2017 -- H 5486

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LC001206

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2017

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Kazarian, Regunberg, Blazejewski, Fogarty, and Tanzi

     Date Introduced: February 15, 2017

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-1 of the General Laws entitled "Department of Health" is

hereby amended by adding thereto the following section:

     23-1-59. Emergency contraception.

     (a) As used in this section "emergency contraception" shall, unless the context clearly

requires otherwise, mean any drug approved by the Federal Food and Drug Administration as a

contraceptive method for use after sexual intercourse.

     (b) Notwithstanding any other general, public or special law to the contrary, a licensed

doctor, professional nurse or pharmacist may dispense emergency contraception in accordance

with written, standardized procedures or protocols developed by an actively practicing physician

registered with the department to distribute or dispense a controlled substance in the course of

professional practice pursuant to title 23 if such procedures or protocols are filed at the

pharmacist's place of practice and with the department.

     (c) Before dispensing emergency contraception authorized under this section, a

pharmacist shall complete a training program approved by the commissioner on emergency

contraception, which training shall include, but not be limited to, proper documentation, quality

assurance, and referral to additional services, including appropriate recommendation that the

patient follow up with a medical practitioner.

     (d) A pharmacist dispensing emergency contraception under this section shall annually

provide to the department of health the number of times such emergency contraception is

dispensed. Reports made pursuant to this section shall not identify any individual patient, shall be

confidential and shall not be public records.

     (e) The department of health, board of medical licensure and discipline, and board of

registration in pharmacy shall adopt rules and regulations necessary to implement this section.

     SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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

     27-18-83. Health insurance contracts - Full year coverage for contraception.

     (a) Beginning on the first day of each plan year after January 1, 2018, 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, 29

U.S.C. §§1001 et seq.

     (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 laws of this state;

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

     (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. Section 27-18-57 of the General Laws in Chapter 27-18 entitled "Accident

and Sickness Insurance Policies" is hereby amended to read as follows:

     27-18-57. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy that provides

prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide

coverage for F.D.A. approved contraceptive drugs and devices requiring a prescription. Provided,

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that nothing in this subsection shall be deemed to mandate or require coverage for the

prescription drug RU 486.

     (b) Every individual or group health insurance contract plan or policy licensed pursuant

to this title that is issued, amended, renewed, effective or delivered on or after January 1, 2018,

shall provide coverage for all of the following services and contraceptive methods:

     (1) All FDA-approved contraceptive drugs, devices, and other products. This includes all

FDA-approved over-the-counter contraceptive drugs, devices, and products as prescribed or as

otherwise authorized under state or federal law. The following applies to this coverage:

     (i) Where the FDA has approved one or more therapeutic and pharmaceutical equivalent,

as defined by the FDA, versions of a contraceptive drug, device, or product, a group or blanket

policy is not required to include all such therapeutic and pharmaceutical equivalent versions in its

formulary, so long as at least one is included and covered without cost-sharing and in accordance

with this subsection;

     (ii) If the covered therapeutic and pharmaceutical equivalent versions of a drug, device,

or product are not available or are deemed medically inadvisable a group or blanket policy shall

provide coverage for an alternate therapeutic and pharmaceutical equivalent version of the

contraceptive drug, device, or product without cost-sharing;

     (iii) This coverage shall include emergency contraception without cost-sharing when

provided pursuant to an ordinary prescription, or a non-patient specific regimen order, and when

lawfully provided other than through a prescription or order; and

     (iv) This coverage must allow for the dispensing of a twelve (12) month supply of a

contraceptive at one time;

     (2) Voluntary sterilization procedures;

     (3) Patient education and counseling on contraception; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this subsection, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (c) A group or blanket policy subject to this subsection shall not impose a deductible,

coinsurance, copayment, or any other cost-sharing requirement on the coverage provided

pursuant to this subsection.

     (d) Except as otherwise authorized under this subsection, a group or blanket policy shall

not impose any restrictions or delays on the coverage required under this subsection.

     (e) Benefits for an enrollee under this subsection shall be the same for an enrollee's

covered spouse or domestic partner and covered non-spouse dependents.

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     (b)(f) Notwithstanding any other provision of this section, any insurance company may

issue to a religious employer an individual or group health insurance contract, plan, or policy that

excludes coverage for prescription contraceptive methods which are contrary to the religious

employer's bona fide religious tenets.

     (c)(g) As used in this section, "religious employer" means an employer that is a "church

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

     (d)(h) This section does not apply to insurance coverage providing benefits for: (1)

hospital confinement indemnity; (2) disability income; (3) accident only; (4) long term care; (5)

Medicare supplement; (6) limited benefit health; (7) specified diseased indemnity; (8) sickness of

bodily injury or death by accident or both; and (9) other limited benefit policies.

     (e)(i) Every religious employer that invokes the exemption provided under this section

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

contraceptive health care services the employer refuses to cover for religious reasons.

     SECTION 4. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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

     27-19-74. Health insurance contracts - Full year coverage for contraception.

