Health Innovations State Law Database

4/1/2019

Tracking State Laws for Health Care Transformations, 2015-2019

Search key on keybroadNCSL’s Health Program seeks to help state legislators and their staff learn about promising health system reforms and policy innovations that promote a more efficient and effective health care system and improve Americans’ health.

The health care system is undergoing a critical transformation in both financing and service delivery. The reforms and changes aim to improve the efficiency and effectiveness of health organizations and services, reduce costs and improve people’s health. State and federal governments play important roles in promoting this transformation. 

This database of recently enacted laws includes information on state health transformation initiatives and related changes in state statutes, as well as a description of topics and categories of legislation for 2015-2018. 

  • Update: An expanded look at 2018 session enacted legislation, now at least 250 laws in 42 states and D.C. In addition,nine states and P.R.adopted nonbinding resolutions.
  • New Jersey Update: On May 31, N.J. Governor Murphy signed two bills that may "reset" the health insurance market.: The new laws (S1877) give the state the authority to impose the individual mandate and collect a fee from people who do not buy insurance. The fees collected under the new state law would be deposited into the New Jersey Health Insurance Premium Security Fund, using an HHS 1332 waiver, which is created by the second law signed, (S1878). IIn 2015, 189,000 New Jerseyans collectively paid $93 million, or roughly $500 in fees, rather than comply with the individual mandate, according to IRS data collected by the research institute, New Jersey Policy Perspective.
  • For 2015-2016 NCSL identified more than 800 recently enacted laws and resolutions in all 50 states, D.C. and Puerto Rico (Between January 2015 and November 2016).

At the bottom section of the page, below the search term check-offs, you will find additional information on what legislatures are doing related to health innovations and a list of helpful search keywords. 

Also see additional NCSL health database resources:
2015-2018 Prescription Drug Legislation Database   |  2015-2018 Injury Prevention Legislation Database | 2017-2018 Health Scope of Practice policy
2014 Healthcare Reform Legislative Database  |  2011-2013 Health Reform Legislative Database 

For faster performance, please use the fields below to filter your results. If nothing is picked, the default search is to include all topics and states in current session year. The full text of bills is available by clicking on the bill number. This feature is available for bills from 2015 and later.

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Keyword
Status
Bill Number
Year
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Enacted laws and adopted resolutions for 2017.

Map of 2017 enacted laws and resolutions in NCSL database

NCSL Health Innovations Project: Highlights of activities supported by the Commonwealth Fund.  Review the diverse completed publications, online reports, Webinars, invitational meetings and national meeting sessions made possible by this grant-funded collaboration. Updated for summer 2017.

2016 state actions include enacted laws in 46 states. In addition there are three states with Executive Orders: Connecticut, Louisiana and Montana. Four states did not hold a regular session in 2016: Montana, Nevada, North Dakota and Texas.

Health Innovations map of enacted laws 2015-2016

Actions Toward Health System Change 2017: This is a web landing page for links to NCSL information and resources regarding the activity of the Trump Administration and Congress to revise federal health law pertaining to the health insurance market and Medicaid.

State Health Systems InnovationsNCSL’s Health Program, through support from the Commonwealth Fund, seeks to help state legislators and their staff learn about promising health system reforms and policy innovations in areas such as Access, Medicaid, Health Providers and Workforce, private market, public health, social determinants and state laws. Health Reports, 2017

Using the search box above, you can search legislation by state, topic, keyword, current status, and/or primary legislative sponsor.

New and updated laws: All state legislative material is updated weekly for actions through the date listed at the top of the page (Status updates and additions occur every Tuesday by 8 a.m.). New measures will be added as they are enacted. Members are invited to submit suggested updates for recently adopted laws by email.

Selections: To view all items click on the "All Topics" or "All States" box. To select multiple items (e.g., state or topic) in the database lists, click the boxes next to your desired selections.

The full text of every act is included in the bill search results.  Members are encouraged to login for maximum access to site resources. Nonmembers and the public may access all features of this online resource, at no charge and without use of a password.  

 

NCSL acknowledges the generous support provided by a grant from The Commonwealth Fund.

