Issues & Research » Health » 2011-2013 Health Insurance Reform Enacted State Laws Related to the PPACA

Go 19948

2011 - 2013 Health Insurance Reform Enacted State Laws Related to the Affordable Care Act

Federal Health Law and the Supreme Court

On June 28, 2012, the Supreme Court issued an opinion upholding the Patient Protection and Affordable Care Act, with limitations on penalties for states that choose not to expand their Medicaid programs. The decision did not affect other provisions. The information on this web page continues to reflect state actions addressing the PPACA.

For NCSL’s updated summary and analysis of the Court’s decision and its effects see: U.S. Supreme Court and Federal Health Law

States Implement Heallth Reform NCSL banner Updated May, 2013

The 2010 federal Affordable Care Act establishes a series of “early market reforms” - uniform, 50-state requirements and additional options that build on existing state regulation of health insurance policies. The law requires implementation timetables that began in July 2010, expanded to a dozen provisions in late September 2010 and added more in January and July 2011. The result is that states are expected to review and adjust their existing programs in a short time period.

The issues involving states include standard-price insurance coverage for individuals with pre-existing conditions, family coverage that includes dependent members up to age 26, expanded review of premium rates, required ratios of insurer expenditures on health services, consumer assistance or ombudsman offices, reduced employer shares for retirees between ages 55-64, and patients’ rights to appeal denied coverage.

A dozen features have already taken effect under the ACA, along with permissible exceptions and optional federal grants to states. Provisions include preventive screenings and services with no co-payments; more uniform mandated or required "essential benefits," no lifetime or annual limits on standard policies and options for multi-state or out-of-state health insurance purchasing.

While many states have enacted laws related to market reforms, this does not mean that the state has regulatory or enforcement power to oversee the numerous specific insurance provisions in the ACA. In fact, a report released February 2013 by the Commonwealth Fund, concludes, “that-without new legislation-some states face limitations in fully enforcing these reforms.

For pre-existing condition exclusions, 27 states are running the federally created “PCIP” insurance plans within their state while 23 states and D.C. allow HHS to administer it. The 2014 requirement affecting all policies has not been addressed as a separate requirement in most state laws – 6 states did enact fully complying language
For essential health benefits, 19 states and D.C. selected a “benchmark plan” that is consistent with an existing state-regulated “small group plan”, 4 state selected a benchmark plan consistent with an existing state non-medicaid HMO plan, and 3 states picked a state employee health plan as their benchmark plan; the other 24 states were assigned the “largest small group plan” benefit mandates list. These packages are currently regulated by insurance departments in virtually all states. However, states may need more explicit legal authority to have that enforcement power apply to all new federally-required insurance.

The ACA establishes numerous requirements and standards, as noted above but generally it does not directly preempt existing state laws and regulations. For example, existing state mandates remain a valid and enforceable part of state insurance regulation, unless the state chooses to alter, repeal or expand them. This report tallies state laws that “relate” to the ACA but includes measures not intended to simply conform to or enforce the federal law. Some measures may relate to the ACA but establish a different or even contradictory policy.

The following are separate NCSL reports on closely-related policy areas affecting health insurance policy:

"State Actions to Implement the American Health Benefit Exchange" - Exchanges are a central element of insurance reform, but that legislation is identified and listed separately. NCSL database users can obtain a single list that combines both groups of bills.

"Challenging and Alternatives" legislation, opposing health reform, also affects health insurance policy. This approach is described in a separate NCSL online report, but is not included in this report on laws.

NCSL Session at 2011 Legislative Summit, August 11:

Here and Now: States Respond to Health Insurance Reform. Featuring presentations by Gary Cohen, (Director, CCIIO/CMS); Commissioner Sandy Praeger, (Kansas Insurance Department, Kansas; Chair NAIC Insurance Comm.); Kim Holland, Blue Cross Blue Shield Association.

Latest Reports and Guidance, 2013:

The Office of Personnel Management (OPM) published a final rule on the Multi-State Plan Program (MSPP), establishing standards for the MSPP and OPM’s approach to MSPP implementation. - March 1, 2013

The Requirement to Buy Coverage Under the Affordable Care Act Beginning in 2014 - Kaiser Family Foundation, January 30, 2013

Health Affairs posted the latest in a series of summaries and interpretation of HHS/CCIIO regulation about the implementation of the Affordable Care Act on:

Guidance regarding federally facilitated and partnership exchanges, http://healthaffairs.org/blog/2013/03/05/implementing-health-reform-federally-facilitated-and-partnership-exchanges -March 2013
The benefits and payment parameters final rule, http://healthaffairs.org/blog/2013/03/03/implementing-health-reform-the-benefit-and-payment-parameters-final-rule/, March 2013
The multi-state plan program final rule, http://healthaffairs.org/blog/2013/03/02/implementing-health-reform-the-multi-state-plan-program-final-rule/
Regulations governing the Small Business Health Options Program (SHOP) and Multiple Employer Welfare Arrangements (MEWAs). http://healthaffairs.org/blog/2013/03/01/implementing-health-reform-a-burst-of-regulatory-activity/ - March 2013

Implementing the Affordable Care Act: State Action on the 2014 Market Reforms - Commonwealth Fund, February 1, 2013

CMS Fact Sheet: Individual Shared Responsibility For Health Insurance Coverage and Minimum Essential Coverage Proposed Rules - Centers For Medicare and Medicaid Services, January 30, 2013

Implementing the ACA: State Action on Early Maket Reforms - Issue brief by the Commonwealth Fund, March 2012 [added 6/11/2012]
- Interactive map of state actions - 3/2012

2011-2013 Legislative Actions

At least 44 states have enacted and signed more than 175 laws specific to ACA health insurance implementation. They cover a wide variety of issues in at least 19 categories.

During the 2011 legislative sessions more than 300 bills and resolutions were filed in 47 different states.
During the 2012 legislative sessions more than 330 bills and resolutions were filed in 42 different states.
So far, during the 2013 legislative sessions at least 179 bills and resolutions have been filed in 41 different states.

For details see the summaries of laws in Table 2 below. Note that state legislation often varies and may not have the same intent or effect from state to state.

NCSL has a comprehensive 2011-2012 Health Reform State Legislative Tracking Database. This online feature includes latest listings with individual bill summaries and status.

► Select "Health Insurance Reform" for an updated state-by-state listing on this topic.

Table 1 - Summary of 2011 - 2012 and 2013 Laws

Policy Addressed in 2011 - 2012 and 2013 State Law	States: 2011 - 2012	# of States	States: 2013	# of States
Adult dependents - requiring family policies to allow coverage for adult dependents up to age 26 [NCSL Fact Sheet]	Delaware, Kentucky, Minnesota, South Dakota, Virginia	5
Any willing provider - certain providers or facilities must be able to participate in health insurance benefit delivery	North Dakota, Oregon	2
Child-only health policies to be offered by health insurers serving the individual market	Arkansas, Colorado, Georgia, Washington	4
Confidentiality protection for providers	Tennessee	1
Consumer protections/ coverage for pre-existing conditions, and others [NCSL Report]	Hawaii, Indiana, Maryland, Oklahoma	4	Virginia	1
Essential Health Benefits	California, Maryland, Oregon, Utah, Vermont, Washington	6	California, Montana, New York, South Dakota, Virginia	5
External review or independent appeal of coverage denials for consumers [NCSL Report]	Delaware , Hawaii, Iowa, Nevada, North Dakota, Ohio, Oregon, Virginia, Washington	9
General insurance reforms, requiring coordination with ACA - Broad implementation of ACA insurance provisions, 2011-2013	California, Connecticut, Indiana, Illinois, Maine, Maryland, Michigan, Minnesota, New Hampshire, New York, North Carolina, North Dakota, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington	19	Arkansas, California, Colorado, Georgia, Nebraska, New Mexico, Virginia	7
Health/Wellness Program coverage within health policies	Tennessee	1
High Risk Pools: the federal "Pre-existing Condition Insurance Program" [NCSL Report]	Illinois , Kansas, Nebraska, Oklahoma, Oregon, South Dakota, Washington	7	Arkansas, Minnesota, Utah, Wyoming	4
HSA’s/high deductible health policies integrated with ACA	Michigan, Wisconsin	2	Illinois	1
Mandates defining or requiring health insurance coverage or services [examples; additional mandate laws in Table 3]	Arkansas, California, Colorado, Louisiana, Montana, Rhode Island, Utah, West Virginia	8
Additional mandate laws, not referencing ACA. A Full list of mandate laws is in Table 3 below.	Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Georgia, Indiana, Illinois, Louisiana, Maryland, Michigan, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oregon, Rhode Island, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia	28
Medical Loss Ratios (MLR) defining minimum expenditures on health services [NCSL Report]	Connecticut, Georgia, Idaho, Maine, Maryland, Michigan, Nebraska	7
Premium Rate Review, coordinating state and federal requirements [NCSL Report]	Maine, New Mexico, North Carolina, North Dakota, South Dakota, Tennessee, Vermont, Washington	8	Montana	1
Single payer universal coverage as an alternative to ACA provisions	Illinois, Vermont	2
Small employer health coverage	Arizona, Delaware, Missouri, Vermont	4
State employee health plans coordinated with ACA	Connecticut, Georgia, Idaho, Massachusetts, Nevada, Wisconsin, Utah	7
Out-of-State policies available for in-state sale [NCSL Report]	Georgia, Kentucky, Maine	3
Other	Arizona , Delaware, Hawaii, Illinois, Maine, Massachusetts, Mississippi, New Jersey, Oklahoma, Rhode Island, Virginia, Washington	12	Colorado, Georgia, Kansas, Massachusetts, Oklahoma	5

For a detailed academic analysis of 2010-2011 state actions see "State Action on Early Market Reforms" described below

