2015 -- H 5706

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LC000391

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Tanzi, Bennett, Fogarty, Lally, and Ruggiero

     Date Introduced: February 26, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

Insurance Policies" is hereby amended by adding thereto the following section:

     27-18-82. Health insurance contracts - Full year coverage for contraception. – (a)

Beginning on the first day of each plan year after July 1, 2015, every health insurance issuer

offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive to fewer than

three hundred sixty-five (365) days at a time.

     (b) Subsection (a) of this section shall not apply to self-insured employee welfare benefit

plans established pursuant to the Federal Employee Retirement Income Security Act of 1974.

     (c) Nothing in this section shall be construed as requiring a health insurance carrier to

cover any prescription contraceptive that it does not currently cover or require any pharmacy to

dispense any medication that it does not currently dispense.

     (d) This section shall be applicable to all contracts, plans, or policies of:

     (1) All health insurers subject to this title;

     (2) All group and blanket health insurers subject to this title;

     (3) All nonprofit hospital, medical, surgical, dental, and health service corporations;

     (4) All health maintenance organizations;

     (5) Any provision of medical, hospital, surgical, and funeral benefits, and of coverage

against accidental death or injury, when the benefits or coverage are incidental to or part of other

insurance authorized by the statutes of this state;

     (6) All health care facilities, as defined in § 23-17-2(6);

     (7) All pharmacies subject to the provisions of chapter 19.1 of title 5; and

     (8) Family planning centers and essential community providers.

     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

Corporations" is hereby amended by adding thereto the following section:

     27-19-73. Health insurance contracts - Full year coverage for contraception. -- (a)

Beginning on the first day of each plan year after July 1, 2015, every health insurance issuer

offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive to fewer than

three hundred sixty-five (365) days at a time.

     (b) Subsection (a) of this section shall not apply to self-insured employee welfare benefit

plans established pursuant to the Federal Employee Retirement Income Security Act of 1974.

     (c) Nothing in this section shall be construed as requiring a health insurance carrier to

cover any prescription contraceptive that it does not currently cover or require any pharmacy to

dispense any medication that it does not currently dispense.

     (d) This section shall be applicable to all contracts, plans, or policies of:

     (1) All health insurers subject to this title;

     (2) All group and blanket health insurers subject to this title;

     (3) All nonprofit hospital, medical, surgical, dental, and health service corporations;

     (4) All health maintenance organizations;

     (5) Any provision of medical, hospital, surgical, and funeral benefits, and of coverage

against accidental death or injury, when the benefits or coverage are incidental to or part of other

insurance authorized by the statutes of this state;

     (6) All health care facilities, as defined in § 23-17-2(6);

     (7) All pharmacies subject to the provisions of chapter 19.1 of title 5; and

     (8) Family planning centers and essential community providers.

     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

Corporations" is hereby amended by adding thereto the following section:

     27-20-69. Health insurance contracts - Full year coverage for contraception. -- (a)

Beginning on the first day of each plan year after July 1, 2015, every health insurance issuer

offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive to fewer than

three hundred sixty-five (365) days at a time.

LC000391 - Page 2 of 5

     (b) Subsection (a) of this section shall not apply to self-insured employee welfare benefit

plans established pursuant to the Federal Employee Retirement Income Security Act of 1974.

     (c) Nothing in this section shall be construed as requiring a health insurance carrier to

cover any prescription contraceptive that it does not currently cover or require any pharmacy to

dispense any medication that it does not currently dispense.

     (d) This section shall be applicable to all contracts, plans, or policies of:

     (1) All health insurers subject to this title;

     (2) All group and blanket health insurers subject to this title;

     (3) All nonprofit hospital, medical, surgical, dental, and health service corporations;

     (4) All health maintenance organizations;

     (5) Any provision of medical, hospital, surgical, and funeral benefits, and of coverage

against accidental death or injury, when the benefits or coverage are incidental to or part of other

insurance authorized by the statutes of this state;

     (6) All health care facilities, as defined in § 23-17-2(6);

     (7) All pharmacies subject to the provisions of chapter 19.1 of title 5; and

     (8) Family planning centers and essential community providers.

     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

Organizations" is hereby amended by adding thereto the following section:

     27-41-86. Health insurance contracts - Full year coverage for contraception. -- (a)

Beginning on the first day of each plan year after July 1, 2015, every health insurance issuer

offering group or individual health insurance coverage that covers prescription contraception

shall not restrict reimbursement for dispensing a covered prescription contraceptive to fewer than

three hundred sixty-five (365) days at a time.

     (b) Subsection (a) of this section shall not apply to self-insured employee welfare benefit

plans established pursuant to the Federal Employee Retirement Income Security Act of 1974.

     (c) Nothing in this section shall be construed as requiring a health insurance carrier to

cover any prescription contraceptive that it does not currently cover or require any pharmacy to

dispense any medication that it does not currently dispense.

     (d) This section shall be applicable to all contracts, plans, or policies of:

     (1) All health insurers subject to this title;

     (2) All group and blanket health insurers subject to this title;

     (3) All nonprofit hospital, medical, surgical, dental, and health service corporations;

     (4) All health maintenance organizations;

     (5) Any provision of medical, hospital, surgical, and funeral benefits, and of coverage

LC000391 - Page 3 of 5

against accidental death or injury, when the benefits or coverage are incidental to or part of other

insurance authorized by the statutes of this state;

     (6) All health care facilities, as defined in § 23-17-2(6);

     (7) All pharmacies subject to the provisions of chapter 19.1 of title 5; and

     (8) Family planning centers and essential community providers.

     SECTION 5. Chapter 42-12.3 of the General Laws entitled "Health Care for Children and

Pregnant Women" is hereby amended by adding thereto the following section:

     42-12.3-3.1. Medical assistance expansion for women - Full year coverage for

contraception. – (a) By one hundred eighty (180) days from July 1, 2015, the department of

human services shall develop and implement a system by which the Medicaid program

reimburses for, and Medicaid pharmacies dispense:

     (1) Twelve (12) months of prescription contraception at a time to enrollees with a valid

prescription for twelve (12) months of contraception; or

     (2) As many months of prescription contraception as there is a valid prescription for, up

to twelve (12) months.

     (b) This section shall apply to all Medicaid programs, including managed care.

     (c) The department of human services may issue rules and regulations to implement the

provisions of this section.

     (d) This section shall serve as legislative approval for any Medicaid State Plan

Amendment that is required by the Centers for Medicare and Medicaid Services to implement this

section.

     SECTION 6. This act shall take effect upon passage.

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LC000391

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE - ACCIDENT AND SICKNESS INSURANCE POLICIES

***

     This act would provide full year contraceptive coverage to persons covered by health

insurance contracts, plans or policies and authorizes the department of human services to issue

rules and regulations to require Medicaid pharmacies to dispense twelve (12) months of a

contraception prescription and to reimburse Medicaid eligible persons for a full year of coverage

for contraception.

     This act would take effect upon passage.

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LC000391

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