Transcript Highlights:

• House Bill 1216 deals with co-pay accumulators, and what that is is very, very hard to explain and understand
• The copay accumulators are not welcome in North Dakota.

Bills: SB2271, HB1216

Keywords: adult residential facilities, care services, Medicaid, payment rates, elderly care, health services, North Dakota, prescription drugs, drug affordability, copay assistance, copayment accumulator, deductible accumulator, out-of-pocket maximum, health insurance, health benefit plan, self-insured health plan, self-funded plan, third-party payment, manufacturer assistance, patient assistance program

Summary: The Appropriations Committee met with a quorum and took up three bills. House Bill 1216, dealing with prescription drug expense co-pay accumulators in health plans, was presented by Rep. Karen Carl’s, who explained it would prevent insurers from refusing to count third-party assistance toward deductibles for patients using high-cost, non-generic drugs. An amendment was offered to clarify effective dates, including a delayed January 1, 2026 start for PERS coverage. PERS testified that the amendment would align with its calendar-year benefit structure and likely reduce the fiscal note. The amendment was adopted 16-0, and the bill was set aside for further discussion later. House Bill 1199, creating a criminal justice data-sharing system and missing persons/missing Indigenous people task force, was introduced with a committee amendment changing the Attorney General reference to the Attorney General or designee. The committee noted the bill includes a $250,000 general fund appropriation for ongoing costs. The amendment passed 16-0, and the amended bill received a do pass recommendation by a 15-1 vote, with one no vote from Senator Magrum. House Bill 1531, appropriating $75,000 for an irrigation expansion study by the Agriculture Commissioner, was supported as a way to update older economic-impact studies on irrigation and assess opportunities for expansion. Members discussed its relationship to broader study pauses and the history of irrigation development in the state, including Garrison Diversion and remaining authorized acres. The bill passed 16-0. The committee then discussed scheduling for the coming week, noting a heavy bill load and plans for daily morning meetings before adjourning.

Transcript Highlights:

• federal law changes that might could adjust any definitions of preventative care or co-pays or cost accumulators
• federal law changes that might could adjust any definitions of preventative care or co-pays or cost accumulators
• federal law changes that might could adjust any definitions of preventative care or co-pays or cost accumulators
• federal law changes that might could adjust any definitions of preventative care or co-pays or cost accumulators
• And this basically just removed some of the wording in the definition of HSAs. co-pays or cost accumulators

Bills: HB300, HB40, SB19, HB283, HB179, HB296, HB300, HB40, SB19, HB283, HB179, HB296

Keywords: HB300, Choctaw County, probate court, probate judge, recording fee, filing fee, deed tax, mortgage tax, deeds, mortgages, property records, recordation, county local act, local legislation, technology upgrades, digitalization of records, recordkeeping, county treasury, special fund, court administration

Bills: SB19

Keywords: SB19, prostate cancer, prostate cancer screening, PSA test, digital rectal exam, preventive screening, health insurance mandate, no cost sharing, copay, deductible, coinsurance, high-risk men, African American men, men over 50, men over 40, family history, genetic marker, health benefit plan, insurer coverage, Alabama insurance code

Bills: SB190, HB515, SB190

Keywords: SB190, prostate cancer, prostate screening, PSA test, digital rectal exam, preventive screening, health insurance mandate, cost-sharing, copay, deductible, coinsurance, high-risk men, African American men, family history, genetic marker, men over 50, men over 40, health benefit plan, insurance coverage, mandated benefits

Bills: HF169, HF195, HF194, HF1756, HF2133

Keywords: HF169, Minnesota insurance, health plan, summary of benefits and coverage, SBC, patient assistance program, deductible, health insurer, consumer disclosure, out-of-pocket costs, medical assistance funds, copay assistance, health coverage transparency, chapter 62Q, enrollee, HF195, Fairmont, street reconstruction, bonding bill, capital investment

Bills: SB279, HB478, SB279, HB478

Keywords: Alabama State House, Montgomery, Legislative Council, demolition, state capitol, state capitol building, historic preservation, state property, inventory removal, fixtures, furnishings, reuse, recycling, upcycling, surplus property, public assets, legislative chambers, desk sale, chair sale, state auditor