Table 2 - 2013 Enacted Laws by State

State	Law / Date / Summary / Links	Topic
Arkansas (AR)	S 1107; Enacted & signed into law as Act No. 713, 4/4/2013 Amends the comprehensive health insurance pool act to provide for the orderly cessation of operations	High Risk Pools
	H 1143; Enacted as Chapter No. 1498, 4/23/2013 Creates the Health Care Independence Act of 2013; provides that the State through the Department of Human Services shall utilize a private insurance option for "low-risk" adults; ensures that private health care options increase and government-operated programs such as Medicaid decrease; relates to the State covering low-income Arkansans through offering new coverage opportunities, stimulating market competition, and offering alternatives to the existing Medicaid program.	General Insurance Reform
	S 1020; Enacted as Chapter No. 1497, 4/23/2013 Creates the Health Care Independence Act of 2013; ensures that private health care options increase and government-oriented programs such as Medicaid decrease, and decisions about the design, operation and implementation of this option, including cost, remain within the purview of the State and not with Washington, D.C.	General Insurance Reform
California (CA)	A 2a; Enacted & signed into law as Chapter No. 1, 5/9/2013 Requires a health plan or insurer to offer, market, and sell all of the plan's or insurer's health benefit plans that are sold in the individual market to all individuals and dependents in each service area in which the plan or insurer provides or arranges for the provision of health care services. Prohibits these plans from imposing any pre-existing condition upon any individual.	Essential Health Benefits, General Insurance Reform
California (CA)	S 2a; Enacted & signed into law as Chapter No. 2, 5/9/2013 Requires a plan or insurer to offer, market, and sell all of the plan's or insurer's health benefit plans that are sold in the individual market for policy years on or after a specified date, to all individuals and dependents in each service area in which the plan or insurer provides or arranges for the provision of health care services. Modifies small employer enrollment periods and coverage effective dates. Modifies guarantee issue requirements.	Essential Health Benefits, General Insurance Reform
Colorado (CO)	H 1015; Enacted as Chapter No. 38, 3/15/2013 Amends current state law that prohibits small group health plans from disclosing mental health history, diagnosis, or treatment services information received in an initial application for coverage, or in subsequent claims for benefits, without the written consent of the insured person, repeals this prohibition, enables small group carriers to report mental health claims to the all-payer claims database as a cost and quality program, while protecting the privacy of all patients in accordable with federal law.	Other
Colorado (CO)	H 1266; Enacted & signed by Governor, 5/13/2013 Aligns the "Colorado Health Care Coverage Act" (Colorado law) with the federal "Patient Protection and Affordable Care Act of 2010" and the federal "Health Care and Education Reconciliation Act of 2010" (federal law) to give the insurance commissioner the necessary authority to regulate health insurers with respect to new requirements of the federal law.	General Insurance Reform
Georgia (GA)	H 389; Enacted & chaptered as Act No. 278, 5/7/2013 Sunsets requirements to provide conversion and enhanced conversion rights and coverage, adds new provisions allowing for the discontinuance of conversion and enhanced conversion coverage, sunsets certain provisions related to the assignment system, adds new provisions allowing for the discontinuance of assignment system benefit plans, provides for related matters, repeals conflicting laws.	General Insurance Reform
Georgia (GA)	S 236; Enacted & chaptered as Act No. 338, 5/7/2013 Requires insurers issuing accident and sickness policies in this state to indicate on their premium statement to consumers the amount of the premium increase, if any, attributable to the Patient Protection and Affordable Care Act.	Other
Illinois (IL)	S 3233; Enacted & signed into law as Public Act No. 1148, 1/24/2013 Amends the Health Maintenance Organization Act; changing specified definitions related to evidence of coverage; provisions of the act regarding deductibles and copayments of enrollees would apply to enrollees and does not limit health care plan payment for services provided by non-participating providers; also redefines the out-of-pocket expenses of a high deductible health plan under a health savings account (HSA).	General Insurance Reform, HSA
Kansas (KS)	H 2107; Enacted & signed by Governor, 4/16/2013 Concerns insurance, enacts the Electronic Notice and Document Act, allows the use of electronic notices and documents in lieu of any other provision of law for the sending of insurance notices and documents, relates to adverse underwriting decisions by an insurance company or health maintenance organization, allows return of premiums separate from notice.	Other
Massachusetts (MA)	H 57; Enacted & signed by Governor as Chapter 3 of the Acts of 2013, 2/15/2013 Establishes the commonwealth Healthcare Payment Reform Fund. The health policy commission shall be the trustee of the fund and may expend from the fund, without further appropriation, to carry out the purposes of chapter 224 of the acts of 2012.	Other
Minnesota (MN)	H 5; Enacted, signed by Governor and filed with the Secretary of State as Chapter No. 2013-9, 3/20/2013 Provides the commissioner of commerce, in consultation with the board of directors of the Minnesota Comprehensive Health Association, the authority to develop and implement the phase-out and eventual appropriate termination of coverage provided by the Minnesota Comprehensive Health Association under Minnesota Statutes, chapter 62E. The phase-out of coverage shall begin no sooner than January 1, 2014, or upon the effective date of the operation of the Minnesota Insurance Marketplace and the ability to purchase qualified health plans.	High Risk Pools
Montana (MT)	H 87; Enacted as Chapter No. 334, 4/30/2013 Provides the state insurance commissioner with health insurance rate review authority.	Rate Review
Montana (MT)	H 22; Enacted as Chapter No. 169, 4/9/2013 Revises state auditor laws on insurance and amends provisions regarding insurance including the type of plans small employer carriers are required to offer to small employers.	Essential Health Benefits
Nebraska (NE)	L 336; Enacted & signed by Governor, 3/7/2013 Changes sickness and accident insurance provisions for policies subject to the federal Patient Protection and Affordable Care Act, provides not such policy subject to the Act shall be delivered or issued, nor shall an endorsement, rider, certificate, or application be used until a copy of the form and of the premium rates and of the classification of risks pertaining thereto has been filed with and approved by the Director of Insurance.	General Insurance Reform
New Mexico (NM)	H 2; Enacted as Chapter No. 227 Makes general appropriations and authorizing expenditures by state agencies required by law.	General Insurance Reform
New York (NY)	S 2606; Enacted & signed by Governor as Chapter No. 56, 3/28/2013 Amends various laws to provide for the enactment of the State Budget. Will address the health benefit exchange; navigators, insurers/providers and essential health benefits.	Essential Health Benefits
Oklahoma (OK)	SJR 8; Enacted & signed by Governor, 4/16/2013 Non-binding resolution, memorializes the President, vice-president and Congress to "work to eliminate or reform the Affordable Care Act's health insurance tax (2% tax on insurers) and other Affordable Care Act taxes."	Other
South Dakota (SD)	S 139; Enacted & signed by Governor, 3/8/2013 Regulates certain market activity in a health exchange. Any qualified health plan sold in South Dakota through a health care exchange, as mandated by the Patient Protection and Affordable Care Act of 2010, shall provide for placement through a licensed insurance producer upon enrollment. Any commission paid by a health insurance carrier for the sale of a health insurance plan through a health exchange shall be the same as commission paid by the same health insurance carrier outside the exchange for a similar plan.	Essential Health Benefits
Utah (UT)	H 47; Enacted & signed by Governor, 4/1/2013 Modifies the Insurance Code to include provisions regarding health benefit plan offerings, COBRA benefits and employer group coverage; addresses powers of the board related to the Utah Comprehensive Health Insurance Pool Act; amends lifetime maximum for covered benefits from the Comprehensive Health Insurance Pool.	High Risk Pools
Virginia (VA)	H 1900; Enacted, became law without Governor's signature, 4/3/2013 Revises state law pertaining to the regulation of health insurance and related products in order to be consistent with relevant requirements of the federal PPACA, effective January 1, 2014; including addressing premium rate restrictions on health benefit plans providing individual and small group health insurance coverage, prohibiting discrimination based on health status. Prohibits insurers from establishing any annual or lifetime limit on the dollar amount of essential health benefits (EHB), but would not prohibit annual or lifetime limits on benefits not defined as essential health benefits.	Consumer Protections, Essential Health Benefits
	H 2138; Enacted as Chapter 709, 3/23/2013 Recommends what health benefits should be required to be included within the scope of the essential health benefits.	Essential Health Benefits
	S 922; Enacted & signed into law as Chapter No. 679, 3/21/2013 Authorizes the State Corporation Commission, with assistance from the Virginia Department of Health, to perform plan management functions required to certify health benefit plans for participation in a federally facilitated health benefit exchange in Virginia.	General Insurance Reform
Wyoming (WY)	S 84; Enacted & signed by Governor as Chapter No. 113, 3/1/2013 Freezes premiums for the Wyoming health insurance pool; provides that for the period July 1, 2013 through June 30, 2015, premium rates shall be the rates in effect on January 1, 2013, except the board may adjust those rates to reflect increases in the cost of claims and expenses.	High Risk Pools

