2023 -- S 0563 SUBSTITUTE A AS AMENDED

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LC001940/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

____________

A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR PREVENTION OF HIV

INFECTION

     Introduced By: Senators Murray, Valverde, Lauria, Pearson, Euer, Lawson, Mack,

     Date Introduced: March 07, 2023

     Referred To: Senate Health & Human Services

     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 sections:

     27-18-91. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

constitute a separate method of administration. A health insurer is not required to cover any

preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an

out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

pharmacy benefit.

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer’s provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

network where it can be established that the required services are not available from a provider in

the health insurer’s network.

     27-18-92. Expedited Prior Authorization.

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

18.9-6(a)(1).

     27-18-93. Dispensing and Administration of HIV PrEP or PEP Drugs.

     (a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a)

pursuant to a standing order or collaborative practice agreement or to protocols developed by the

board for when there is no prescription drug order, standing order or collaborative practice

agreement in accordance with the requirements in this subsection and may also order laboratory

testing for HIV infection as necessary.

     (b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (1) The patient tests negative for HIV infection, as documented by a negative HIV test

result obtained within the previous seven (7) days. If the patient does not provide evidence of a

negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted

directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction.

If the patient tests positive for HIV infection, the pharmacist or person administering the test shall

direct the patient to a primary care provider and provide a list of primary care providers and clinics

within a reasonable travel distance of the patient's residence;

     (2) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (3) The patient does not report taking any contraindicated medications;

     (4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

LC001940/SUB A/2 - Page 2 of 15

PEP drug to a single patient once every two (2) years without a prescription;

     (5) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (7) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (d) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (1) The pharmacist screens the patient and determines that the exposure occurred within

the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post

exposure prophylaxis drug under CDC guidelines;

     (2) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (4) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (e) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

LC001940/SUB A/2 - Page 3 of 15

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

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

     27-19-83. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

constitute a separate method of administration. A health insurer is not required to cover any

preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an

out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

pharmacy benefit.

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer’s provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

network where it can be established that the required services are not available from a provider in

the health insurer’s network.

     27-19-84. Expedited Prior Authorization.

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

18.9-6(a)(1).

     27-19-85. Dispensing and Administration of HIV PrEP or PEP Drugs.

     (a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a)

pursuant to a standing order or collaborative practice agreement or to protocols developed by the

board for when there is no prescription drug order, standing order or collaborative practice

agreement in accordance with the requirements in this subsection and may also order laboratory

testing for HIV infection as necessary.

     (b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

LC001940/SUB A/2 - Page 4 of 15

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (1) The patient tests negative for HIV infection, as documented by a negative HIV test

result obtained within the previous seven (7) days. If the patient does not provide evidence of a

negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted

directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction.

If the patient tests positive for HIV infection, the pharmacist or person administering the test shall

direct the patient to a primary care provider and provide a list of primary care providers and clinics

within a reasonable travel distance of the patient's residence;

     (2) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (3) The patient does not report taking any contraindicated medications;

     (4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (5) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (7) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (d) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (1) The pharmacist screens the patient and determines that the exposure occurred within

LC001940/SUB A/2 - Page 5 of 15

the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post

exposure prophylaxis drug under CDC guidelines;

     (2) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (4) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (e) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

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

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

     27-20-79. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

constitute a separate method of administration. A health insurer is not required to cover any

preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an

out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

pharmacy benefit.

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer’s provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

LC001940/SUB A/2 - Page 6 of 15

network where it can be established that the required services are not available from a provider in

the health insurer’s network.

     27-20-80. Expedited Prior Authorization.

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant § 27-

18.9-6(a)(1).

     27-20-81. Dispensing and Administration of HIV PrEP or PEP Drugs.

     (a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a)

of this section pursuant to a standing order or collaborative practice agreement or to protocols

developed by the board for when there is no prescription drug order, standing order or collaborative

practice agreement in accordance with the requirements in this subsection and may also order

laboratory testing for HIV infection as necessary.

     (b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (1) The patient tests negative for HIV infection, as documented by a negative HIV test

result obtained within the previous seven (7) days. If the patient does not provide evidence of a

negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted

directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction.

