MMA Legislative Priorities at the Half-way Mark

March 20, 2025

With the 2025 legislative session half-over, several MMA legislative priorities appear on track for passage. 

The MMA’s Medical Assistance (MA) reform and financing legislation, which increases outpatient reimbursement rates to 100% of Medicare, has been heard in both House and Senate committees, and laid over for inclusion in a future omnibus bill. The Senate bill assesses managed care organizations (MCOs) and maximizes available federal matching funds, while minimizing the impact on the MCOs by reimbursing them for 99% of the assessment. (A website has been created that supports the legislation. Click here to add your name to the effort.) 

Current MA reimbursement rates are about 70% of Medicare, and 30% of commercial plans. The proposal to increase rates is the result of a 2024 Department of Human Services (DHS) study, which also proposed raising reimbursement rates for community mental health services that are included in the bill. 

A second MMA priority, to limit pharmacy benefit managers (PBMs) and health plans from forcing patients to change their medications in the middle of a patient’s contract year, has also been heard in both House and Senate committees. 

Laurel Ries, MD, testifies in support of HF 1652, an MMA legislative priority to help ensure patients have access to needed medications.

“Once a patient and physician find an effective treatment plan, patients will often choose their health insurance plan based on whether a health plan covers their needed medications,” said Laurel Ries, MD, MMA past president, at the House Health Finance and Policy Committee hearing on March 19. “Yet, nothing in law stops insurers or PBMs from changing their drug formulary at any point in the insurance contract year. This leads to delays in care, unexpected and increased medical expenses, and overall worse health outcomes for patients.” 

This bill also moved through committees in 2023, but was not included in the final budget package due to its high cost to the state. The 2025 bill has been amended to allow changes if a generic drug replaces a brand name drug, and further clarifies definitions in the bill to lower the fiscal impact.  

Another MMA priority to extend audio-only telehealth coverage was included in the governor’s revised budget proposal. Coverage for audio-only services is currently set to expire on June 30 of this year. The current legislation would extend coverage until 2027, though the MMA has argued that the sunset date should be removed altogether. 

Two other MMA priorities -- establishment of a statewide registry for Provider Orders for Life Sustaining Treatment (POLST) forms and one-time funding for Treat Yourself First, a statewide campaign to support healthcare workers’ well-being -- have yet to receive committee hearings.