2011 State Laws Implementing Health Insurance Market Reforms - MAP

Table 3 - 2011 and 2012 Enacted Laws by State

State	Law / Date / Summary / Links	Topic
Arkansas (AR)	H 1315; Enacted & signed into law as Act No. 196, 03/04/2011 Provides health insurance coverage for autism spectrum disorders. Specifies that on and after January 1, 2014, if these provisions require benefits that exceed the essential health benefits specified under the Affordable Care Act, the specific benefits that exceed the specified essential health benefits would not be required of a health benefit plan when the plan is offered by a health care insurer in the state through the state medical exchange, the provisions would continue to apply to plans offered outside the state medical exchange.	Mandate: Autism
Arkansas (AR)	H 1428; Enacted and signed into law as Act No. 269, 03/14/2011 2011 signed law, requires child-only individual market health insurance policies to be an option offered by all state regulated insurance companies, on a guaranteed-issue basis without any limitations or exclusions based upon the applicant's health status. Effective March 2011 through December 31, 2013.	Child-only
Arizona (AZ)	S 1619; Enacted & signed into law as Chapter No. 31, 04/06/2011 Requires by December 31, 2012 the Arizona Health Care Cost Containment System administration (AHCCCS, the Medicaid agency) to transfer to the counties such portion, if any, as may be necessary to comply with section 10201(c)(6) of the Affordable Care act (P.L. 111-148), regarding the counties' proportional share of the state's contribution. Relates to 2011-2012 state budget reconciliation, to the duties and responsibilities of the (AHCCCS) administration, to the Children’s Rehabilitative Services Program, to Provider Rates and Hospital Reimbursement, to Cost Sharing, Covered Services and Eligibility, Prescription Drug Rebates, disproportionate Share Hospital Payments.	Medicaid only- General Insurance Reform
	H 2016; Enacted & signed into law as Chapter No. 83, 4/13/2011 Provides that the state administration shall offer a health benefit plan on a guaranteed issuance basis to small employers as required, with all small employers qualified for this guaranteed offer of coverage. The program "shall consider age, sex, health status-related condition, group size, geographic area and community rating when it establishes premiums for the healthcare group program."	Small employer
	H 2534; Enacted & signed into law as Chapter No. 122; 3/29/2012 Pertains to funding for particular programs using an 1115 Medicaid waiver; would require cost sharing from eligible individuals. Also would require the state health care cost containment system administration to request the Center for Medicare and Medicaid Services (CMS) to approve federal matching Medicaid funding for designated rural hospitals. Also authorizes that the state "shall administer a healthcare group program" to allow willing contractors to deliver health care services to for small employers and public employers.	Other
California (CA)	A 36; Enacted and Chaptered by Secretary of State as Chapter No. 17, 4/7/2011 Provides additional conformity with federal income tax laws by adopting specified provisions of the Affordable Care Act of 2010 relating to gross income exclusions for reimbursements for medical care expenses under specified plans for dependents.	General Insurance Reform
	A 210; Enacted and Chaptered by Secretary of State as Chapter No. 508, 10/6/2011 The law requires every group health insurance policy to provide coverage for maternity services, which is defined to include prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care. The law specifies that the definition of "maternity services" shall remain in effect until such time as federal regulations and guidance issued pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148) define the scope of benefits to be provided under the maternity benefit requirement of that act, after which time the definition of that term under the federal act and associated regulations and guidance shall apply to these provisions.	Mandate: Maternity
	A 242; Enacted and Chaptered by Secretary of State as Chapter No. 727, 10/9/2011 Provides additional modified conformity to provisions of the federal Affordable Care Act relating to simple cafeteria plans for small businesses, health care benefits of Indian tribe members, free choice vouchers, therapeutic discovery project grants, student loan repayment programs, and deduction for self-employment taxes.	General Insurance Reform
	A 922; Enacted and Chaptered by Secretary of State as Chapter No. 552, 10/7/2011 Creates the Office of Health Consumer Assistance and eliminates the Office of Patient Advocate, to provide outreach and education about health care coverage to consumers. The Office will receive and respond to all phone and in-person inquiries, complaints, and requests for assistance from individuals concerning all health care coverage available in California, including coverage available through the Medi-Cal program, the Exchange, and the Healthy Families Program.	General Insurance Reform
	S 51; Enacted and Chaptered by Secretary of State as Chapter No. 644, 10/9/2011 Relates to provisions of the federal Affordable Care Act that prohibit a health insurance issuer from establishing lifetime limits or unreasonable annual limits on the dollar value of benefits for any participant or beneficiary and which require an issuer to provide an annual rebate to each enrollee based on certain issuer revenue expenditures. Requires health care service plans and health insurers to comply with such requirements to the extent required by federal law.	General Insurance Reform
	S 136; Enacted and Chaptered by Secretary of State as Chapter No. 698, 10/9/2011 Amends the Knox-Keene Health Care Service Plan Act; requires health care service plan contracts and health insurance policies to provide coverage for tobacco cessation treatment that includes specified courses of treatment and medication; requests the University of California, as a part of the Health Benefit (mandate) Review Program, to prepare a report regarding any state savings as a result of this coverage requirement.	Mandate: Tobacco Cessation Treatment
	S 146; Enacted and Chaptered by Secretary of State as Chapter No. 381, 9/30/2011 Prohibits health care service plans offered through the state insurance exchange, from restricting members from selecting any professional clinical counselor, a licensed professional clinical counselor who has received specific instruction in assessment, diagnosis, prognosis, counseling, and psychotherapeutic treatment of mental and emotional disorders, which is equivalent to the instruction required for licensure. Mandates insurers to provide such provider coverage.	General Insurance Reform
	S 222; Enacted and Chaptered by Secretary of State as Chapter No. 509, 10/6/2011 Requires every individual health insurance policy to provide coverage for maternity services for all insureds covered under that policy.	Mandate: Maternity
	S 946; Enacted and Chaptered by Secretary of State as Chapter No. 650, 10/9/2011 Makes technical changes to existing law in order to comply with a provision of the federal Patient Protection and Affordable Care Act that prohibits a health insurance issuer offering group or individual health insurance coverage from imposing any preexisting condition for children with respect to plan years beginning on or after September 23, 2010, and for adults with respect to plan years beginning on or after January 1, 2014.	General Insurance Reform
	A 1083; Enacted and Chaptered by Secretary of State as Chapter No. 852, 9/30/2012 Amends the state role in the federal Affordable Care Act, the Knox-Keene Health Care Service Plan Act of 1975, and the Voluntary Alliance Uniting Employers Purchasing Program, changing definitions and criteria related to risk adjustment factors, age categories, health status-related factors and small employers. Also addresses employer contribution requirements and pre-existing conditions. Prohibits encouraging or directing employers to purchasing pools under the health benefit exchange.	General Insurance Reform
	A 1453; Enacted and Chaptered by Secretary of State as Chapter No. 854, 9/30/21012 Requires the Board of Health Benefit Exchange to submit to the Assembly Committee on Health and the Senate Committee on Health a recommendation for an existing health plan to set the benchmark for items and services to be included in the definition of essential health benefits as contemplated under PPACA and a specified federal bulletin.	General Insurance Reform
	A 1846; Enacted and Chaptered by Secretary of State as Chapter No. 859, 9/30/2012 Authorizes the Insurance Commissioner to issue a certificate of authority to a consumer operated and oriented plan (CO-OP) established under the Patient Protection Act. Specifies that a plan is subject to all other provisions of law relating to insurance. Provides any plan insurer and any solvency loan are subject to requirements imposed on mutual insurers. Authorizes a request for information regarding the loan. Would prohibit the conversion of a plan and authorizes certification revocation for a violation.	General Insurance Reform
	S 122; Enacted and Chaptered by Secretary of State as Chapter No. 789, 9/29/2012 Conforms state law to the federal Affordable Care Act and the Knox-Keene Health Care Service Plan Act of 1975. Exempts from dependent coverage requirements plans or health insurance policies that provide only supplemental "excepted" benefits and retiree-only plans or policies	General Insurance Reform
	S 728; Enacted and Chaptered by Secretary of State as Chapter No. 451, 9/22/2012 Requires the board of the California Health Benefit Exchange to work with the Office of Statewide Health Planning and Development, the Department of Insurance, and the Department of Managed Health Care to develop a risk adjustment system for products sold in the Exchange and outside of the Exchange, as specified.	General Insurance Reform
	S 951; Enacted and Chaptered by Secretary of State as Chapter No. 866, 9/30/2012 States the intent of the Legislature to enact a law that would implement the essential health benefits as established under specified provisions of the Federal Patient Protection and Affordable Care Act.	General Insurance Reform, Essential Health Benefits
Colorado (CO)	S 128; Enacted as Chapter 133, 5/3/2011 Requires an insurance carrier that participates in the individual health insurance market in Colorado to issue child-only plans on a guaranteed-issue basis.	Child-only
Colorado (CO)	H 1144; Enacted & signed into law as Session Law Chapter No. 65, 03/25/2011 Requires health insurance coverage for multidisciplinary evaluations of children suspected of having fetal alcohol spectrum disorders (FASD). Specifies that if the "essential benefits" provisions for exchanges under the federal health care reform act do not include FASD coverage, thereby triggering a potential cost to the state, the bill directs the state to study the coverage of FASD and to advise about whether the state should cover the costs for health care exchange enrollees.	Mandate: Fetal alcohol
Connecticut (CT)	H 6308; Enacted, became law without governor's signature, 7/1/2011 Establishes the Connecticut Healthcare Partnership as a pooled or combined health purchasing plan; allowing nonstate public employers, municipal-related employers, small commercial employers and nonprofit employers to join the state employee health plan. Also bars lifetime limits by state law and coordinates state and federal oversight of medical loss ratios (MLRs).	State employee health plans, Medical Loss Ratio
	S 1240; Enacted & signed into law as Public Act No. 11-44, 6/13/2011 Creates a bureau of rehabilitative services and implementation of provisions of the budget concerning human services; relates to the hospital tax on net patient revenue, Medicare coinsurance, the state's insurance plan for the uninsured, premiums for health insurance coverage for autism spectrum disorders.	General Insurance Reform
	H 5038; Enacted & signed into law, 6/15/2012 Would implement the Governor's budget recommendations concerning an all-payer claims database program.	General Insurance Reform
