2022 -- H 7626

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LC004999

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

     Introduced By: Representatives Morales, Kislak, McGaw, Potter, Caldwell, McEntee,
Diaz, Barros, Kazarian, and Slater

     Date Introduced: March 02, 2022

     Referred To: House Finance

     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:

     27-18-89. Over-the-counter COVID-19 tests.

     (a) Every individual or group health insurance contract, plan or policy issued for delivery

or renewed in this state on or after July 1, 2022, which provides medical coverage that includes

coverage for physician services in a physician's office, and every policy which provides major

medical or similar comprehensive-type coverage, shall include coverage for FDA approved over-

the-counter ("OTC") COVID-19 tests.

     (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the-

counter diagnostic test kit that serves to detect active COVID-19 infections and for which the

United States Food and Drug Administration has issued an authorization. The term includes:

     (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain

reaction (PCR) test, which provides results after a sample is received by a laboratory;

     (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which

provides results in minutes; and

     (3) Any other OTC test developed in the future that serves to detect active COVID-19 and

receives FDA authorization.

     (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained

without involvement of a health care provider. The coverage must be provided without imposing

any cost-sharing requirements, prior authorization, or other medical management requirements.

     (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member

to fewer than eight (8) tests per thirty (30) day period or per calendar month.

     (1) Insurers shall not be permitted to limit members to a smaller number of these OTC

COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week).

     (2) Insurers shall count each test separately if multiple tests are sold in one package.

     (e) To comply with this section, insurers must provide direct coverage for OTC COVID-

19 tests to members by reimbursing sellers directly without requiring members to provide upfront

payment and seek reimbursement.

     (1) Insurers shall establish a network of pharmacies or retailers online and in convenient

locations in Rhode Island, where members will be able to receive tests for free.

     (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer

must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests,

though an adequate number of retail locations, including both in-person and online locations.

     (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other

retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve

dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)).

     (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on

behalf of other covered members in the same household.

     (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal

use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through

various permissible activities; provided that, such steps do not create significant barriers for

members to obtain these tests.

     (h) Insurers shall inform enrollees in writing of the coverage available under this section.

     (i) The health insurance commissioner shall promulgate any regulations and issue any

guidance, as the commissioner deems necessary for the efficient administration and enforcement

of this section.

     (j) Insurers who do not comply with this section shall be considered non-compliant with §

27-18-86.

     (k) This section shall not apply to insurance coverage providing benefits for:

     (1) Hospital confinement indemnity;

     (2) Disability income;

     (3) Accident only;

     (4) Long-term care;

LC004999 - Page 2 of 10

     (5) Medicare supplement;

     (6) Limited benefit health;

     (7) Specified disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

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

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

     27-19-81. Over-the-counter COVID-19 tests.

     (a) Every individual or group health insurance contract, plan or policy issued for delivery

or renewed in this state on or after July 1, 2022, which provides medical coverage that includes

coverage for physician services in a physician's office, and every policy which provides major

medical or similar comprehensive-type coverage, shall include coverage for FDA approved over-

the-counter ("OTC") COVID-19 tests.

     (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the-

counter diagnostic test kit that serves to detect active COVID-19 infections and for which the

United States Food and Drug Administration has issued an authorization. The term includes:

     (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain

reaction (PCR) test, which provides results after a sample is received by a laboratory;

     (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which

provides results in minutes; and

     (3) Any other OTC test developed in the future that serves to detect active COVID-19 and

receives FDA authorization.

     (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained

without involvement of a health care provider. The coverage must be provided without imposing

any cost-sharing requirements, prior authorization, or other medical management requirements.

     (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member

to fewer than eight (8) tests per thirty (30) day period or per calendar month.

     (1) Insurers shall not be permitted to limit members to a smaller number of these OTC

COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week).

     (2) Insurers shall count each test separately if multiple tests are sold in one package.

     (e) To comply with this section, insurers must provide direct coverage for OTC COVID-

19 tests to members by reimbursing sellers directly without requiring members to provide upfront

payment and seek reimbursement.

     (1) Insurers shall establish a network of pharmacies or retailers online and in convenient

LC004999 - Page 3 of 10

locations in Rhode Island, where members will be able to receive tests for free.

     (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer

must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests,

though an adequate number of retail locations, including both in-person and online locations.