Explanation of Search Keywords

Exchanges and Health Marketplaces

States have the option of playing a variety of legislative roles with Affordable Care Act authorized health exchanges or marketplaces. This includes state authorizing, funding, structure and regulation of state and federally facilitated exchanges; also activity related to private exchanges and the small employer market.

Free Market; Challenges and Alternatives

Legislatures may include provisions emphasizing free-market and state-initiated innovations: expanded use of health savings accounts; cross-state insurance sales and purchases; health interstate compacts; noncompliance with penalties for lacking individual health insurance; or employers choosing not to offer insurance.

Market—Cost Containment

Cost containment includes measures intended to moderate or slow health cost increases, inefficiencies, duplication and waste.

Market—Coverage

Legislative efforts to define or expand enrollment, consumer rights and assistance, establish limits on deductibles and copayments, assure coverage for adult dependents and use of public-private program coordination. These include the approach known as "no wrong door."

Market—Delivery Reform

Health provider delivery reforms include medical homes, accountable care organizations (ACOs), and use of primary care networks.

Market—Health Insurance Reforms

State insurance laws include health regulations and ACA-related reforms and responses, also covering premium rate review, defined medical loss ratios and ombudsman-style consumer rights and assistance.

Market—Mandates and Essential Health Benefits

State laws that define health insurance mandates and affect federally created essential health benefits, including requirements, restrictions and flexibility as enacted by states.

Market—Network Adequacy

Policymakers can require health insurers to include larger numbers or variety of providers. Alternatively states can authorize the availability of more limited provider networks at lower premium costs.

Market—Other

New and emerging innovations that do not fit typical or widespread policies may be listed here.

Market—Payment Reforms

Commercial and private market payment reforms can include incentives or requirements for value-based purchasing, pay-for-performance, accountable care organizations, and bundled and global payments.

Market—Price Transparency

Price disclosure and transparency initiatives include all-payer-claims databases, requirements to publish or publicly post charges and rates, and related privacy issues.

Medicaid—Payment Reform

Payment reform is a promising tool for controlling health care spending and often supports changes in the delivery system. Traditionally, Medicaid providers have been reimbursed on a fee-for-service (FFS) basis, which compensates for every service, test or procedure provided. Rather than reward volume, payment reform models seek to reward value and create financial incentives for health care providers to focus on primary and preventive care, improve access, and adopt more effective, efficient models of care delivery to improve quality and reduce costs.

Medicaid Expansion

Provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines by Jan. 1, 2014. On June 28, 2012, the U.S. Supreme Court ruled that Congress may not make a state’s entire existing Medicaid funds contingent upon the state’s compliance with the ACA Medicaid expansion. In practice, this ruling makes the Medicaid expansion a voluntary action by states.

Medicaid—General

These laws amend or change state Medicaid in ways other than expansion and payment reform. (Users may check all three Medicaid search options to view program changes from a broader perspective) See NCSL's Medicaid online resource.

PPACA—ACA-Health Reforms

This category allows users to examine a range of new state laws that implement or respond to provisions in the Affordable Care Act, including insurance protections, exchanges, Medicaid, 1332 waivers for alternative designs, and other pilot programs or grants provided for in the 2010 federal law.

Reduce Disparities

While Americans as a group are healthier and living longer, disparities persist. For a number of racial and ethnic minorities in the U.S., good health is more difficult to attain because appropriate care is often associated with an individual's economic status, race and gender. Policymakers are responding to these issues by introducing legislation aimed at eliminating health disparities. Also see NCSL's online resource on Health Disparities.

State—Run Programs

State-run programs include state and local public employee benefits, single payer proposals, state-funded public-private partnerships and other measures not tied to federal structures.

Telehealth Programs

Telehealth and telemedicine programs include encouraging, regulating and reimbursing electronic and remote health services, both video and audio, and out-of state. These measures are now tracked above, for sessions starting in 2016 and seprately for earlier years via NCSL's Telehealth webpage.

 

Database Project staff: Richard Cauchi, Colleen Becker, Kate Blackman, Samantha Scotti, and Lisa Waugh. Previously: Ashley Noble (2015-17), Laura Tobler and former health staff Melissa Hansen contributed to this project, 2015. NCSL Health Program, Denver.