Delaware (DE)	S 35; Enacted & signed into law as Chapter No. 18, 5/4/2011 Enables any eligible child dependent, who is a full time student as of May 1, 2011, and covered under a parent's health insurance as of that date, to remain an 'eligible child dependent' until the age of 26, subject only to the limitations on dependent coverage in the federal Affordable Care Act of 2010.	Adult dependents
	S 56; Enacted & signed by governor, 6/27/2011 Requires insurers administering CHIP buy-in programs in other states to cause similar childrens buy-in programs to be offered in Delaware if they should engage in insurance sales or affiliations with Delaware insurers or health service corporations.	Other (CHIP buy-in programs)
	H 160; Enacted & signed into law Chapter No. 159, 7/29/2011 Changes provisions for supplemental health insurance coverage for children of insureds, raising the age children may be covered by their parents or parents' health insurance to the age of 26; provides that the provisions of this Act shall have no force or effect if the health care bill passed by Congress and signed by the President of the United States in 2010 is declared unconstitutional by the Supreme Court of the United States of America.	Adult dependents
	H 161; Enacted & signed into law as Chapter No. 141, 7/25/2011 Provides that no individual health insurance policy, contract or certificate that is delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provides for hospital or medical expenses shall deny coverage to a child under the age of 19 because of a pre-existing condition.	General Insurance Reform
	S 153; Enacted & signed into law as Chapter No. 226, 4/19/2012 Conforms state law to new federal law prescribing external review of adverse decisions by health carriers regarding denial, reduction or termination of benefits where the review may be conducted, and that written notice shall be mailed requesting delivery confirmation by the United States Postal Service.	External Review
	H 170; Enacted & signed into law as Chapter No. 246, 5/22/2012 Allows qualified individuals who are covered by small employer plans to continue their coverage at their own cost, for up to 9 months after termination of coverage; also provides that the Act shall have no force or effect if the Health Care bill passed by Congress and signed by the President in 2010 is declared unconstitutional by the U.S. Supreme Court or the provisions addressed by this Act are preempted by federal law on January 1, 2014.	Small Employer
Georgia (GA)	H 47; Enacted & signed into law, 5/13/2011 Authorizes health insurers to offer "cross-border" or out-of-state individual sickness insurance policies in-state, that have been approved for issuance in other states; providing for minimum standards for such policies and allowing insurers authorized to transact insurance in other states to issue individual accident and sickness policies in the state.	Out-of state policies
	H 78; Enacted & signed into law as Act No. 223, 5/12/2011 Reduce state funds within the FY 2012 state budget by implementing a minimum Medical Loss Ratio (MLR) of 87% and including the 2.25% state premium tax within the existing administrative percentage for Care Management Organization (CMO) cap rate. Line item vetoes did not affect these provisions.	Medical Loss Ratio
	H 741; Enacted & signed into law as Act No. 406, 3/15/2012 State FY 2012 supplemental budget, increases public "employee premiums 6.2% due to increased costs as a result of the requirements of the Patient Protection and Affordable Care Act (PPACA). Total Funds: $17,900,000."	State Employee Health Plans
	H 1166; Enacted & signed into law as Act No. 634, 5/1/2012 Establishes that as a condition of issuing health insurance coverage in the individual market insurers must offer child-only policies during open enrollment until January 1, 2014.	Child Only
	H 742; Enacted & signed into law as Act No. 775, 5/7/2012 FY 2013 state budget, increases public employee premiums 6.2% due to increased costs as a result of the requirements of the Patient Protection and Affordable Care Act (PPACA) (Total Funds: $35,000,000).	State Employee Health Plans
Hawaii (HI)	S 1273; Enacted & signed into law as Act No. 15, 4/25/2011 Authorizes the state insurance commissioner to enforce the consumer protections and market reforms relating to health insurance, including HMOs, mutual and fraternal benefit societies, as set forth in the Affordable Care Act.	Consumer protections/market reforms
	H 1134; Enacted & signed into law, 7/12/2011 Provides for the continuation of the Hawaii Prepaid Health Care Act, with its operational employer mandate, by deleting the existing provision that would terminate that plan once a national health plan is enacted. The bill states, "The legislature is supportive of the Affordable Care Act... However, the legislature continues to believe that the Hawaii Prepaid Health Care Act provides superior benefits for the people of Hawaii, and the legislature is wary that current efforts to rescind or amend the federal Affordable Care Act may jeopardize the Hawaii Prepaid Health Care Act."	Other (Hawaii Prepaid Health Care Act)
	S 1274; Enacted & signed into law, 7/12/2011 Provides uniform standards for external review procedures based on NAIC Uniform Health Carrier External Review Model Act, to comply with the requirements of the federal Affordable Care Act of 2010.	External Review
	S 1276; Enacted & signed into law as Act No. 254, 7/6/2012 Prohibits any state entity from establishing a basic health program, pursuant to the Patient Protection and Affordable Care Act, without legislative authority to do so.	Other
Idaho (ID)	HJM 3; Adopted non-binding resolution, 3/21/2011 Adopted non-binding resolution, "urgently" requests the U.S. Department of Health and Human Services to remove health insurance agent and broker commissions from the medical loss ratio (MLR) calculation; also "strongly encouraging Congress" to amend the Affordable Care Act to remove agent and broker commissions from the MLR calculation.	Medical Loss Ratio
Idaho (ID)	H 323; Enacted & signed into law as Chapter No. 292, 4/11/2011 FY 2011 Appropriations bill requires the director of administration to maintain grandfather status for state-administered health insurance for FY 2012.	State Employee plan
Illinois (IL)	HR 22; Adopted non-binding resolution, 4/6/2011 Adopted non-binding resolution urges Congress and the President to immediately consider enactment of a Single Payer option based on the Medicare model for adoption as an additional component of a national health reform plan.	Single payer
	H 103; Enacted & Chaptered as Public Act No. 98, 7/14/2011 Requires the state Attorney General to post on its public website the summary pricing reports required from pharmaceutical manufacturers and group purchasing organizations under the transparency provisions of federal Patient Protection and Affordable Care Act.	General Insurance Reform
	S 1313; Enacted & signed into law as Public Act No. 695, 6/21/2012 Amends the state high risk, Comprehensive Health Insurance Plan Act; deletes state-only subsidies of cost of health insurance coverage to coordinate with the federal pre-existing condition insurance plan (PCIP).	High Risk Pools
	S 2885; Enacted & signed into law as Public Act No. 715, 6/28/2012 Sets forth provisions concerning health care cooperatives; provides that in addition to all other provisions of the Article concerning domestic mutual companies, a company seeking to organize as a health care cooperative shall meet certain requirements; sets forth provisions concerning the naming of and applications for entities seeking to organize as health care cooperatives.	Other
Indiana (IN)	S 461; Enacted & Chaptered as Public Law No. 160-2011, 5/12/2011 To prepare for ACA, allows the office of Medicaid policy and planning to request federal approval to change how the state determines Medicaid eligibility for the aged, blind and disabled. Requires the Indiana Check Up Plan to include any federally required bench mark services; allows, instead of requires, the plan to include dental and vision services; makes specified changes concerning the plan beginning January 1,2014. Requires external review and appeals of health insurance denials consistent with the ACA. Sec. 2 requires that a "state agency may not implement or prepare to implement the federal health care act," and may not adopt regulations unless authorized by state law. An agency may not apply for or accept a grant related to the ACA unless it is reviewed and recommended by the Legislative Council.	General Insurance Reform
Indiana (IN)	H 1001; Enacted & Chaptered as Public Law No. 229-2011, 5/13/2011 Revises the eligibility requirements for the Indiana high-risk pool, run as the Comprehensive Health Insurance Association, requiring applicants to first apply for the federal Pre-existing Condition Insurance Plan (PCIP) or the Healthy Indiana insurance program.	Pre-existing conditions
Iowa (IA)	H 597; Enacted & signed into law, 4/28/2011 Provides procedures for external review of adverse determinations made by health carriers, as required by the federal Patient Protection and Affordable Care Act, as amended by the federal Health Care and Education Reconciliation Act of 2010, which amends the Public Health Service Act; provides that the new provisions apply to all requests for external review filed on or after July 1, 2011.	External review
Kansas (KS)	H 2075; Enacted & signed into law, 8/10/2011 Pertains to the payment of the premium for and coverage under group life insurance; relates to health care related claim adverse decision utilization reviews and external review organizations; adds individual eligibility criteria and an increase in the maximum lifetime benefit under the State Uninsurable Health Plan Act; provides that providers of coverage for health care benefits and the insurance exchange shall exclude elective abortions, and provides such coverage shall only be through an optional rider.	General Insurance Reform
Kansas (KS)	S 14; Enacted & signed into law, 5/14/2012 Eliminates lifetime limits from Kansas high risk pool (Uninsurable Health Insurance Plan Act) and expands participation in the plan for children under 19 with pre-existing conditions. Also provides by state law that "The government shall not interfere with a resident's right to purchase health insurance or with a resident's right to refuse to purchase health insurance" nor enforce fines or penalties for non-purchase of coverage.	High Risk Pools
Kentucky (KY)	SR 55a; Adopted Senate resolution, 4/6/2011 Adopted Senate resolution, expressing support to override the Governor's veto of an enacted budget section that provided that all receipts received by the state through the Early Retiree Reinsurance Program of the Affordable Care Act shall be deposited in a sub-account of the Public Employee Health Insurance Trust Fund for future appropriation by the General Assembly to cover a portion of health insurance premium increases in future plan years. The ACA Early Retiree fund earmark section was VETOED by the Governor on March 25, 2011, as contradicting an existing earmark allocation.	Early Retiree Reinsurance
	H 255; Enacted & signed into law as Act No. 54, 03/16/2011 2011 signed law allows an exclusion from state gross income tax for health insurance premiums for family policies which permit parents to provide health insurance coverage for an adult child, up to age 27, who is not their tax dependent. The change aligns the state law with the eligibility and tax deductible coverage specified in the Affordable Care Act of 2010.	Adult dependents
	H 265; Enacted & signed into law as Act No. 144, 4/13/2012 Authorizes the state to seek "to explore the feasibility of an Interstate Reciprocal Health Benefit Plan Compact (IRHBPC) with contiguous states" to allow Kentucky and residents of contiguous states to purchase health benefit plan coverage among the states participating with the compact. The purposes of this compact are, through means of joint and cooperative action among the compacting states to promote and protect the interest of consumers purchasing health benefit plan coverage. The compact generally is authorized in section 1333 of the PPACA.	Out-of-State