If the patient tests positive for HIV infection, the pharmacist or person administering the test shall

direct the patient to a primary care provider and provide a list of primary care providers and clinics

within a reasonable travel distance of the patient's residence;

     (2) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (3) The patient does not report taking any contraindicated medications;

     (4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

LC001940/SUB A/2 - Page 7 of 15

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (5) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (7) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (d) A pharmacist shall dispense or administer a complete course of a post-exposure

prophylaxis drug as long as all of the following conditions are met:

     (1) The pharmacist screens the patient and determines that the exposure occurred within

the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post

exposure prophylaxis drug under CDC guidelines;

     (2) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (4) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (e) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

LC001940/SUB A/2 - Page 8 of 15

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order to collaborative practice agreement.

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

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

     27-41-96. Coverage for treatment of pre-exposure prophylaxis (PrEP) for the

prevention of HIV and post-exposure prophylaxis (PEP) to prevent HIV infection.

     (a) Every group health insurance contract, or every group hospital or medical expense

insurance policy, plan, or group policy delivered, issued for delivery, or renewed in this state, by

any health insurance carrier, on or after January 1, 2024, shall provide coverage for treatment of

pre-exposure prophylaxis (“PrEP”) for the prevention of HIV and post-exposure prophylaxis

(“PEP”) to prevent HIV infection. Each long-acting injectable drug with a different duration shall

constitute a separate method of administration. A health insurer is not required to cover any

preexposure prophylaxis drug or post exposure prophylaxis drug dispensed or administered by an

out-of-network pharmacy provider unless the enrollee’s health plan provides an out-of-network

pharmacy benefit.

     (b) The healthcare benefits outlined in this chapter apply only to services delivered within

the health insurer’s provider network; provided that, all health insurers shall be required to provide

coverage for those benefits mandated by this chapter outside of the health insurer’s provider

network where it can be established that the required services are not available from a provider in

the health insurer’s network.

     27-41-97. Expedited Prior Authorization.

     To the extent a prior authorization is permitted and applied, then it shall be conducted in

an expedited manner as soon as possible, but no later than seventy-two (72) hours pursuant to § 27-

18.9-6(a)(1).

     27-41-98. Dispensing and Administration of HIV PrEP or PEP Drugs.

     (a) Notwithstanding any provision of law to the contrary and as authorized by the Rhode

Island board of pharmacy (the “board”) in accordance with rules and regulations adopted under

subsection (e) of this section, a pharmacist may prescribe, dispense and administer HIV PrEP or

PEP drugs (hereinafter sometimes referred to as “prevention drugs”) as described in § 27-18-91(a)

pursuant to a standing order or collaborative practice agreement or to protocols developed by the

board for when there is no prescription drug order, standing order or collaborative practice

agreement in accordance with the requirements in this subsection and may also order laboratory

testing for HIV infection as necessary.

     (b) Before furnishing an HIV PrEP or PEP drug to a patient, a pharmacist shall complete a

LC001940/SUB A/2 - Page 9 of 15

training program approved by the board on the use of protocols developed by the board for

prescribing, dispensing and administering an HIV prevention drug, on the requirements for any

laboratory testing for HIV infection and on guidelines for prescription adherence and best practices

to counsel patients prescribed an HIV prevention drug.

     (c) A pharmacist shall dispense or administer a PrEP or PEP drug in at least a thirty (30)

day supply, and up to a sixty (60) day supply, as long as all of the following conditions are met:

     (1) The patient tests negative for HIV infection, as documented by a negative HIV test

result obtained within the previous seven (7) days. If the patient does not provide evidence of a

negative HIV test result, the pharmacist shall order an HIV test. If the test results are not transmitted

directly to the pharmacist, the pharmacist shall verify the test results to the pharmacist's satisfaction.

If the patient tests positive for HIV infection, the pharmacist or person administering the test shall

direct the patient to a primary care provider and provide a list of primary care providers and clinics

within a reasonable travel distance of the patient's residence;

     (2) The patient does not report any signs or symptoms of acute HIV infection on a self-

reporting checklist of acute HIV infection signs and symptoms;

     (3) The patient does not report taking any contraindicated medications;

     (4) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the ongoing use of a PrEP or PEP drug. The pharmacist shall notify the patient that the patient shall

be seen by a primary care provider to receive subsequent prescriptions for a PrEP or PEP drug and

that a pharmacist shall not dispense or administer more than a sixty (60) day supply of a PrEP or

PEP drug to a single patient once every two (2) years without a prescription;

     (5) The pharmacist documents, to the extent possible, the services provided by the

pharmacist in the patient's record in the patient profile record system maintained by the pharmacy.