     (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other

retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve

dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)).

     (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on

behalf of other covered members in the same household.

     (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal

use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through

various permissible activities; provided that, such steps do not create significant barriers for

members to obtain these tests.

     (h) Insurers shall inform enrollees in writing of the coverage available under this section.

     (i) The health insurance commissioner shall promulgate any regulations and issue any

guidance as the commissioner deems necessary for the efficient administration and enforcement of

this section.

     (j) Insurers who do not comply with this section shall be considered non-compliant with §

27-19-78.

     (k) This section shall 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 disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

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

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

     27-20-77. Over-the-counter COVID-19 tests.

     (a) Every individual or group health insurance contract, plan or policy issued for delivery

or renewed in this state on or after July 1, 2022, which provides medical coverage that includes

LC004999 - Page 4 of 10

coverage for physician services in a physician's office, and every policy which provides major

medical or similar comprehensive-type coverage, shall include coverage for FDA approved over-

the-counter ("OTC") COVID-19 tests.

     (b) As used in this section, FDA approved OTC COVID-19 test means an over-the-counter

diagnostic test kit that serves to detect active COVID-19 infections and for which the United States

Food and Drug Administration has issued an authorization. The term includes:

     (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain

reaction (PCR) test, which provides results after a sample is received by a laboratory;

     (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which

provides results in minutes; and

     (3) Any other OTC test developed in the future that serves to detect active COVID-19 and

receives FDA authorization.

     (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained

without involvement of a health care provider. The coverage must be provided without imposing

any cost-sharing requirements, prior authorization, or other medical management requirements.

     (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member

to fewer than eight (8) tests per thirty (30) day period or per calendar month.

     (1) Insurers shall not be permitted to limit members to a smaller number of these OTC

COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week).

     (2) Insurers shall count each test separately if multiple tests are sold in one package.

     (e) To comply with this section, insurers must provide direct coverage for OTC COVID-

19 tests to members by reimbursing sellers directly without requiring members to provide upfront

payment and seek reimbursement.

     (1) Insurers shall establish a network of pharmacies or retailers online and in convenient

locations in Rhode Island, where members will be able to receive tests for free.

     (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer

must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests,

though an adequate number of retail locations, including both in-person and online locations.

     (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other

retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve

dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)).

     (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on

behalf of other covered members in the same household.

LC004999 - Page 5 of 10

     (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal

use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through

various permissible activities; provided that, such steps do not create significant barriers for

members to obtain these tests.

     (h) Insurers shall inform enrollees in writing of the coverage available under this section.

     (i) The health insurance commissioner shall promulgate any regulations and issue any

guidance as the commissioner deems necessary for the efficient administration and enforcement of

this section.

     (j) Insurers who do not comply with this section shall be considered non-compliant with §

27-20-74.

     (k) This section shall 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 disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

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

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

     27-41-94. Over-the-counter COVID-19 tests.

     (a) Every individual or group health insurance contract, plan or policy issued for delivery

or renewed in this state on or after July 1, 2022, which provides medical coverage that includes

coverage for physician services in a physician's office, and every policy which provides major

medical or similar comprehensive-type coverage, shall include coverage for FDA approved over-

the-counter ("OTC") COVID-19 tests.

     (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the-

counter diagnostic test kit that serves to detect active COVID-19 infections and for which the

United States Food and Drug Administration has issued an authorization. The term includes:

     (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain

reaction (PCR) test, which provides results after a sample is received by a laboratory;

     (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which

LC004999 - Page 6 of 10

provides results in minutes; and

     (3) Any other OTC test developed in the future that serves to detect active COVID-19 and

receives FDA authorization.

     (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained

without involvement of a health care provider. The coverage must be provided without imposing

any cost-sharing requirements, prior authorization, or other medical management requirements.

     (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member

to fewer than eight (8) tests per thirty (30) day period or per calendar month.

     (1) Insurers shall not be permitted to limit members to a smaller number of these OTC

COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week).

     (2) Insurers shall count each test separately if multiple tests are sold in one package.

     (e) To comply with this section, insurers must provide direct coverage for OTC COVID-

19 tests to members by reimbursing sellers directly without requiring members to provide upfront

payment and seek reimbursement.