Louisiana (LA)	S 154; Enacted & signed into law as Act No. 144, 6/24/2011 Requires that all health care coverage plans which include prescription benefits as part of its policy or contract provide coverage for step therapy or fail first protocols.	Mandate: Rx Step therapy or fail first protocols.
Louisiana (LA)	H 771; Enacted & signed into law as Act No. 208, 5/23/2012 Amends the state's existing requirements related to coverage of the diagnosis and treatment of autism spectrum disorders. Specifies that any provisions of the proposed law that would exceed the essential health benefits provided pursuant to the federal Patient Protection Affordable Care Act would not be required of a health benefit plan that is offered by a health care insurer in the state.	Mandates Defining or requiring health insurance
Maine (ME)	H 979; Enacted & signed into law as Public Law 2011-90, 5/17/2011 Gradually modifies the community rating provisions for individual and small group health plans; expanding in 3 increments the rating bands from the current ratio of 1.5:1 to 3:1 by January 1, 2014; allows financial incentives except for emergency care services; maintains the requirement that plans must provide reasonable access to services for all members; allows plans to provide financial incentives to members to reward providers for quality and efficiency. Also provides, “Notwithstanding any other provision of this Title, a domestic insurer or licensed health maintenance organization authorized to transact individual health insurance in this State may offer for sale in this State an individual health plan duly authorized for sale in Connecticut, Massachusetts, New Hampshire or Rhode Island by a parent or corporate affiliate of the domestic insurer or licensed health maintenance organization.	General insurance reforms; rate review, out-of-state policies
	H 1140; Enacted & signed into law as Public Law 2011-364, 6/16/2011 Amends the state health insurance laws to incorporate changes to implement the requirements of the federal Affordable Care Act adopted in 2010, including that carriers may vary the premium rate due to smoking status (20%) and family membership; also a state 78% medical loss ratio (averaged over 3 years); and a bar on ost pre-existing condition exclusions.	General Insurance Reforms; Medical Loss Ratio
	H 1243; Enacted & signed into law as Public Law 611, 4/9/2012 Provides that if an insurer does not include prescription drugs subject to coinsurance under the total out-of-pocket limit for benefits provided under a health plan, the carrier shall establish a separate out-of-pocket limit not to exceed a specified amount per year for prescription drugs subject to coinsurance provided under a health plan to the extent not inconsistent with the federal Affordable Care Act.	General Insurance Reform
	S 569; Enacted & signed into law as Public Law 638, 4/17/2012 Extends the provisions of the law governing the Maine Guaranteed Access Reinsurance Association to insurers that offer small group health plans to groups of 10 or fewer members.	Other
Maryland (MD)	H 170; Enacted & signed into law as Chapter No. 4, 4/12/2011; also: S 183; Enacted & signed into law as Chapter No. 3, 4/12/2011 Expands a person's right to a hearing and the right to an appeal from an action of the Maryland Insurance Commissioner, providing by state law that provisions of federal law apply to specified insurers, nonprofit health service plans, and health maintenance organizations, authorizing the Commissioner to enforce consumer rights, appeals and coverage requirement in the federal law, and expanded notification of enrollee rights.	Consumer protections/market reforms
	H 286; S 484; Enacted & signed into law as Chapter No. 74 and 75, 4/10/2012 Requires the Secretary of Health and Mental Hygiene to publish specified medical loss ratio (MLR) premium and profit information for managed care organizations participating in the Medicaid Program on the Web site of the Department of Health and Mental Hygiene.	Medical Loss Ratio
	S 954; Enacted & signed into law as Chapter No. 326, 5/2/2012 Authorizes a covered entity to disclose protected health information as allowed under specified federal privacy laws; authorizes a medical laboratory to disclose the results of a laboratory examination under specified circumstances; establishes specified exceptions to the prohibition on the disclosure of specified medical records by an insurer, an insurance service organization, a nonprofit health service plan, or a Blue Cross or Blue Shield plan.	General Insurance Reform
	H 443; Enacted & signed into law as Chapter No. 152, 5/2/2012 Requires the State Health Benefit Exchange to make specified qualified dental and qualified vision plans available to specified individuals and employers, requires the Exchange to modify the format to accommodate the differences in plan options, requires the Exchange to establish and implement navigator program, prohibits any vision plan that is not qualified, provides that the SHOP Exchange shall be a separate insurance market within the Exchange, requires a SHOP Exchange navigator program, establishes a state-run process to select the essential health benefits benchmark.	Essential Health Benefits
Massachusetts (MA)	H 3318; Enacted and signed into law as Chapter 9, 4/13/2011 Requires all contracts issued by the state's Health Insurance Connector Authority (exchange) the state employee Group Insurance Commission, and Medicaid to a third party insurer to provide health care insurance paid for by the state must provide that the third party will withhold payments to any nonprofit community hospital or nonprofit community health center which fails to reimburse the state. The provision is contained within a larger FY 2011 supplemental state budget.	Other (insurance reimbursement)
	H 3535; Budget enacted and signed into law as Chapter 68, 7/11/2011 FY 2012 annual budget includes $3,500,000 for providing small business health insurance wellness subsidies pursuant to 2006 Connector, with up to 15% of eligible employer health care costs for credit by the federal government under the federal Affordable Care Act.	State employee plan
	S 2148; Enacted & signed into law as Chapter No. 61 - 2012, 3/23/2012 Provides that a limited network health plan must continue to provide coverage for medically necessary services that are part of the treatment program for a patient, prior to joining the network, undergoing treatment at a comprehensive cancer center, pediatric hospital or a specialty unit, stating "the carrier shall cover the services out-of-network, for as long as the service is unavailable in-network." Also requires that an insurer offering a tiered network plan must "clearly and conspicuously indicate the cost-sharing differences for enrollees in the various tiers." Applies to policies offered in the "Connector" or exchange.
Michigan (MI)	S 348; Enacted & signed into law as Public Act 142, 9/20/2011 Creates Health Insurance Claims Assessment Act; provides an assessment from every carrier and third party administrator on paid claims; creates the Health Insurance Claims Assessment Fund; requires the Department of Treasury to develop and implement a dashboard to provide information to state citizens regarding the amount of revenue collected from carriers and third party administrators subject to the assessment.	General Insurance Reform
Michigan (MI)	SR 181; Enacted, 11/28/2012 Non-binding resolution, expresses support for an congressional amendment to the PPACA that will allow insurance companies to consider Health Savings Account (HSA) contributions toward the payment of benefits and premiums in the medical loss ratio (MLR) calculation	HSA. Medical Loss Ratio
Minnesota (MN)	H 79; Enacted & filed with Secretary of State as Chapter No. 8, 3/21/2011 Conforms state tax law to cover the federal extension of dependent health care coverage to adult children under age 27 for tax year 2010.	Adult dependents
Minnesota (MN)	S 1045; Enacted & signed into law as Chapter No. 108, 5/27/2011 Regulates pharmacy benefit managers, insurance coverages, adjusters and appraisers.	General Insurance Reform
Mississippi (MS)	H 1514; Enacted & signed into law, 4/06/2011 Authorizes the Mississippi Department of Insurance to receive, budget and expend federal funds up to $500,000 in order to comply with and as a result of the passage of the Affordable Care Act.	Other (Insurance Dept. funding)
Missouri (MO)	H 45; Enacted & signed into law, 7/8/2011 Provides that "any federal mandate implemented by the state shall be subject to statutory authorization of the general assembly." Create a new $20,000 employer tax deduction for each new full-time jobs created with an annual salary of at least the average annual county wage if the small business also offers new employee health insurance and pays at least 50% of the health insurance premiums of all full-time employees who opt into the offered plan. Any new proposed rule must "Certify that the rule does not have an adverse impact on, or must exempt small businesses with fewer than fifty full- or part-time employees."	Small Employer
Montana (MT)	H 53; Enacted & signed into law as Chapter No. 54, 3/25/2011 Consolidates state mandated benefits for the state employee group benefit plan and the Montana University System benefit plan.	Mandated benefits; State Employee
Nebraska (NE)	L 73; Enacted & signed into law, 5/17/2011 Changes the Comprehensive Health Insurance Pool Act (high risk pool), providing for a pool administrator to be selected by bid including the "ability to negotiate reduced health care provider reimbursement rates for benefits payable under pool coverage for covered services;" also establishes health care provider reimbursement rates at 125% of Medicare rates; repeals provisions regarding the taxation of insurers.	High Risk Pools
Nebraska (NE)	L 1158; Enacted & signed by governor, 4/11/2012 Provides for a minimum medical loss ratio of eighty-five percent on all medical assistance program contracts and agreements as related to at-risk managed care for behavioral health services.	Medical Loss Ratio
Nevada (NV)	A 74; Enacted & signed into law as Chapter No. 506, 6/17/2011 Existing law provides a set of procedures for the external review of an adverse determination by a managed care organization. (NRS 695G.241-695G.310) Sections 2, 3, 8, 9, 79-118.8, 123-127 and 129-131 of this bill amend the external review process to comply with the federal Patient Protection and Affordable Care Act (Public Law 111 - 148) and enact other related provisions necessary to comply with the minimum standards prescribed by federal law.	External Review
Nevada (NV)	A 80; Enacted & signed into law as Chapter No. 453, 6/17/2011 Makes various changes relating to the Nevada Public Employees' Benefits Program; relates to health benefits, preexisting conditions, retired employees and the spouses of employees. Eliminates the exclusion for certain preexisting conditions, as provided for in the Affordable Care Act.	State Employee Health Plans
New Hampshire (NH)	H 601; Enacted & chaptered, became law without governor's signature, 7/14/2011 Requires that before establishing standards for enforcing the provisions of the federal Affordable Care Act, the insurance commissioner "shall obtain approval from the proposed N.H. legislature's Health Insurance Reform Oversight Committee. The provision applies "to any state official or agency that seeks to enforce the insurance provisions of the Act."	General Insurance Reform
New Jersey (NJ)	SR 57; Adopted on 3/15/2012 Expresses support of federal policy that accommodates religious employers regarding contraceptive services required to be covered under federal Patient Protection and Affordable Care Act.	Other
New Mexico (NM)	S 208; Enacted and signed into law as Chapter No. 2011-144, 04/07/2011 Amends state insurance code to provide greater transparency and new standards in rate review of applications for health insurance premium rate increases, providing for public hearings and administrative and judicial review of determinations in health insurance premium rate review matters.	Rate review
New York (NY)	S 5800; Enacted & signed into law as Chapter No. 219, 7/20/2011 Expands pre-existing condition protection and preventive health care; increases the age of dependent children; provides for choice of health care providers; prohibits lifetime and annual coverage limits "of essential health benefits in an individual, group or blanket policy of hospital, medical, surgical or prescription drug expense insurance;" eliminates certain patient appeal requirements; allows commissioner to implement regulations.	General Insurance Reform