Transcript Highlights:

• Copay accumulator and maximizer programs allow private insurance companies and pharmacy benefit managers
• Copay maximizers are similar to co-pay accumulator programs, set a patient's cost-sharing amount to be
• <00:43:09.760> accumulator<00:43:10.319> and care professional copay accumulator and
• care professional copay accumulator and Max<00:43:11.000> maximizer<00:43:11.720> programs
• > accumulator<00:45:06.599> programs similar to co-pay accumulator programs similar to

Keywords: 1191, senate, all

Transcript Highlights:

• It doesn't cap the copay.
• A couple of other things: in states that have passed bans on copay accumulators, they've compared the
• accumulators, allowing the patient to actually access the copay and have it count toward their deductible
• And the copay assistance then is absorbed by the mothership.
• If their copay card is worth $20,000...

Bills: HB591, HB765, HB826, HB870, HB938, HB1151, HB1162, HB1176, HB1196, HB1236, HB1241

Keywords: family leave, insurance, paid leave, employment benefits, caregiver support, liability insurance, coverage defenses, direct action, judgment enforcement, legal procedures, insurance referrals, compensation, non-licensed agents, consumer protection, insurance products, HB 870, Act 907, Louisiana insurance, health insurance, prescription drugs

Transcript Highlights:

• But my final bill is SB 1199, which would ban the use of copay accumulators in California, joining 20
• Banning copay accumulators can also help avoid situations in which individuals may forgo necessary treatments
• Thank you. and has a copay accumulator program.
• It will protect patients like me from unethical, harmful copay accumulator policies.
• accumulators.

Keywords: 988, house, all

Transcript Highlights:

• So a reminder, this is the co-pay accumulator bill.
• So this bill would allow a copay accumulator to be used for that. in favor say aye as many opposed nay
• So this bill would allow a copay accumulator to be used for that.
• We talked about the copay accumulator. We talked about the prior authorization bill.
• If I understand this chart correctly, our current grandfather plan has a $30 copay or a $35 copay.

Keywords: 908, all

Summary: The Senate reconvened and handled several House messages and conference committee appointments before taking up a series of bills. It appointed conference committees on Senate Bill 2265 and House Bills 1454, 1448, and 1524. The chamber also adopted a Senate amendment to House Bill 1216, delaying its effective date for the copay accumulator prescription drug bill to January 1, 2026, with later renewal timing for non-PERS plans. House Bill 1216 then came up for final passage. Senators debated whether allowing copay accumulator programs to count manufacturer coupons toward deductibles would help patients with expensive drugs or unfairly shift costs to insurers and other policyholders. Supporters said it would help people afford life-saving medications and that the coupon payments go to pharmacies, not insurers; opponents argued it could raise premiums and create perverse incentives for drug pricing. The bill passed 29-18. The Senate also concurred in House amendments to Senate Bill 2160, which changes health insurance benefits under the Uniform Group Insurance Program to move from a grandfathered to a non-grandfathered plan, with supporters emphasizing added benefits and flexibility and opponents warning of higher costs and irreversible changes. That bill passed concurrence 33-14 and final passage 39-8. The Senate next concurred in House amendments to Senate Bill 2339, the wildfire mitigation bill, which requires utility mitigation plans to be updated every two years, incorporate national electric standards, and creates a rebuttable presumption of reasonable care if the plan is followed. The bill then passed final passage 46-1. The chamber also adopted conference committee reports and passed House Bill 1460 on adult foster care and monitoring devices, House Bill 1440 on cigar lounge tobacco use, and Senate Bill 2374 on insurance-related provisions including property insurance arbitration, managed repair programs, and surplus lines issues; SB 2374 also added a study on towing and recovery coverage. The session ended with announcements of upcoming conference committee meetings and adjournment until April 22, 2025.

Transcript Highlights:

• But my final bill is SB 1199, which would ban the use of copay accumulators in California, joining 20
• Banning copay accumulators can also help avoid situations in which individuals may forego necessary treatments
• It will protect patients like me from unethical, harmful copay accumulator policies.
• It will protect patients like me from unethical, harmful copay accumulator policies.
• accumulators.