     (a) Beginning on the first day of each plan year after January 1, 2018, 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, 29

U.S.C. §§1001 et seq.

     (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 laws of this state;

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

     (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. Section 27-19-48 of the General Laws in Chapter 27-19 entitled "Nonprofit

Hospital Service Corporations" is hereby amended to read as follows:

     27-19-48. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy that provides

prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide

coverage for F.D.A. approved contraceptive drugs and devices requiring a prescription. Provided,

that nothing in this subsection shall be deemed to mandate or require coverage for the

prescription drug RU 486.

     (b) Every individual or group health insurance contract, plan or policy licensed pursuant

to this title that is issued, amended, renewed, effective or delivered on or after January 1, 2018,

shall provide coverage for all of the following services and contraceptive methods:

     (1) All FDA-approved contraceptive drugs, devices, and other products. This includes all

FDA-approved over-the-counter contraceptive drugs, devices, and products as prescribed or as

otherwise authorized under state or federal law. The following applies to this coverage:

     (i) Where the FDA has approved one or more therapeutic and pharmaceutical equivalent,

as defined by the FDA, versions of a contraceptive drug, device, or product, a contract is not

required to include all such therapeutic and pharmaceutical equivalent versions in its formulary,

so long as at least one is included and covered without cost-sharing and in accordance with this

subsection;

     (ii) If the covered therapeutic and pharmaceutical equivalent versions of a drug, device,

or product are not available or are deemed medically inadvisable a contract shall provide

coverage for an alternate therapeutic and pharmaceutical equivalent version of the contraceptive

drug, device, or product without cost-sharing;

     (iii) This coverage shall include emergency contraception without cost-sharing when

provided pursuant to an ordinary prescription, or a non-patient specific regimen order, and when

lawfully provided other than through a prescription or order; and

     (iv) This coverage must allow for the dispensing of a twelve (12) month supply of a

contraceptive at one time;

     (2) Voluntary sterilization procedures;

     (3) Patient education and counseling on contraception; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

LC001206 - Page 5 of 12

under this subsection, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (c) A contract subject to this subsection shall not impose a deductible, coinsurance,

copayment, or any other cost-sharing requirement on the coverage provided pursuant to this

subsection.

     (d) Except as otherwise authorized under this subsection, a contract shall not impose any

restrictions or delays on the coverage required under this subsection.

     (e) Benefits for an enrollee under this subsection shall be the same for an enrollee's

covered spouse or domestic partner and covered non-spouse dependents.

     (b)(f) Notwithstanding any other provision of this section, any hospital service

corporation may issue to a religious employer an individual or group health insurance contract,

plan, or policy that excludes coverage for prescription contraceptive methods which are contrary

to the religious employer's bona fide religious tenets.

     (c)(g) As used in this section, "religious employer" means an employer that is a "church

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

     (d)(h) Every religious employer that invokes the exemption provided under this section

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

contraceptive health care services the employer refuses to cover for religious reasons.

     SECTION 6. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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

     27-20-70. Health insurance contracts - Full year coverage for contraception.

     (a) Beginning on the first day of each plan year after January 1, 2018, 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, 29

U.S.C. §§1001 et seq.

     (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;

LC001206 - Page 6 of 12

     (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 laws of this state;

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

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

     (8) Family planning centers and essential community providers.

     SECTION 7. Section 27-20-43 of the General Laws in Chapter 27-20 entitled "Nonprofit

Medical Service Corporations" is hereby amended to read as follows:

     27-20-43. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy that provides

prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide

coverage for F.D.A. approved contraceptive drugs and devices requiring a prescription. Provided,

that nothing in this subsection shall be deemed to mandate or require coverage for the

prescription drug RU 486.

     (b) Every individual or group health insurance contract, plan or policy licensed pursuant

to this title that is issued, amended, renewed, effective or delivered on or after January 1, 2018,

shall provide coverage for all of the following services and contraceptive methods:

     (1) All FDA-approved contraceptive drugs, devices, and other products. This includes all

FDA-approved over-the-counter contraceptive drugs, devices, and products as prescribed or as

otherwise authorized under state or federal law. The following applies to this coverage:

     (i) Where the FDA has approved one or more therapeutic and pharmaceutical equivalent,

as defined by the FDA, versions of a contraceptive drug, device, or product, a contract is not

required to include all such therapeutic and pharmaceutical equivalent versions in its formulary,

so long as at least one is included and covered without cost-sharing and in accordance with this

subsection;

     (ii) If the covered therapeutic and pharmaceutical equivalent versions of a drug, device,

or product are not available or are deemed medically inadvisable a contract shall provide

coverage for an alternate therapeutic and pharmaceutical equivalent version of the contraceptive

drug, device, or product without cost-sharing;

     (iii) This coverage shall include emergency contraception without cost-sharing when

provided pursuant to an ordinary prescription, or a non-patient specific regimen order, and when

lawfully provided other than through a prescription or order; and

LC001206 - Page 7 of 12

     (iv) This coverage must allow for the dispensing of a twelve (12) month supply of a

contraceptive at one time;

     (2) Voluntary sterilization procedures;

     (3) Patient education and counseling on contraception; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this subsection, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (c) A contract subject to this subsection shall not impose a deductible, coinsurance,

copayment, or any other cost-sharing requirement on the coverage provided pursuant to this

subsection.