North Carolina (NC)	S 323; Enacted & signed into law as Session Law No. 2011-85, 5/23/2011 Provides for the provision of online services to applicants and licensees; establishes the Seniors' Health Insurance Information Program as a statewide health benefits counseling program for Medicare beneficiaries; relates to certificates of insurance, insurance premium rates, nondependent child coverage and open enrollment, domestic insurers, health organizations, life or health insurers, property or casualty insurers, company risk level, claims and adjusters, insurance boards, and self insurers.	General Insurance Reform; rate review
	H 578, S 608; Enacted & signed into law as Session Law No. 2011-96, 5/26/2011 Allows the state health plan for teachers and state employees to provide the basic plan premium-free using available cash balance reserves; delays implementation of certain changes to the state health plan until September 2011; complies with the federal Affordable Care Act; clarifies the state health plan's subrogation rights; grants the state treasurer immediate access to confidential state health plan documents to plan for the transfer.	General Insurance Reform
	S 496; Enacted, Governor's veto overridden by Senate, 7/13/2011 Provides fraud and abuse provisions required by the federal Affordable Care Act of 2010.	General Insurance Reform
North Dakota (ND)	H 1125; Enacted & signed into law, 04/07/2011 Provides that the state administer and enforce the provisions of the Affordable Care Act that apply to insurance companies subject to the Commissioner's jurisdiction and to the extent that the provisions are not under the exclusive jurisdiction of any federal agency. Amends state insurance code to provide greater transparency and new standards in rate review of applications for health insurance premium rate increases, providing for public hearings and administrative and judicial review of determinations in health insurance premium rate review matters.	General Insurance Reform ; Rate review
	H 1127; Enacted & signed into law, 4/27/2011 Establishes or expands health carrier external review, utilization review, and grievance procedures; and regulates limitations on health insurance company risks and independent external reviews; including a penalty for violations.	External review
	H 1386; Enacted and signed into law, 4/20/2011 Establishes an "any willing provider" consumer freedom of choice for health care services; providing that a health care insurer may not prevent a beneficiary from selecting the health care service provider of their choice provided that the health care provider is licensed in the state; also provides that the insurer may not impose upon any beneficiary selecting a provider a copayment fee or other condition not imposed upon all other beneficiaries; providing penalties for denying any provider the right to participate as a preferred provider.	Any willing provider
	S 2237; Enacted & signed into law, 4/26/2011 Prohibits specific practices in the health insurance business; making or permitting any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for any contract of life insurance or of life annuity; includes unfair discrimination based on an individual's history or status as a subject of domestic abuse, disability, or geographic location.	Rating restrictions
Ohio (OH)	H 218; Enacted & signed into law as Session Law No. 2011-48, 9/26/2011 Revises health insurance plan external review processes to meet ACA requirements.	External Review
Oklahoma (OK)	S 563; Enacted & signed into law as Chapter No. 175, 5/9/2011 Modifies the state Health Insurance High Risk Pool Act, adding the federally funded "Pre-existing Condition Insurance Plan" (PCIP) as creditable health insurance coverage and modifying determination of certain premium rates.	High Risk Pools; Pre-existing conditions
Oklahoma (OK)	H 1554; Enacted & signed into law, 5/2/2011 Creates the Oklahoma Options Counseling for Long-term Care Program within the Department of Human Services Aging Services Division and administered within the Aging Services Division Aging and Disability Resource Consortium. The program and its partner community agencies will provide individuals or their representatives, or both, with long-term care options consultation. Legislation requires that the Program not be used to implement any provisions of the federal Affordable Care Act (a permissible state choice under federal law).	Other (Long Term Care)
Oregon (OR)	S 88; Enacted & signed into law as Chapter No. 69, 5/19/2011 Requires the Director of Department of Consumer and Business Services to adopt internal and external review procedures for denial of long term care insurance claims. Requires insurer to notify insured of review procedures. Extends prompt payment requirements and interest on unpaid claims for health benefit plans to long term care insurers.	External review
	S 89; Enacted & signed into law, 6/23/2011 Authorizes the state to enforce health insurance requirements of federal law; modifying definitions of health benefit plan and including student health insurance within definition; prohibits health insurers from canceling, rescinding or refusing to renew policy on or after September 23, 2010, except for fraud or intentional misrepresentation of material fact. Also requires health insurers to notify covered persons and departments regarding rescinded policies.	General Insurance Reform
	S 104; Enacted and signed into law as Chapter No. 70, 5/19/2011 Updates authorization for the federally-funded Temporary High Risk Pool Program, established to ensure health insurance coverage for individuals who are uninsured and are not enrolled in the Oregon Medical Insurance Pool or other publicly funded medical assistance.	High Risk Pools
	S 1509; Enacted & signed into law as Chapter No. 80, 3/27/2012 Provides that dentists and dental hygienists that meet specified requirements may practice in the state without a valid license issued by the State Board of Dentistry; also provides that a fully capitated health plan (HMO), physician care organization, or coordinated care organization may not discriminate with respected to participation against any willing health care provider who is acting within the scope of the provider's license or certification under state law.	Any Willing Provider
	H 4164; Enacted & signed into law as Chapter No. 38, 3/12/2012 Requires State Health Insurance Exchange Corporation to establish and deposit moneys into accounts in federally insured depositories, removes this requirement but still permits excess moneys collected by the corporation from insurers and state programs to be held and invested to offset future net losses, prescribes investments to be made with excess charges that are held and invested, authorizes the corporation to borrow money and give guarantees under specified conditions, establishes a state-run process to select the essential health benefits benchmark.	Essential Health Benefits
Pennsylvania (PA)	S 1336; Enacted & signed into law as Act No. 2011-134, 12/22/2011 Amends the act of December 18, 1996 (P.L.1066, No.159), known as the Accident and Health Filing Reform Act; divides the act into Federal compliance and Commonwealth exclusivity; provides in Federal compliance for required filings, for review, for disapproval, for record maintenance, for public comment, for penalties, for regulations and for expiration; provides in Commonwealth exclusivity for regulations and for action by the Insurance Commissioner.	General Insurance Reform
Rhode Island (RI)	S 107; Enacted & signed into law as Public Law 2011-175 Requires that health insurance contracts and plans issued or renewed in Rhode Island as of January 1, 2012, provide coverage for the screening, diagnosis, and treatment of autism spectrum disorders.	Mandate: Autism spectrum disorder
	H 7909, S 2887; Enacted & signed into law as Public Law No. 256, 262, 6/18/2012 Establishes health insurance rules and standards in addition to, but not inconsistent with, the health insurance standards established in the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010. These rules and standards include, but are not limited to, prohibitions on rescission of coverage, discrimination in coverage, and prohibitions on annual and lifetime limits of coverage unless such limits meet set minimum amounts.	General Insurance Reform
	H 7982, S 2888; Enacted & signed into law as Public Law No. 385, 361; 6/21/2012 Makes various amendments to healthcare chapters to ensure consistency with applicable federal law; including preexisting condition exclusions, dependent coverage, the merger of the individual health insurance market into the small employer market, premium rate restrictions and community rating areas, construction industry association rates, and marketing requirements.	General Insurance Reform
	H 7784; Enacted & signed into law as Public Law No. 390, 6/21/2012 Directs the health insurance commissioner to establish a workgroup of health care providers and insurers for the purpose of developing processes, guidelines and standards to streamline health care administration in the state.	Other
South Dakota (SD)	S 43; Enacted & signed into law as Chapter No. 216, 3/14/2011 Revises health insurance standards, provides that no health insurer may terminate coverage of any person younger than 26, or 29 if a full-time student, provides for continuation, provides for filing of insurance rates, provides that no one under nineteen is subject to a preexisting condition limitation, requires low-dose mammography coverage, provides that genetic information may not be treated as a preexisting condition, requires rate filing before a small employer carrier rate increase.	Adult dependents, Pre-existing conditions, rate review
South Dakota (SD)	H 1220; Enacted & signed by governor, 3/12/2012 Repeals certain provisions establishing network adequacy standards, quality assessment and improvement requirements, utilization review and benefit determination requirements, and grievance procedures for managed health care plans, and certain standards for managed health care plans if the Patient Protection and Affordable Care Act is found to be unconstitutional.	General Insurance Reform
Tennessee (TN)	S 484; Enacted & signed into law, 4/12/2011 Provides certain confidentiality protections from court-ordered discovery to certain health care organizations and providers for activities of quality improvement committees (QICs).	Confidentiality
	S 1119; Enacted and signed into law as Chapter No. 118, 4/25/2011 Authorizes insurers to use incentives and rewards to encourage or reward participation in a health promotion program.	Health/Wellness Program
	S 1539; Enacted & signed into law, 5/30/2011 Requires rate review, with medical service corporations and hospitals to submit premium rates and risk classifications to commissioner of commerce and insurance prior to any group policies being issued.	Rate review
Utah (UT)	H 18; Enacted & signed into law as Chapter No. 148, 03/22/2011 2011 signed law requires state employees hired after July 1, 2011 to be enrolled in a high deductible health insurance plan (consumer directed health plan) with a Health Savings Account, unless they select an alternative plan. Plans offered by the act must "promote appropriate utilization of health care, including preventive services." State employers must design trainings and require employees to attend training regarding such plans.	State employee plan
	H 404; Enacted & signed into law as Chapter No. 373, 03/29/2011 Directs a committee to study the way the state provides health insurance to its employees and retirees, requiring the committee to coordinate its study of health insurance benefits for state employees with the study by the Health System Reform Task Force of the operations of the Health Insurance Exchange, also would require the Public Employees' Benefit and Insurance Program to provide assistance and information to the interim committee.	State employee plan