The pharmacist shall maintain records of PrEP or PEP drugs dispensed or administered to each

patient;

     (6) The pharmacist does not dispense or administer more than a sixty (60) day supply of a

PrEP or PEP drug to a single patient once every two (2) years, unless otherwise directed by a

practitioner; and

     (7) The pharmacist notifies the patient's primary care provider that the pharmacist

completed the requirements specified in this subsection. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (d) A pharmacist shall dispense or administer a complete course of a post-exposure

LC001940/SUB A/2 - Page 10 of 15

prophylaxis drug as long as all of the following conditions are met:

     (1) The pharmacist screens the patient and determines that the exposure occurred within

the previous seventy-two (72) hours and the patient otherwise meets the clinical criteria for a post

exposure prophylaxis drug under CDC guidelines;

     (2) The pharmacist provides HIV testing to the patient or determines that the patient is

willing to undergo HIV testing consistent with CDC guidelines. If the patient refuses to undergo

HIV testing but is otherwise eligible for a post-exposure prophylaxis drug under this subsection,

the pharmacist may dispense or administer a post-exposure prophylaxis drug;

     (3) The pharmacist provides counseling to the patient, consistent with CDC guidelines, on

the use of a post-exposure prophylaxis drug. The pharmacist shall also inform the patient of the

availability of a PrEP or PEP drug for persons who are at substantial risk of acquiring HIV; and

     (4) The pharmacist notifies the patient's primary care provider of the dispensing or

administering of the post-exposure prophylaxis drug. If the patient does not have a primary care

provider, or refuses consent to notify the patient's primary care provider, the pharmacist shall

provide the patient a list of physicians, clinics or other health care providers to contact regarding

follow-up care.

     (e) The board shall promulgate rules and regulations establishing standards for authorizing

pharmacists to prescribe, dispense and administer HIV prevention drugs in accordance with this

section, including adequate training requirements and protocols for when there is no prescription

drug order, standing order or collaborative practice agreement.

     SECTION 5. Section 23-6.3-2 of the General Laws in Chapter 23-6.3 entitled "Prevention

and Suppression of Contagious Diseases - HIV/AIDS" is hereby amended to read as follows:

     23-6.3-2. Definitions.

     As used in this chapter the following words shall have the following meanings:

     (1) "Agent" means a person empowered by the patient to assert or waive the confidentiality,

or to disclose or consent to the disclosure of confidential information, as established by chapter

37.3 of title 5, as amended, entitled "Confidentiality of Health Care Communications and

Information Act."

     (2) "AIDS" means the medical condition known as acquired immune deficiency syndrome,

caused by infection of an individual by the human immunodeficiency virus (HIV).

     (3) "Anonymous HIV testing" means an HIV test that utilizes a laboratory generated code

based system, which does not require an individual's name or other identifying information that

may reveal one's identity, including information related to the individual's health insurance policy,

to be associated with the test.

LC001940/SUB A/2 - Page 11 of 15

     (4) "Antibody" means a protein produced by the body in response to specific foreign

substances such as bacteria or viruses.

     (5) "Community-based organization" means an entity that has written authorization from

the department for HIV counseling, testing and referral services (HIV CTRS).

     (6) "Confidential HIV testing" means an HIV test that requires the individual's name and

other identifying information including information related to the individual's health insurance

policy, as appropriate.

     (7) "Consent" means an explicit exchange of information between a person and a healthcare

provider or qualified professional HIV test counselor through which an informed individual can

choose whether to undergo HIV testing or decline to do so. Elements of consent shall include

providing each individual with verbal or written information regarding an explanation of HIV

infection, a description of interventions that can reduce HIV transmission, the meanings of positive

and negative test results, the voluntary nature of the HIV testing, an opportunity to ask questions

and to decline testing.

     (8) "Controlled substance" means a drug, substance, or immediate precursor in schedules

I-V listed in the provisions of chapter 28 of title 21 entitled, "Uniform Controlled Substances Act."

     (9) "Department" means the Rhode Island department of health.

