State News

Oklahoma passed legislation simplifying the prior authorization process, reports KFOR. This
legislation requires prior authorization procedures to be published on websites available to
patients and providers, those with chronic conditions must be notified no less than 60 days prior
to changes that will affect them, appeals must be reviewed by providers of the same or similar
specialties, and insurers must respond to urgent requests within 72 hours and nonurgent
requests within seven days. Moreover, the new law requires hospitals prove compliance with
federal price transparency regulations before pursuing collections. The new law aims to improve
health care efficiency and reduce administrative burdens on health care providers, ultimately
benefiting patient care and accessibility.

Maryland will require health insurance carriers to cover prostheses and hearing aids, reports
WYPR News. State-regulated insurance plans will have to cover prostheses (a custom device to
treat partial or total limb loss) medically necessary hearing aids for adults, effective January 1,
2025.

Iowa will require insurers to cover supplemental and diagnostic breast examinations for state-
regulated plans beginning January 1, 2025, reports the Des Moines Register. Screening
mammograms are covered under law, but supplemental and diagnostic screenings with MRI
and ultrasound, which are often requested during follow-up visits, are not covered, leading to
extra costs for patients and causes some to avoid the screenings.

Wisconsin’s hospital prices are 5th highest in the country, according to Wisconsin Public Radio.
The study found that Wisconsin employers and employees paid over three times (318%) what
Medicare pays for the same service from 2020 to 2022, above the national average of 254
percent. However, he data used in the report is volunteered by employers and insurance
providers and does not capture all outpatient visits and discharges in the state.

Health care costs in Connecticut have risen 4.8 percent annually over the past two decades,
reports the Hartford Business Journal. The Office of Health Strategy Cost Growth Benchmark
released a report, which found that the increase exceeds inflation and wage growth, putting
financial pressure on residents and businesses. The average family premium for employer-
sponsored coverage nearly tripled over the last two decades, rising from $8,781 in 2001 to
$24,746 in 2022.

A national study found that Indiana’s hospital prices are 8th highest in the country, reports WFYI
Indianapolis. The study found that Indiana employers and employees paid nearly three times
what Medicare pays for the same services from 2020 to 2022, above the national average of
254 percent. The study also found that Indiana had the fifth highest prices for medication like
chemotherapy and other infusion medications given by physicians in outpatient hospital
settings. The data used in the RAND report is volunteered by employers and insurance
providers and does not capture all outpatient visits and discharges in the state.

Health care spending in Rhode Island increased post-COVID but is now stabilizing, reports the
Rhode Island Current. A report from the Office of Health Insurance Commissioner found health
care spending in 2022 increased 1.6 percent from 2021, about half the rate of increase in the
prior year. The report highlights concerns over escalating pharmaceutical costs and emphasizes
the shift towards outpatient services: inpatient spending decreased by 5.4 percent while
outpatient costs rose by 4.4 percent.

California’s Office of Health Care Affordability (OHCA) has set a 3.5 percent cap on health care
spending growth, according to JD Supra. The cap starts in 2025 and will decrease to 3.0
percent by 2029. The cap will apply to health care entities including hospitals, facilities,
outpatient clinics, large physician groups, and labs, as well as payors and fully integrated
delivery systems. Starting in 2026, the OHCA will have authority to take enforcement action
against facilities that exceed the target, including requiring explanation in public meetings,
performance improvement plans, and/or financial penalties.

Oregonians with commercial and Medicare Advantage health insurance paid an average of 31.9
percent more in health insurance deductibles between 2015 and 2022, according to a newly
released report delving into rising health care costs, reports the Lund Report. Moreover, the
study by the Oregon Health Authority premiums for both family and single plans rose by about
20 percent during the same period. About half of Oregon households have commercial
insurance, with most (92.7%) through an employer; from 2015 to 2022, the proportion of
employer-sponsored plans defined as high-deductible plans grew from about a third to more
than a half.