August 22, 2022

State legislatures and regulatory agencies hit full swing during the second quarter of 2022. Many focused on paid leave provisions — new, revised, clarified and/or validated — with developments in Colorado, Connecticut, Delaware, Illinois, Maryland, New Mexico, New York, Oregon, Virginia and Washington, DC, as well as two other cities. Insulin costs and pharmacy benefit manager (PBM) limitations remained at the forefront as Colorado, Florida, Iowa, Louisiana, Maine, Maryland, Oklahoma, Tennessee, Vermont and West Virginia enacted new laws. Numerous states added coverage mandates to existing insurance laws, including provisions addressing health savings account (HSA) eligibility. Georgia, Oklahoma and Virginia moved to align mental health parity (MHP) protections with federal requirements. Telehealth, surprise billing, association health plans (AHPs) and Washington’s long-term care mandate also received attention.

Download the 18-page print-friendly PDF to read all details. Here are some highlights of what’s covered.

Paid leave

Several states addressed paid family and medical leave (PFML) and sick and safe leave in the first half of 2022. Some expanded or clarified existing laws, while Delaware and Maryland enacted new laws, as did two cities (San Francisco and Bloomington, MN). Virginia adopted a voluntary paid family leave insurance program, perhaps as a precursor to a more substantive law. With no meaningful progress on paid leave at the federal level (see Build Back Better Act’s healthcare and paid leave reforms face uncertain future (Jan. 13, 2022)), other states looked to add paid leave provisions, but the bills fell short. Those states included Illinois, Louisiana, Maine, Michigan, Minnesota, Vermont and Wisconsin, among others.

Prescription drugs

Prescription drug costs (especially insulin) continue to be a legislative and regulatory priority. PBMs again were in legislators’ focus as several states looked to further restrict activities and practices. California took a bold step in getting more directly involved in negotiating pricing with manufacturers and supporting the development of biosimilars.


Legislators expanded coverage requirements to address state-specific concerns. Maine expanded its dependent definition with two laws. Several states corrected prior coverage mandates to recognize that an HDHP can only reimburse limited expenses on a predeductible basis.

Mental health parity

A few states enhanced mental health parity protections for fully insured plans in light of the federal nonquantitative treatment limitation (NQTL) requirements under the No Surprises Act (NSA) portion of the 2021 Consolidated Appropriations Act (2021 CAA).


A few states — Louisiana, New York, Rhode Island and South Carolina — offered different solutions for making telehealth more accessible for their populations.

Other benefit-related issues

Much of the NSA portion of the 2021 CAA addresses surprise medical bills and cost transparency, and some states reexamined existing measures to align with — or expand upon — the federal law.

Association health plans (AHPs) continue to be the subject of ongoing litigation at the federal level (specifically, in New York v. US Department of Labor (DOL) at the DC Circuit), but this did not stop Virginia and Vermont from delving into the issue. Washington received positive news about its groundbreaking long-term care program from a federal district court.

Rich Glass
by Rich Glass

Principal, Mercer’s Law & Policy Group

Katharine Marshall
by Katharine Marshall

Principal, Mercer's Law & Policy Group

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