State Legislation

Many states have taken steps to implement shared decision making (SDM) through a variety of policy strategies, such as legislation and incorporation into state standards and expectations (e.g. medical home or Accountable Care Organizations). Although many of these states are in early stages of implementation, important lessons are already evident from their experiences. A recent National Academy of State Health Policy report provides a comprehensive review of the current SDM policy activity among five key states, as well as implementation challenges, strategies and lessons learned. The companion piece to this report examines state legislative and regulatory approaches to SDM.

See a map of the SDM state policy activity


California Health Policy Strategy


  • Legislation containing shared decision making was proposed.


Connecticut Health Policy Strategy


  • Legislation containing shared decision making was proposed.


Maine Health Policy Strategy

View Maine State’s informed consent legislation. (PDF 270 kb)


  • 2009 legislation required formation of stakeholder group to determine implementation plan.
  • 2009 legislation required final report to legislature on findings and recommendations.

Incorporation into State Standards and Expectations

  • Planning to integrate shared decision making into Accountable Care Organization (ACO) models that will provide care through the state employee health plan.
  • Incorporated into guidelines on informed consent from Maine Board of Licensure in Medicine.


Massachusetts Health Policy Strategy


  • Legislation outlined standards of certification for patient-centered medical homes (PCMHs), including SDM for preference-sensitive care.
  • Legislation established ACOs as a way to reduce costs, improve the quality of care and promote patient-centered care; SDM included in criteria for ACOs.


Minnesota Health Policy Strategy


View Minnesota’s 2012 pending legislation.

  • Legislation considered that would have mandated that providers engage in SDM for a list of preference-sensitive conditions performed in non-emergency situations, and certify the patient participated in SDM prior to receiving authorization or reimbursement.

Incorporation into State Standards and Expectations

  • Incorporated SDM into health care home certification standards in 2010.
  • Required plans to ensure patients have an opportunity to engage in SDM in order to be re-certified as a health care home at the end of their first year.


Oregon Health Policy Strategy


  • May be incorporated into legislation in 2012.

Incorporation into State Standards and Expectations

  • Oregon Public Employees’ Benefit Board and Oregon Public Educators Board included SDM as patient education following a shift to value-based insurance design in 2010.
  • Considering how to incorporate SDM into medical home standards.
  • Considering how to implement SDM in conjunction with its recent health reform efforts to create Coordinated Care Organizations.


Vermont Health Policy Strategy


View Vermont’s legislation (PDF 143 kb).


Washington Health Policy Strategy


View Washington State’s legislation.

  • 2007 legislation mandated a SDM demonstration project at one or more multi-specialty practice sites.
  • 2007 legislation recognized SDM in the state’s law on informed consent by establishing SDM and use of certified patient decision aids as prima facie evidence of patients’ informed consent.
  • 2011 legislation designated SDM as one strategy to be used by a governor-appointed collaborative to improve health care quality, cost-effectiveness and outcomes.