     (1) Insurers shall establish a network of pharmacies or retailers online and in convenient

locations in Rhode Island, where members will be able to receive tests for free.

     (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer

must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests,

though an adequate number of retail locations, including both in-person and online locations.

     (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other

retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve

dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)).

     (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on

behalf of other covered members in the same household.

     (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal

use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through

various permissible activities; provided that, such steps do not create significant barriers for

members to obtain these tests.

     (h) Insurers shall inform enrollees in writing of the coverage available under this section.

     (i) The health insurance commissioner shall promulgate any regulations and issue any

guidance as the commissioner deems necessary for the efficient administration and enforcement of

this section.

     (j) Insurers who do not comply with this section shall be considered non-compliant with §

27-41-91.

LC004999 - Page 7 of 10

     (k) This section shall 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 disease indemnity;

     (8) Sickness or bodily injury or death by accident or both; and

     (9) Other limited benefit policies.

     SECTION 5. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human

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

     42-7.2-21. Over-the-counter COVID-19 tests.

     (a) Rhode Island Medicaid and its contracted managed care entities shall provide coverage

for FDA approved over-the-counter (OTC) COVID-19 tests through the pharmacy benefit.

     (b) As used in this section, FDA approved OTC COVID-19 test means an over-the-counter

diagnostic test kit that serves to detect active COVID-19 infections and for which the United States

Food and Drug Administration has issued an authorization. The term includes:

     (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain

reaction (PCR) test, which provides results after a sample is received by a laboratory;

     (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which

provides results in minutes; and

     (3) Any other OTC test developed in the future that serves to detect active COVID-19 and

receives FDA authorization.

     (c) Rhode Island Medicaid and its contracted managed care entities must cover FDA

approved OTC COVID-19 tests, including tests obtained without involvement of a health care

provider. The coverage must be provided without imposing any cost-sharing requirements, prior

authorization, or other medical management requirements.

     (d) Rhode Island Medicaid and its contracted managed care entities shall not limit the

number of OTC COVID-19 tests covered for each member to fewer than eight (8) tests per thirty

(30) day period or per calendar month.

     (1) Rhode Island Medicaid and its contracted managed care entities shall not be permitted

to limit members to a smaller number of these OTC COVID-19 tests over a shorter period (for

example, limiting individuals for two (2) tests per week).

LC004999 - Page 8 of 10

     (2) Rhode Island Medicaid and its contracted managed care entities shall count each test

separately if multiple tests are sold in one package.

     (e) To comply with this section, Rhode Island Medicaid and its contracted managed care

entities must provide direct coverage for OTC COVID-19 tests to members by reimbursing sellers

directly without requiring members to provide upfront payment and seek reimbursement.

     (1) Rhode Island Medicaid and its contracted managed care entities shall establish a

network of pharmacies or retailers online and in convenient locations in Rhode Island, where

members will be able to receive tests for free.

     (2) In providing OTC COVID-19 tests through the direct coverage program, Rhode Island

Medicaid and its contracted managed care entities must take reasonable steps to ensure that

members have adequate access to OTC COVID-19 tests, though an adequate number of retail

locations, including both in-person and online locations.

     (3) Rhode Island Medicaid and its contracted managed care entities shall permit members

to elect to purchase OTC COVID-19 tests from other retailers outside the network. In such cases,

Rhode Island Medicaid and its contracted managed care entities shall reimburse the member at least

twelve dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars

($12.00)).

     (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on

behalf of other covered members in the same household.

     (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal

use and not for resale. Rhode Island Medicaid and its contracted managed care entities may act to

prevent, detect, and address fraud and abuse through various permissible activities; provided that,

such steps do not create significant barriers for members to obtain these tests.

     (h) Rhode Island Medicaid and its contracted managed care entities shall inform enrollees

in writing of the coverage available under this section.

     (i) The secretary shall promulgate any regulations and issue any guidance as the secretary

deems necessary for the efficient administration and enforcement of this section.

     SECTION 6. This act shall take effect on January 1, 2023.

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LC004999

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LC004999 - Page 9 of 10

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 mandate that health insurance companies and Medicaid provide coverage

for FDA approved COVID-19 home testing kits.

     This act would take effect on January 1, 2023.

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LC004999

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LC004999 - Page 10 of 10