Summary: The Assembly Health Committee heard several measures, beginning with SB 331 by Sen. Menjivar, which would require large-group health plans to cover hearing aids for children. The author and supporters described the bill as a long-running effort to address a developmental emergency and reduce out-of-pocket costs for families, while opponents were absent. Testimony from parents, advocates, medical experts, and organizations emphasized the importance of early access to hearing aids; committee members voiced strong support, and the bill was moved on a do-pass basis to Appropriations, with several members requesting to be added as coauthors. The committee then heard SB 608, also by Sen. Menjivar, to expand access to condoms in school-based health centers and related settings and to prevent barriers such as ID checks. Supporters, including students and school health advocates, argued the bill would improve sexual health and reduce stigma, while opponents from family and faith groups argued it would undermine parental authority and normalize early sexual activity. The bill was supported by committee members and moved forward on a do-pass basis to Appropriations. Next, SB 971 by Sen. Choi proposed community-based healthy aging partnerships for older adults, with testimony from the California Senior Legislature and supporters from aging and dementia organizations. The measure was described as voluntary and focused on connection, independence, and local collaboration; there was no opposition, and the committee moved it on a do-pass basis to Appropriations. The committee also heard SB 869 by Sen. Weber Pierson, which would require warning icons and statements on chain restaurant menus for beverages with very high added sugar content. Supporters framed it as a transparency and public health measure, while restaurant and beverage industry representatives opposed it unless amended, citing cost and menu-space concerns; the bill was nevertheless moved on a do-pass basis to Appropriations after a roll call vote, with some members voting no and the measure placed on call. The committee also considered SB 950 by Sen. Weber Pierson, aimed at ensuring timely coverage of FDA-approved, medically necessary treatments for early-onset Alzheimer’s disease on commercial plans. Supporters, including the Alzheimer’s Association and a patient advocate, said the bill would reduce delays and barriers to care, while health plan representatives opposed it over step therapy and utilization-management concerns. Members discussed the limited treatment window and the need for early access, and the bill was moved on a do-pass basis to Appropriations. In addition, SB 490 by Sen. Umberg would set timelines for DHCS investigations of unlicensed sober living homes and allow counties to assist if the department cannot act in time; supporters from Anaheim and a patient-brokering survivor described serious abuse and oversight gaps, while county behavioral health representatives opposed the county role as an unfunded and potentially liability-creating burden. After discussion, the bill was also moved on a do-pass basis to Appropriations. Finally, the committee began hearing SB 1037 by Sen. Weber Pierson on health insurance affordability and rate review, with supporters arguing it would tie premium increases more closely to affordability targets and public reporting; the transcript cuts off before the committee completed action on that measure.

Transcript Highlights:

• You know, the Cat Fund is intended to be funded by the accumulate cash from premiums paid by insurance
• So the annual premiums paid to the calf any investment income accumulates each year into a hurricane
• As I said, it will charge an annual premium for coverage and those amounts accumulate into we reimburse
• It takes time for us to accumulate.
• So if the cat Fund makes it a nation that accumulate cash is insufficient to cover its obligations and

Transcript Highlights:

• act ensuring prompt access to health care, which would include several critical conditions without copay
• But under copay accumulator practices, the insurance companies accept...
• But under copay accumulator practices, the insurance companies accept the financial assistance, do not
• Accumulator adjusters allow insurers to accept these payments, real dollars, but do not count them toward
• One example is co-pay accumulator adjustment programs.