	H 128; Enacted & signed into law as Chapter No. 400, 3/31/2011 Relates to health care reform to include third party payors, physician and clinic quality data, the Health Insurance Exchange brokers and the large group market, dental coverage under CHIP, state contractor employee health plans, group health plans premium rates, mental health insurance, NetCare, group premiums based on gender, insurance customer representatives practices, the Health Care System Reform Task Force, and health insurance actuarial reviews. Effective 2011, gives the Utah Insurance Commissioner authority to require health insurers to comply with ACA provisions on lifetime and annual limits; prohibition of rescissions; coverage of preventive health services; coverage for a child or dependent; pre-existing condition coverage for children; insurer transparency of consumer information including plan disclosures, uniform coverage documents, and standard definitions; premium rate reviews; essential benefits; provider choice; waiting periods and appeals processes.	General Insurance Reform
	S 138; Enacted as Chapter No. 127, 4/2/2012 Amends the Accident and Health Insurance Policy chapter of the Insurance Code, applies a health insurance mandate that is enacted by the state after January 1, 2012, to a public school district, charter school, or a state funded institution of higher education, requires the state to evaluate the cost of an insurance mandate enacted after January 1, 2012, for the state employees' risk pool, a public school district, a charter school, and state funded institutions of higher education.	State Employee Health Plans
	H 272; Enacted as Chapter No. 402, 3/26/2012 Amends the Public Employees' Benefit and Insurance Program Act to create a pilot program to provide coverage for treatment of autism spectrum disorders; would require the Public Employees' Benefit and Insurance Program to establish a pilot program to provide coverage for treatment of autism spectrum disorders; describes minimum coverage amounts and limits for the autism coverage required by this bill.	Autism Spectrum Disorder
	H 144; Enacted & signed into law as Chapter No. 279, 5/8/2012 Amends provisions in the Health Code and Insurance Code related to the state's strategic plan for health system reform. Establishes the Legislature as the entity to determine the benchmark for an essential health benefit plan for the state.	General Insurance Reform; Essential Health Benefits
Vermont (VT)	H 65; Enacted & signed into law as Act No. 3, 02/17/2011 Adjusts state insurance rate review to be consistent with the Affordable Care Act by deleting the specific provision that required "maintaining the premiums at levels due on June 15, 2008."	Rate review
	H 202; Enacted & signed into law, 5/26/2011 Establishes a strategic plan for creating a single-payer and unified health system; establishing a board to ensure cost-containment in health care, to create system-wide budgets, and to pursue payment reform; also establishes a health benefit exchange for Vermont as required under federal health care reform laws; creating a public-private single-payer health care system to provide coverage for all Vermonters after receipt of federal waivers. Also see S. 57.	Single payer
	H 438; Enacted & signed into law as Act No. 21, 5/19/2011 Makes various amendments to the Vermont statutes pertaining to insurance, securities, and health care administration; authorizes the Superintendent of Insurance to adopt and amend rules, establishes standards and enforces federal statutes and regulations in order to carry out the purposes of the Affordable Care Act. Defines "insured" as a member of a health benefit plan not otherwise subject to department's jurisdiction which has voluntarily agreed to use the external review process; also updates medical loss ratio requirements.	General insurance reforms
	H 558; Enacted & signed into law as Act No. 75, 3/7/2012 Makes adjustments in the fiscal year 2012 appropriations act; creates emergency rules regarding insurance rate reviews, a health care information technology reinvestment fee from health insurers, and health insurance claims assessment; also modifies necessary rules related to eligibility and services to implement the family planning option of section 2303 of the PPACA.	Premium Rate Review
	H 559; Enacted & signed into law as Act No. 171, 5/16/2012 Implements a number of changes to Vermont's health insurance, health coverage, and health care provider regulatory frameworks, including defining a small employer for the first three years of the Vermont health benefit exchange as an employer with 100 employees or fewer, merging the individual and small group insurance markets, expanding the duties and clarifying the role of the Green Mountain Care board, and giving the Green Mountain Care board authority over the health insurer rate review.	Small Employer Health Coverage, General Health Insurance Reform, Essential Health Benefits
Virginia (VA)	H 1928; Enacted & signed into law, 04/06/2011 2011 signed law expands the scope of Virginia's process for independent reviews of a health insurer's adverse decision regarding covered consumer health care benefits, in compliance with requirements of the federal Affordable Care Act, also eliminating the minimum eligibility threshold and $50 filing fee for appeals hearings. Also expands situations eligible for an independent external review to include covered persons of all licensed health carriers.	External review
	H 1958; Enacted & signed into law as Chapter 882, 4/29/2011 Conforms inconsistent and conflicting requirements of Virginia's health insurance laws to corresponding provisions of the federal Affordable Care Act that became effective on September 23, 2010; requiring employers that offer dependent coverage to provide coverage for dependents of employees who do not have access to other employer-based health care.	Dependent coverage
	H 343; Enacted & signed into law as Chapter No. 693, 4/9/2012 Creates the Virginia All-Payer Claims Database in order to facilitate data-driven, evidence-based improvements in access, quality, and cost of health care through understanding of health care expenditure patterns and operation and performance of the health care system.	Other
Washington (WA)	H 1220; Enacted & signed into law as Chapter No. 312, 5/11/2011 Modifies insurance provisions, eliminating the Insurance Commissioner's authority to review and disapprove rates for individual products. Also affects public inspection of actuarial formulas, statistics, and assumptions, credit history and insurance scores, and certain items required to be filed with the Insurance Commissioner by insurers or rating organizations or by title insurers.	Rate review
	S 5371; Enacted & signed into law as Chapter No. 315, 5/11/2011 Expands access to commercial health insurance coverage for persons under age 19, requiring sale of child-only policies to individuals under age 19 through the state-administered high risk pool.	Child-only
	S 5122; Enacted & signed into law as Chapter No. 314, 5/11/2011 Implements provisions of the Affordable Care Act; makes changes relating to coverage of dependents under disability insurance and health maintenance contracts, preexisting conditions, requirements that insurers offer certain medical plans, emergency services, adverse determinations, grievances, denials or termination of coverage, independent review organization recordkeeping requirements, loss ratio filings, contracts of the State Health Insurance Pool, and regulation of health care sharing ministries.	General insurance reforms
	H 2523; Enacted as Chapter No. 211, 3/30/2012 Enacted statute regulating insurers and insurance products. Updates provisions regarding health insurance portability and internal and external review processes; prohibits a waiting period for outpatient prescription drugs for enrollees in the State Health Insurance Pool; changes the solvency trigger for Insurance Commissioner action for health insurers and life insurers.	External Review
	S 6412; Enacted as Chapter No. 64, 3/23/2012 Relates to health carrier requirements of persons applying for individual health benefit plans; provides that if a person is seeking an individual health benefit plan, or enrollment in a basic health plan as a nonsubsidized enrollee, because his or her carrier is discontinuing coverage, completion of a standard health questionnaire shall not be a condition of coverage if certain criteria are met; makes changes concerning coverage in catastrophic health plans and preexisting condition waiting periods.	Other, Preexisting Conditions
	H 2319; Enacted as Chapter No. 87, 3/23/2012 Provides for the further implementation of the health benefit exchange and related provisions of the Affordable Care Act that includes the offering of individual health plans and catastrophic health plans outside the state health benefit exchange, the levels of plans offering under the exchange, the certification of a plan under the exchange, plan premium rate methods, deductibles and out-of-pocket expenses, exchange status reports, and high risk pool coverage. Provides that consistent with federal law, the insurance commissioner, in consultation with the board and the health care authority, shall, by rule, select the largest small group plan in the state by enrollment as the benchmark plan for the individual and small group market for purposes of establishing the essential health benefits in Washington state under P.L. 111-148 of 2010, as amended.	General Insurance Reform, Essential Health Benefits
	S 5940; Enacted & signed by Governor, 5/2/ 2012 Requires school districts to modify their benefits for employees to require every employee to pay a minimum premium for the medical benefit coverage, subject to collective bargaining; requires school districts offering medical, vision, and dental benefits to include specified options that are similar to those of required for state employees; requires the Superintendent of Public Instruction to limit a school district's authority to offer employee benefits for failing to report specified information.	Other
Wisconsin (WI)	S 2a; Enacted & signed into law as Act No. 2011-1, 01/24/2011 Creates a nonrefundable individual state income tax credit for certain amounts relating to health savings accounts (HSAs) that may be deducted from, or are exempt from, federal income taxes.	HSA
	A 11a, Enacted & signed into law as Act No. 2011-10, 03/11/2011 Requires the director of Office of State Employment Relations (OSER) and the secretary of Employee Trust Funds to study the feasibility of requiring state employees to receive health care coverage through a health benefits exchange established pursuant to the federal law and creating a health care insurance purchasing pool for all public employees and individuals receiving health care coverage under the Medical Assistance (Medicaid) program. No later than June 30, 2012, the director and secretary must report their findings and recommendations to the governor.	State employee plan
	Governor’s Executive Order #10, ordered 3/1/2011 By 2011 Governor's Executive Order, creates the Office of Free Market Health Care, jointly directed by the Department of Health Services and the Commissioner of Insurance. The Office is required to conditionally develop a plan for the design and implementation of a "Wisconsin health benefit exchange that utilizes a free-market, consumer driven approach," and explore all opportunities and alternative approaches that would free Wisconsin from establishing a health benefit exchange, including federal waivers.	HSA
West Virginia (WV)	H 2693; enacted & signed into law as Chapter No. 13, 4/1/2011; Effective 7/1/2011 Requires insurance coverage for autism spectrum disorders in individuals ages three through eighteen years for a applied behavioral analysis by a licensed physician or licensed psychologist.	Mandate: Autism spectrum disorder
West Virginia (WV)	H 4260; Enacted & signed by governor, 4/2/2012 Modifies existing insurance coverage mandate for autism spectrum disorders; specifies application of benefit caps; adds evaluation of autism spectrum disorder to included coverage; clarifies diagnosis, evaluation and treatment requirements; provides that coverage is no longer mandated if determined to not be counted as an essential benefit under the PPACA of 2010.	Mandate: Autism Spectrum Disorder

