaid recipients to affiliated pharmacies through differential cost-sharing, restrictive network design, or the mandatory use of a mail order pharmacy provider; (iv) require the state pharmacy benefits manager to (a) meet network adequacy standards established by the Department; (b) allow any willing pharmacy to participate in the pharmacy network; (c) verify that all contracted pharmacies are actively accepting Medicaid recipients; (d) submit annual reports containing certain information; (e) disclose to the Department pricing and maximum acquisition cost methodologies; and (f) allow invoice-based or national average drug acquisition cost-based appeals and require an adjustment of rates network-wide when an appeal is upheld; and (v) include enforcement mechanisms and monetary penalties for noncompliance. Additionally, the bill requires Department to annually calculate the savings generated by the use of the state pharmacy benefits manager and to annually increase its dispensing fee by the amount of such savings. The bill requires the Department to annually (1) publish and make available on its website its annual and total savings achieved, the annual and total amount applied to dispensing fees increases, and the updated dispensing fees and (2) report to the General Assembly on the state pharmacy benefits manager's compliance, national average drug acquisition cost compliance, pharmacy reimbursement trends, network adequacy compliance, and dispensing fee sufficiency.
Medical malpractice; limitation on recovery; certain actions. Eliminates the cap on the recovery in actions against health care providers for medical malpractice where the act or acts of malpractice occurred on or after July 1, 2026, and occurred against a patient age 10 or younger.
Department of Behavioral Health and Developmental Services; Early Childhood Mental Health Consultation Program established; pilot programs; development of modules; report. Establishes the Early Childhood Mental Health Consultation Program, to be administered by the Department of Behavioral Health and Developmental Services (the Department) in coordination with the Department of Education and the Department of Health, for the purpose of providing and expanding the accessibility of early childhood mental health consultation services, as that term is defined in the bill. The bill requires, pursuant to the Program, early childhood mental health consultation services shall be provided to families of children three through five years of age who exhibit developmental delays and behavioral health concerns and to early childhood care and education programs as enumerated in the bill. The bill requires the Department, in administering the Program, to (i) develop, or contract with community services boards to develop, and make available to early childhood care and education programs and providers developmental readiness modules, in accordance with the requirements of the bill; (ii) designate three pilot regions for initial implementation of the Program, with implementation beginning no later than January 1, 2027; and (iii) submit to the Governor and the General Assembly by November 1 of each year a report on the implementation and outcomes of the Program for each pilot region selected for initial implementation. The provisions of the bill relating to initial implementation of the Program in the pilot regions shall expire on July 1, 2029.
Health Care Decisions Act; patients incapable of making informed decisions; absence of next of kin. Authorizes, for purposes of the Health Care Decisions Act, the patient care consulting committee to make health care decisions for a patient incapable of making informed decisions when no next of kin is reasonably available.
Medical assistance services; volunteer emergency medical services agencies; supplemental payment for ground emergency medical services vehicle transportation. Directs the State Board of Health to include a provision in the state plan for medical assistance services to implement a supplemental payment program for qualified volunteer emergency medical services agencies to cover the difference between the agency's costs for ground emergency medical services vehicle transport services and the reimbursement amount received from the Department of Medical Assistance Services.
Nursing facilities; related party rent disclosures; incentive payment reduction; penalty. Requires any nursing facility enrolled as a Medicaid provider that makes rent or lease payments to publicly disclose information related to the rent or lease payments, including whether payments are made to a related party, the nature of the related party, and the related party rent expense, as defined in the bill. The bill requires the Department of Medical Assistance Services to determine whether related party rent expenses exceed a fair rental value benchmark and if so, deduct a portion of any incentive payment owed to the nursing facility. A knowingly false attestation or disclosure is punishable as a Class 3 misdemeanor.
State employee health insurance plan; coverage for prosthetic devices. Provides that the plan established by the Department of Human Resource Management for the provision of health insurance coverage for state employees shall include coverage for medically necessary prosthetic devices and their repair, fitting, replacement, and components.
