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:

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

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

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

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

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offering group or individual health insurance coverage that covers prescription contraception

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

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

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

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

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

11

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

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dispense any medication that it does not currently dispense.

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

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     (1) All health insurers subject to this title;

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

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

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     (4) All health maintenance organizations;

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

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

 

1

insurance authorized by the statutes of this state;

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

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

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     (8) Family planning centers and essential community providers.

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

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

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

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

9

offering group or individual health insurance coverage that covers prescription contraception

10

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

11

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

12

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

13

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

14

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

15

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

16

dispense any medication that it does not currently dispense.

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

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     (1) All health insurers subject to this title;

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

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

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     (4) All health maintenance organizations;

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

23

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

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insurance authorized by the statutes of this state;

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

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

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     (8) Family planning centers and essential community providers.

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

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

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

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

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offering group or individual health insurance coverage that covers prescription contraception

33

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

34

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

 

LC000391 - Page 2 of 5

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

2

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

3

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

4

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

5

dispense any medication that it does not currently dispense.

6

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

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     (1) All health insurers subject to this title;

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

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

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     (4) All health maintenance organizations;

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

12

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

13

insurance authorized by the statutes of this state;

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

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

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     (8) Family planning centers and essential community providers.

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

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

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

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

21

offering group or individual health insurance coverage that covers prescription contraception

22

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

23

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

24

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

25

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

26

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

27

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

28

dispense any medication that it does not currently dispense.

29

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

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     (1) All health insurers subject to this title;

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

32

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

33

     (4) All health maintenance organizations;

34

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

 

LC000391 - Page 3 of 5

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

2

insurance authorized by the statutes of this state;

3

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

4

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

5

     (8) Family planning centers and essential community providers.

6

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

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

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

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

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

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reimburses for, and Medicaid pharmacies dispense:

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

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prescription for twelve (12) months of contraception; or

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

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to twelve (12) months.

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

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

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provisions of this section.

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

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

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section.

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     SECTION 6. This act shall take effect upon passage.

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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 contraceptive coverage to persons covered by health

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

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

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

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for contraception.

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     This act would take effect upon passage.

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LC000391

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LC000391 - Page 5 of 5