Roundup of selected state health developments, second-quarter 2023 

August 14, 2023

Legislative activity typically peaks in the second quarter of a year, and 2023 was no exception. Paid leave continued to make news as Florida, Minnesota, Tennessee, and Texas adopted new paid family and medical leave (PFML) laws. Other states modified existing laws, including Maryland, which delayed its PFML program by one year. Paid sick and safe leave (PSSL) drew attention, with Minnesota again enacting a law that will take effect next year. Costs of prescription drugs (particularly insulin) are an ongoing concern, with Florida, Maryland, North Dakota, and Texas enacting laws that appear to apply to fully insured and self-funded health plans. A few states — including Florida and Washington — expanded the availability of telehealth services. Several states — including Colorado, Florida, Louisiana, Montana, South Carolina, Texas and Washington — addressed coverage of fertility and/or abortion services in insured plans. Other legislative highlights centered on association health plans (AHPs) and domestic partner rights and benefits.

Download the 23-page print-friendly PDF for full details. Here are some highlights of the coverage.

Minnesota’s PFML law provides up to 20 weeks of leave per benefit year. Optional insurance products will soon be available in Florida and Texas, while Tennessee added a tax credit for employers voluntarily offering PFML. In Maryland, PFML contributions will start Oct. 1, 2024, and benefits will become available Jan. 1, 2026. Colorado and Oregon finalized rules ahead of benefits starting Sept 3, 2023, and Jan. 1, 2024, respectively. Washington changed its existing program.

Minnesota’s new paid sick leave program may be a challenge for employers already subject to local paid leave laws in the state. In Massachusetts and Michigan, pending litigation may require changes to current laws. Legislation enacted in Colorado, Connecticut and Georgia amends current leave requirements.

Massachusetts revised its parent leave rules. Nevada now includes sexual assault as a reason to take job-protected leave under state law. A new Virginia law allows unpaid leave for organ donations.

Several states passed pharmacy benefit manager (PBM) laws that arguably apply to self-funded plans. These laws fan the flames of the ERISA preemption debate and the scope of the US Supreme Court’s 2020 Rutledge decision. For a further discussion of this topic, see Is ERISA preemption at risk of being preempted? (Feb. 23, 2023). The Colorado and Florida laws specifically target spread pricing — when a PBM charges a plan more than the acquisition cost. Cost-sharing caps on insulin and other historically high-cost drugs are another area of activity. Texas has particularly focused on Rx issues, passing half a dozen laws. For details on legislative trends, see State legislatures continue to focus on Rx (June 29, 2023).

Several states joined interstate compacts. One Florida law expands telehealth services, while another prohibits the use of telehealth for abortion-related services. Hawaii, Louisiana and Nebraska require a level of reimbursement parity between telehealth and in-person providers. For information on telehealth legislative trends, see What we’re seeing with state telehealth legislation in 2023 (June 1, 2023).

Colorado, Maine, Vermont and Washington mandated abortion coverage for fully insured plans, while Florida and South Carolina passed laws restricting abortion. New laws in Louisiana, Montana and Texas require fertility coverage in certain situations. Legislation enacted in Nevada and Vermont mandates gender transition coverage. Colorado and Nevada enacted laws restricting fully insured plans’ use of step therapy. An Arkansas law will apply utilization-review rules to self-funded plans.

AHP issues arose in Florida and Virginia, while Texas expanded its MEWA law. New rates went into effect July 1 for San Francisco’s Health Care Accountability Ordinance.

• Domestic partner benefits remain popular but present challenges (July 11, 2023)
• Minnesota passes paid family and medical leave law (July 10, 2023)
• 2023 state paid family and medical leave contributions and benefits (Feb. 1, 2023)
• Roundup of selected state health developments — third-quarter 2022 (Nov. 4, 2022)
• San Francisco updates contractor-lessee health plan standards, pay rates (Aug. 31, 2022)
• Roundup: State accrued paid leave mandates (April 29, 2022)
• Roundup of selected state health developments — third-quarter 2019 (Oct. 28, 2019)
• Litigation, legislation leave AHP guidance in flux (May 2, 2019)

• State legislatures continue to focus on Rx (June 29, 2023)
• What we’re seeing with state telehealth legislation in 2023 (June 1, 2023)
• Is ERISA preemption at risk of being preempted? (Feb. 23, 2023)
• Life, absence and disability benefits
• MercerRx
• Voluntary benefits