Keywords: 995, all

Summary: The Joint Committee on Financial Services held a lengthy public hearing with testimony on a wide range of health insurance and access-to-care bills. Early testimony focused on prescription drug pricing and pharmacy reimbursement, with supporters of H. 1326 arguing that pharmacy benefit managers and MassHealth managed care arrangements reimburse independent pharmacies too little, contributing to pharmacy closures and “pharmacy deserts.” The committee also heard repeated support for H. 1151/S. 742 on cognitive rehabilitation for acquired brain injury, H. 1288/S. 716 on telehealth parity for nutrition counseling, H. 1309/S. 761 on full-spectrum pregnancy care without cost-sharing, H. 1312 on insurance coverage for doula services, H. 309 on prompt access to health care by removing deductibles for certain services, H. 809/H. 1227 on biomarker testing, H. 1162/S. 810 on reducing inequities in access to medical procedures by limiting insurer cuts tied to Modifier 25, and S. 726 on insurance coverage for mobile integrated health. Testifiers included legislators, physicians, pharmacists, dietitians, emergency and rehabilitation clinicians, and patients and family members. Supporters of the brain injury bill said cognitive rehabilitation is medically necessary, improves long-term outcomes, and can reduce institutional care and public costs; they noted the bill has been heard repeatedly and has support from the Brain Injury Commission and prior favorable committee action. Supporters of the pregnancy care and doula bills described out-of-pocket costs as a barrier to maternal health and shared personal stories of high bills and unmet support needs. Biomarker testing advocates and cancer patients said coverage gaps deny patients access to precision treatment, can lead to avoidable suffering, and should be standardized across insurers; several speakers said insurers often deny claims despite clinical benefit. Dermatology witnesses said insurers’ use of Modifier 25 cuts reimbursement for same-day evaluation and procedure visits, forcing separate appointments and increasing patient burden. Mobile integrated health supporters described home-based care as a way to reduce emergency department use and hospital readmissions, especially for patients with transportation or mobility barriers. No votes or formal committee actions were taken during the hearing itself.

Transcript Highlights:

• We've accumulated some excess funds over the years.
• And then the idea is... ...giving a copay discount.
• If I don't have a copay, I don't care, right?
• Around the time the Texas Legislature addressed copay accumulator programs in 2023, insurers shifted
• , 500 to 1,000 percent markup just on copays.

Keywords: 1184, house, all

Transcript Highlights:

• operationally, any willing pharmacy, any willing provider, clinician-administered drugs, prior auth, copay
• accumulators, Any willing provider, clinician-administered drugs, prior auth, copay accumulators.
• So when we were testifying on the copay accumulator bill, which I'm sure Representative Osley doesn't

Keywords: 908, all

Summary: The committee met to review the history and current treatment of North Dakota health insurance mandates, with presentations from Blue Cross Blue Shield of North Dakota, Sanford Health Plan, the Public Employees Retirement System (PERS), and the Insurance Department. The discussion focused on how mandates apply differently to fully insured, self-funded, ACA, Medicaid, and PERS plans; how the state’s benchmark plan and federal essential health benefits affect coverage; and how the existing process requires cost-benefit analysis and, for certain measures, a PERS pilot period before broader application. Presenters also reviewed the long list of existing state mandates, including provider, beneficiary, and coverage requirements, and noted that many were enacted decades ago and have not been revisited despite changes in medical evidence and treatment options. Witnesses from the carriers argued that mandates should be reviewed periodically because some are outdated, can create unintended costs, and may not align with current medical guidance. Examples cited included PSA screening, off-label drug coverage, prior authorization rules, step therapy, and cost-sharing provisions for mental health and substance use treatment. They emphasized that carriers often cover services without a mandate when supported by clinical evidence, and that mandates can shift costs to employers and employees, especially in the fully insured small-group market. They also suggested possible policy improvements such as clearer mandate definitions, better transparency around cost-benefit analyses, a regular 10-year review of mandates, and more timely submission of proposals through the interim process. PERS and the Insurance Department highlighted a recurring tension over what counts as a mandate and when a measure triggers the state’s defrayal obligation under federal law. PERS described its interim committee process, the April 1 deadline for fiscal-impact proposals, and the limited pilot program used for certain measures, noting that only a few bills have gone through the full pilot process. The Insurance Department explained that it views new benefit mandates through the lens of the ACA benchmark plan and essential health benefits, distinguishing true new benefits, such as infertility coverage, from changes to existing benefits, such as telehealth or insulin cost-sharing caps. No votes were taken on policy changes; the meeting was informational, with members asking questions about costs, applicability, transparency, and whether a periodic mandate review should be established.