     (10) "Diagnosis of AIDS" means the most current surveillance case definition for AIDS

published in the Centers for Disease Control & Prevention (CDC).

     (11) "Diagnosis of HIV" means the most current surveillance case definition for HIV

infection published in the CDC's (MMWR).

     (12) "Director" means the director of the Rhode Island department of health.

     (13) "ELISA result" means enzyme-linked immunosorbent assay or EIA (enzyme

immunoassay) which is a serologic technique used in immunology to detect the presence of either

antibody or antigen.

     (14) "Health benefits" include accident and sickness, including disability or health

insurance, health benefit plans and/or policies, hospital, health, or medical service plans, or any

health maintenance organization plan pursuant to title 27 or otherwise.

     (15) "Healthcare facility" means those facilities licensed by the department in accordance

with the provisions of chapter 17 of this title.

     (16) "Healthcare provider," as used herein, means a licensed physician, physician assistant,

certified nurse practitioner, pharmacist or midwife.

     (17) "Healthcare settings" means venues offering clinical STD services including, but not

limited to, hospitals, urgent care clinics, STD clinics and other substance abuse treatment facilities,

LC001940/SUB A/2 - Page 12 of 15

mental health treatment facilities, community health centers, primary care and OB/GYN physician

offices, and family planning providers.

     (18) "HIV" means the human immunodeficiency virus, the pathogenic organism

responsible for HIV infection and/or the acquired immunodeficiency syndrome (AIDS) in humans.

     (19) "HIV CD4 T-lymphocyte test result" means the results of any currently medically

accepted and/or FDA approved test used to count CD4 T-lymphatic cells in the blood of an HIV-

infected person.

     (20) "HIV counseling" means an interactive process of communication between a person

and a healthcare provider or qualified professional HIV test counselor during which there is an

assessment of the person's risks for HIV infection and the provision of counseling to assist the

person with behavior changes that can reduce risks for acquiring HIV infection.

     (21) "HIV screening" means the conduct of HIV testing among those who do not show

signs or symptoms of an HIV infection.

     (22) "HIV test" means any currently medically accepted and/or FDA approved test for

determining HIV infection in humans.

     (23) "Occupational health representative" means a person, within a healthcare facility,

trained to respond to occupational, particularly blood borne, exposures.

     (24) "Opts out" means that a person who has been notified that a voluntary HIV test will

be performed, has elected to decline or defer testing. Consent to HIV testing is inferred unless the

individual declines testing.

     (25) "Perinatal case report for HIV" means the information that is provided to the

department related to a child aged less than eighteen (18) months born to an HIV-infected mother

and the child does not meet the criteria for HIV infection or the criteria for "not infected" with HIV

as defined in the most current surveillance case definition for HIV infection published by the CDC.

     (26) "Person" means any individual, trust or estate, partnership, corporation (including

associations, joint stock companies), limited liability companies, state, or political subdivision or

instrumentality of a state.

     (27) "Persons at high risk for HIV infection" means persons defined as being high risk in

the CDC's most current recommendations for HIV testing of adults, adolescents and pregnant

women in healthcare settings or through authority and responsibilities conferred on the director by

law in protecting the public's health.

     (28) "Polymerase chain reaction (PCR) test" means a common laboratory method of

creating copies of specific fragments of DNA or RNA.

     (29) "Qualified professional HIV test counselor" means: (i) A physician, physician

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assistant, certified nurse practitioner, midwife, or nurse licensed to practice in accordance with

applicable state law; (ii) A medical student who is actively matriculating in a medical degree

program and who performs duties assigned to them by a physician; or (iii) A person who has

completed an HIV counseling training program, in accordance with regulations hereunder

promulgated.

     (30) "Sexually transmitted diseases (STD's)" means those diseases included in § 23-11-1,

as amended, entitled "Sexually Transmitted Diseases," and any other sexually transmitted disease

that may be required to be reported by the department.

     SECTION 6. This act shall take effect on January 1, 2024.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- INSURANCE COVERAGE FOR PREVENTION OF HIV

INFECTION

***

     This act would require coverage for the treatment of pre-exposure prophylaxis (PrEP) for

the prevention of HIV and post-exposure prophylaxis (PEP) for treatment of HIV infection,

commencing January 1, 2024.

     This act would take effect on January 1, 2024.

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