     (d) Except as otherwise authorized under this subsection, a contract shall not impose any

restrictions or delays on the coverage required under this subsection.

     (e) Benefits for an enrollee under this subsection shall be the same for an enrollee's

covered spouse or domestic partner and covered non-spouse dependents.

     (b)(f) Notwithstanding any other provision of this section, any medical service

corporation may issue to a religious employer an individual or group health insurance contract,

plan, or policy that excludes coverage for prescription contraceptive methods which are contrary

to the religious employer's bona fide religious tenets.

     (c)(g) As used in this section, "religious employer" means an employer that is a "church

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

     (d)(h) Every religious employer that invokes the exemption provided under this section

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

contraceptive health care services the employer refuses to cover for religious reasons.

     SECTION 8. Chapter 27-41 of the General Laws entitled "Health Maintenance

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

     27-41-87. Health insurance contracts - Full year coverage for contraception.

     (a) Beginning on the first day of each plan year after January 1, 2018, 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, 29

U.S.C. §§1001 et seq.

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

LC001206 - Page 8 of 12

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 laws of this state;

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

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

     (8) Family planning centers and essential community providers.

     SECTION 9. Section 27-41-59 of the General Laws in Chapter 27-41 entitled "Health

Maintenance Organizations" is hereby amended to read as follows:

     27-41-59. F.D.A. approved prescription contraceptive drugs and devices.

     (a) Every individual or group health insurance contract, plan, or policy that provides

prescription coverage and is delivered, issued for delivery, or renewed in this state shall provide

coverage for F.D.A. approved contraceptive drugs and devices requiring a prescription; provided,

that nothing in this subsection shall be deemed to mandate or require coverage for the

prescription drug RU 486.

     (b) Every individual or group health insurance contract, plan or policy licensed pursuant

to this title that is issued, amended, renewed, effective or delivered on or after January 1, 2018,

shall provide coverage for all of the following services and contraceptive methods:

     (1) All FDA-approved contraceptive drugs, devices, and other products. This includes all

FDA-approved over-the-counter contraceptive drugs, devices, and products as prescribed or as

otherwise authorized under state or federal law. The following applies to this coverage:

     (i) Where the FDA has approved one or more therapeutic and pharmaceutical equivalent,

as defined by the FDA, versions of a contraceptive drug, device, or product, a contract is not

required to include all such therapeutic and pharmaceutical equivalent versions in its formulary,

so long as at least one is included and covered without cost-sharing and in accordance with this

subsection;

     (ii) If the covered therapeutic and pharmaceutical equivalent versions of a drug, device,

or product are not available or are deemed medically inadvisable a contract shall provide

LC001206 - Page 9 of 12

coverage for an alternate therapeutic and pharmaceutical equivalent version of the contraceptive

drug, device, or product without cost-sharing;

     (iii) This coverage shall include emergency contraception without cost-sharing when

provided pursuant to an ordinary prescription, or a non-patient specific regimen order, and when

lawfully provided other than through a prescription or order; and

     (iv) This coverage must allow for the dispensing of a twelve (12) month supply of a

contraceptive at one time;

     (2) Voluntary sterilization procedures;

     (3) Patient education and counseling on contraception; and

     (4) Follow-up services related to the drugs, devices, products, and procedures covered

under this subsection, including, but not limited to, management of side effects, counseling for

continued adherence, and device insertion and removal.

     (c) A contract subject to this subsection shall not impose a deductible, coinsurance,

copayment, or any other cost-sharing requirement on the coverage provided pursuant to this

subsection.

     (d) Except as otherwise authorized under this subsection, a contract shall not impose any

restrictions or delays on the coverage required under this subsection.

     (e) Benefits for an enrollee under this subsection shall be the same for an enrollee's

covered spouse or domestic partner and covered non-spouse dependents.

     (b)(f) Notwithstanding any other provision of this section, any health maintenance

corporation may issue to a religious employer an individual or group health insurance contract,

plan, or policy that excludes coverage for prescription contraceptive methods which are contrary

to the religious employer's bona fide religious tenets.

     (c)(g) As used in this section, "religious employer" means an employer that is a "church

or a qualified church-controlled organization" as defined in 26 U.S.C. § 3121.

     (d)(h) Every religious employer that invokes the exemption provided under this section

shall provide written notice to prospective enrollees prior to enrollment with the plan, listing the

contraceptive health care services the employer refuses to cover for religious reasons.

     SECTION 10. 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) Within one hundred eighty (180) days from January 1, 2018, the department of human

services shall develop and implement a system by which the Medicaid program reimburses for,

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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 11. This act shall take effect upon passage.

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LC001206

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

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     This act would provide full year insurance coverage for all forms of FDA-approved

contraceptives and would provide coverage thereto.

     This act would take effect upon passage.

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LC001206

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