Transcript Highlights:

• It all depends on the benefit design that says you have a $10 copay every time you go in up until you
• the full $10 of your copay.
• copay copay every<01:43:06.600> time<01:43:06.800> you<01:43:06.920> go<01:43:07.080
• of 10 lesser of logic you pay $3 copay of 10 lesser of logic you pay $3 100%<01:43:16.760> of
• when you would normally pay $3 $10 copay when you would normally pay $3 or<01:43:23.120> $2.50

Keywords: 1187, senate, all

Bills: HB151, HB152, HB138, SB221, SB190, SB69, SB225, SB272

Keywords: fire chaplains, distinctive license plate, firefighter, volunteer service, criminal penalties, sales tax exemption, baby supplies, baby formula, maternity clothing, menstrual hygiene products, pregnancy, pregnant defendant, incarceration, jail intake, pregnancy test, bail, pre-incarceration probation, supervised probation, electronic monitoring, electronic supervision

Transcript Highlights:

• income thresholds instead of instituting a freeze, or using income thresholds instead of just the flat copay
• How did you get to the freeze and the $100 copay then?
• And this is accumulating. So at the end of budget year plus 3, it will be 672,000 individuals.
• we should be adding the 32,000 plus 230,000 plus 451,000 plus 672,000, no, the 672,000 is the accumulation

Summary: The Assembly Budget Subcommittee on Health held the first of several hearings on the Governor’s May Revision for health care, with opening remarks focused on the state’s projected $12 billion deficit, looming federal Medicaid changes, and the potential impact on Medi-Cal, public health, reproductive health, and safety-net providers. Several members criticized the proposal as balancing the budget on vulnerable Californians, while others defended the need for cost containment and questioned the administration’s assumptions. The chair set ground rules for respectful, focused questioning and outlined three topics: the Medi-Cal proposals, Proposition 35, and Proposition 56. DHCS Director Michelle Baas presented the May Revision’s Medi-Cal package, saying the department’s budget totals $200.6 billion overall, including $45.2 billion General Fund, and that the proposals are intended to address rising caseloads, pharmacy costs, and managed care spending. She described proposed changes for adults with unsatisfactory immigration status, including a freeze on new full-scope enrollment for those 19 and older, $100 monthly premiums beginning in 2027, elimination of adult dental and long-term care coverage, removal of PPS/RAP payments to FQHCs and rural health clinics for that population, and a pharmacy rebate aggregator. Other proposals included eliminating certain OTC drug classes, removing GLP-1 coverage for weight loss, prior authorization and step therapy changes, reinstating the Medi-Cal asset test, eliminating acupuncture as an optional benefit, allowing utilization management for hospice, raising the managed care minimum medical loss ratio to 90%, reducing PACE capitation rates toward the midpoint of the actuarial range, eliminating the skilled nursing facility workforce and quality incentive program, and suspending the SNF backup power requirement. The LAO said the revised Medi-Cal spending estimate is about $2.5 billion higher than the Governor’s Budget in the budget year, and that the increase appears driven more by higher per-enrollee costs than by caseload alone. The LAO said the budget solutions are concentrated in a few areas, are largely ongoing, and should be considered in light of federal uncertainty, but suggested the Legislature could explore alternatives such as more targeted income thresholds for the undocumented expansion and simpler asset-test rules. Department of Finance officials said the proposals are difficult but necessary to address a third consecutive deficit and rising Medi-Cal costs. Members then pressed the administration on the methodology and impacts of the proposals, especially the enrollment freeze, premiums, asset test, hospice controls, PACE reductions, and the elimination of benefits and provider payments. No votes or formal actions were taken at this hearing.

Transcript Highlights:

• thresholds instead of instituting a freeze increase, or using income thresholds instead of just the flat copay
• Than the $100 copay then?
• No, the 672,000 is the accumulation of all the years.

Keywords: 988, house, all

Transcript Highlights:

• Once a referral is required, the copay returns to the specialist copay, keeping with the current practice
• So when you tie something to the primary care copay, in this instance, and other states that have done
• this, have looked at this, and the primary care copay goes up, we try to keep primary care copays really
• So you'll have $5.10 dollars, really cheap copays to primary care.
• They looked at this and they found exactly that, that primary care copays go up, and some states that