Table 3 - Health Insurance Mandates: Laws Enacted in 2011 and 2012

The following 2011 and 2012, 58 signed laws, in 28 states, add or change state health insurance mandated coverage or benefits. They are listed separately because many do not reference the federal Affordable Care Act.

For additional information on existing state mandates, and the pending provisions for the "essential health benefits package," see NCSL's report, "State Health Insurance Mandates and the ACA," published 2011. The latest HHS guidance and bulletin provides new options for all states in defining essential health benefits based directly on state-enacted mandates in effect for the first quarter of 2012 - this can include new laws listed below. Report updated 7/27/2012.

mandates 2011

State	Law
Alabama (AL)	S 283; enacted & signed into law as Act No. 298, 5/8/2012 Autism Spectrum Disorder
Alaska (AK)	S 74; enacted, became law without Governor's signature as Chapter No. 2012-63, 6/27/2012 Autism Spectrum Disorder
Arkansas (AR)	H 1315; enacted & signed into law as Chapter No. 196, 3/4/2011; Effective 10/1/2011 Autism Spectrum Disorder
	H 1428; enacted & signed into law as Chapter No. 269, 3/14/2011; Effective upon approval of Governor Child-only plans

	H 1915; enacted & signed into law as Chapter No. 1042, 4/1/2011; Effective 90 days after adjournment sine die, 7/26/2011 Gastric Pacemakers

	S 213; enacted & signed into law as Chapter No. 1119, 4/4/2011; Effective 90 days after adjournment sine die, 7/26/2011 In Vitro Fertilization
	S 66; enacted & signed into law as Chapter No. 855, 3/31/2011; Effective 1/1/2012 Morbid obesity diagnosis and treatment, including; gastric bypass surgery, and duodenal switch biliopancreatic diversion.
California (CA)	A 210; Enacted and Chaptered by Secretary of State as Chapter No. 508, 10/6/2011; Effective 7/1/2012 Maternity Services
	S 136; Enacted and Chaptered by Secretary of State as Chapter No. 698, 10/9/2011 Tobacco Cessation
	S 222; Enacted and Chaptered by Secretary of State as Chapter No. 509, 10/6/2011; Effective 7/1/2012 Maternity Services
	S 946; Enacted and Chaptered by Secretary of State as Chapter No. 650, 10/9/2011 Behavioral health treatment for a pervasive developmental disorder or autism
Colorado (CO)	H 1186; enacted & signed into law as Chapter No.97, 4/8/2011; Effective 1/1/2012 Acupuncture Services
	S 128; enacted & signed into law as Chapter No. 133, 4/29/2011; Effective upon passage, 4/29/2011 Child-only plans

	H 1144; enacted & signed into law as Chapter No. 65, 03/25/2011; Effective 90 days after adjournment sine die, 8/10/2011 Fetal alcohol spectrum disorders (FASD)
Connecticut (CT)	H 5032; enacted & signed into law as Public Law 11-88, 7/8/2011; Effective 1/1/2012 Health Insurance Coverage for Bone Marrow Testing
	S 10; enacted & signed into law as Public Law 11-67, 7/8/2011; Effective 1/1/2012 Magnetic resonance imaging
	S 923; enacted & signed into law as Public Law 11-83, 7/8/2011; Effective 1/1/2012 Lung cancer screening tests
	S 396; enacted & chaptered as Public Law 11-225, 7/13/2011; Effective 1/1/2012 Screening and treatment of prostate cancer
	S 18; enacted & chaptered as Public Law 11-171, 7/13/2011; Effective 1/1/2012 Breast magnetic resonance imaging
	S 12; enacted & signed into law as Public Act No. 12-61 Colorectal Cancer Screening
	S 97; enacted & signed into law as Public Act No. 12-150 Breast Ultrasound Screening
Delaware (DE)	S 98; enacted & signed into law as Chapter No. 194, 9/14/2011 Evidence-based preventive services, immunizations and recommended vaccinations, health screenings and children's wellness visits
Georgia (GA)	S 17; enacted & chaptered as Act No. 78, 5/11/2011; Effective 2/1/2012 Establishes the Special Advisory Commission on Mandated Health Insurance Benefits; provides for review of proposed legislation containing a mandated health insurance benefit or provider.
Indiana (IN)	H 1467; enacted & chaptered as Public Law 133-2011, 5/9/2011; Effective 7/1/2011 Physical Medicine and Rehabilitative Services
Illinois (IL)	H 1191; enacted & signed into law as Public Act No. 91, 7/11/2011; Effective 1/1/2012 Cancer Clinical Trial Insurance Coverage
Louisiana (LA)	S 154; enacted & signed into law as Chapter No. 144, 6/24/2011; Effective 1/1/2011 Step therapy or fail first protocols
Louisiana (LA)	H 693; enacted & signed into law as Act No.410, 6/1/2012 Orally Administered Anti-Cancer Medications
Maryland (MD)	H 888, S 701; enacted & signed into law as Chapter No. 525, 524; 5/19/2011; Effective 10/1/2011 Prescription eye drops refills
	H 452; enacted & signed into law as Chapter No. 527, 5/19/2011; Effective 10/1/2011 Hearing Aids
	S 154; enacted & signed into law as Chapter No. 425, 5/19/2011; Effective 1/1/2012 Ambulance Services Payment
	S 179; enacted & signed into law as Chapter No. 4, 4/10/2012; Effective 10/1/2012 Orally administered cancer chemotherapy
Michigan (MI)	S 414; Enacted & signed into law as Public Act 99, 4/18/2012 Autism Spectrum Disorder
	S 415; Enacted & signed into law as Public Act 100, 4/18/2012 Autism Spectrum Disorder
	S 981; Enacted & signed into law as Public Act 101, 4/18/2012 Autism Spectrum Disorder
Montana (MT)	H 53; enacted & signed into law as Chapter No. 54, 3/25/2011; Effective 10/1/2011 Consolidates state mandated benefits for the state employee group benefit plan and the Montana University System benefit plan.
Nebraska (NE)	L 882; enacted & signed by governor, 4/6/2012 Orally administered anticancer medication
New Hampshire (NH)	H 31; enacted & signed into law as Chapter No. 133, 6/7/2011; Effective 1/1/2012 Ambulance Payments and Bone Marrow Testing
New Jersey (NJ)	S 1834; enacted & signed into law as Chapter No. 2011-188, 1/17/2012 Oral Cancer Drugs
New Mexico (NM)	S 385; enacted & signed into law as Chapter No. 55, 4/4/2011; Effective 6/17/2011 Orally Administered Anticancer Medication
New Mexico (NM)	S 81; enacted as Chapter No. 27, 3/3/2012 Prescription eye drop refills
New York (NY)	S 5851; enacted & signed into law as Chapter No. 220, 7/20/2011 Expands medical assistance coverage for speech, physical and occupational therapies to persons with traumatic brain injury.
New York (NY)	S 3988; enacted & signed into law as Chapter No. 599, 9/23/2011 Orally Administered Chemotherapy Treatments Coverage
Oregon (OR)	S 787; enacted & signed into law as Chapter No.312, 6/9/2011; Effective 1/1/2012 Telemedical health service provided in connection with the treatment of diabetes
	S 89; enacted & signed into law as Chapter No. 500, 6/23/2011; Effective 1/1/2012 Preventive Health Services
	H 4128; enacted as Chapter No. 21, 3/5/2012 Medically necessary dental or orthodontic services for treatment of craniofacial anomalies
Rhode Island (RI)	S 107; enacted & signed into law as Public Law 2011-175, 6/30/2011; Effective upon passage Autism Spectrum Disorder
Rhode Island (RI)	H 5275; enacted & signed into law as Chapter No. 2011-159, 6/30/2011; Effective upon passage Autism Spectrum Disorder
Tennessee (TN)	H 761; enacted & signed into law as Chapter No. 199, 5/18/2011; Effective 1/1/2012 Hearing aids for dependent children
Texas (TX)	H 438; enacted & signed into law as Chapter No. 105, 5/21/2011; Effective 9/1/2011 Orally Administered Anticancer Medication
Utah (UT)	H 272; Enacted as Chapter No. 402, 3/26/2012 Autism Spectrum Disorder
Utah (UT)
Vermont (VT)	S 15; enacted & signed into law as Chapter No. 35, 5/18/2011; Effective 10/1/2011 Midwifery services and home births
	H 37; enacted & signed into law as Chapter No. 107, 5/8/2012 Telemedicine Services
	S 223; enacted & signed into law as Chapter No. 158, 5/16/2012 Autism Spectrum Disorder
Virginia (VA)	H 2467, S 1062; enacted & signed into law as Chapter No. 876, 878; 4/29/2011; Effective 7/1/2011 Autism Spectrum Disorder
Virginia (VA)	S 450; H 1273; enacted & signed into law as Chapter No. 641, 4/5/2012 Orally administered anticancer medication
Washington (WA)	H 1517; enacted & signed into law as Chapter No. 159, 4/22/2011; Effective 7/22/2011 Orally Administered Anticancer Medication
West Virginia (WV)	H 2693; enacted & signed into law as Chapter No. 13, 4/1/2011; Effective 7/1/2011 Autism Spectrum Disorder
West Virginia (WV)	H 4260; Enacted & signed by governor, 4/2/2012; Effective Ninety days after passage Autism Spectrum Disorder

Sources: NCSL state research; StateNet. Powered by StateNet

Authors: Richard Cauchi, Program Director and Steve Landess, Research Analyst, NCSL Health Program, Denver, Colorado.

Acknowledgments: Information published by the National Association of Insurance Commissioners (NAIC) has been of great value to those seeking to know the decades-long history of state insurance regulation. [Visit: www.naic.org/] Reports, releases and online posted regulations and guidance published by the Center for Consumer Information and Insurance Oversight (CCIIO) at CMS/HHS are important to any understanding of the insurance provisions in the Affordable Care Act. [Visit: http://cciio.cms.gov/]

Updates online: This report has been updated several times a month during the 2011, 2012 and 2013 legislative sessions.



Related Documents Health Health Insurance - Employer & Employee based Insurance Health Insurance - Health Insurance Regulation Health Reform - Insurance Reform
Issues & Resources Find the NCSLstaff member who handles the issue in which you are interested. NCSLprovides access to current state and federal legislation and a comprehensive list of state documents, including state statutes, constitutions, legislative audits and research reports. Members As legislators and legislative staff, you are part of the nation's largest, most influential and only bipartisan organization of state legislators and staff.Learn about the resources NCSL has for you. NCSL offers an array of services for legislative staff. Find out what's available.

Denver Office
Tel: 303-364-7700 | Fax: 303-364-7800 | 7700 East First Place | Denver, CO 80230

Washington Office
Tel: 202-624-5400 | Fax: 202-737-1069 | 444 North Capitol Street, N.W., Suite 515 | Washington, D.C. 20001

2011 - 2013 Health Insurance Reform Enacted State Laws Related to the Affordable Care Act

On This Page

NCSL Resources

NCSL Contact

Federal Health Law and the Supreme Court

The following are separate NCSL reports on closely-related policy areas affecting health insurance policy:

NCSL Session at 2011 Legislative Summit, August 11:

Latest Reports and Guidance, 2013:

2011-2013 Legislative Actions

Table 1 - Summary of 2011 - 2012 and 2013 Laws

Policy Addressed in 2011 - 2012 and 2013 State Law

States: 2011 - 2012

# of States

States: 2013

# of
States

Table 2 - 2013 Enacted Laws by State

State

Law / Date / Summary / Links

Topic

Table 3 - 2011 and 2012 Enacted Laws by State

State

Law / Date / Summary / Links

Topic

Table 3 - Health Insurance Mandates: Laws Enacted in 2011 and 2012

State

Law

Related Documents

Issues & Resources

Members