2022 -- S 2325 | |
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LC004496 | |
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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 | |
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Introduced By: Senators DiMario, Euer, Miller, Cano, Murray, Lawson, Valverde, | |
Date Introduced: February 15, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance |
2 | Policies" is hereby amended by adding thereto the following section: |
3 | 27-18-89. Over-the-counter COVID-19 tests. |
4 | (a) Every individual or group health insurance contract, plan or policy issued for delivery |
5 | or renewed in this state on or after July 1, 2022, which provides medical coverage that includes |
6 | coverage for physician services in a physician's office, and every policy which provides major |
7 | medical or similar comprehensive-type coverage, shall include coverage for FDA approved over- |
8 | the-counter ("OTC") COVID-19 tests. |
9 | (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the- |
10 | counter diagnostic test kit that serves to detect active COVID-19 infections and for which the |
11 | United States Food and Drug Administration has issued an authorization. The term includes: |
12 | (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain |
13 | reaction (PCR) test, which provides results after a sample is received by a laboratory; |
14 | (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which |
15 | provides results in minutes; and |
16 | (3) Any other OTC test developed in the future that serves to detect active COVID-19 and |
17 | receives FDA authorization. |
18 | (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained |
19 | without involvement of a health care provider. The coverage must be provided without imposing |
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1 | any cost-sharing requirements, prior authorization, or other medical management requirements. |
2 | (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member |
3 | to fewer than eight (8) tests per thirty (30) day period or per calendar month. |
4 | (1) Insurers shall not be permitted to limit members to a smaller number of these OTC |
5 | COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week). |
6 | (2) Insurers shall count each test separately if multiple tests are sold in one package. |
7 | (e) To comply with this section, insurers must provide direct coverage for OTC COVID- |
8 | 19 tests to members by reimbursing sellers directly without requiring members to provide upfront |
9 | payment and seek reimbursement. |
10 | (1) Insurers shall establish a network of pharmacies or retailers online and in convenient |
11 | locations in Rhode Island, where members will be able to receive tests for free. |
12 | (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer |
13 | must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests, |
14 | though an adequate number of retail locations, including both in-person and online locations. |
15 | (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other |
16 | retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve |
17 | dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)). |
18 | (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on |
19 | behalf of other covered members in the same household. |
20 | (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal |
21 | use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through |
22 | various permissible activities; provided that, such steps do not create significant barriers for |
23 | members to obtain these tests. |
24 | (h) Insurers shall inform enrollees in writing of the coverage available under this section. |
25 | (i) The health insurance commissioner shall promulgate any regulations and issue any |
26 | guidance, as the commissioner deems necessary for the efficient administration and enforcement |
27 | of this section. |
28 | (j) Insurers who do not comply with this section shall be considered non-compliant with § |
29 | 27-18-86. |
30 | (k) This section shall not apply to insurance coverage providing benefits for: |
31 | (1) Hospital confinement indemnity; |
32 | (2) Disability income; |
33 | (3) Accident only; |
34 | (4) Long-term care; |
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1 | (5) Medicare supplement; |
2 | (6) Limited benefit health; |
3 | (7) Specified disease indemnity; |
4 | (8) Sickness or bodily injury or death by accident or both; and |
5 | (9) Other limited benefit policies. |
6 | SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service |
7 | Corporations" is hereby amended by adding thereto the following section: |
8 | 27-19-81. Over-the-counter COVID-19 tests. |
9 | (a) Every individual or group health insurance contract, plan or policy issued for delivery |
10 | or renewed in this state on or after July 1, 2022, which provides medical coverage that includes |
11 | coverage for physician services in a physician's office, and every policy which provides major |
12 | medical or similar comprehensive-type coverage, shall include coverage for FDA approved over- |
13 | the-counter ("OTC") COVID-19 tests. |
14 | (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the- |
15 | counter diagnostic test kit that serves to detect active COVID-19 infections and for which the |
16 | United States Food and Drug Administration has issued an authorization. The term includes: |
17 | (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain |
18 | reaction (PCR) test, which provides results after a sample is received by a laboratory; |
19 | (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which |
20 | provides results in minutes; and |
21 | (3) Any other OTC test developed in the future that serves to detect active COVID-19 and |
22 | receives FDA authorization. |
23 | (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained |
24 | without involvement of a health care provider. The coverage must be provided without imposing |
25 | any cost-sharing requirements, prior authorization, or other medical management requirements. |
26 | (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member |
27 | to fewer than eight (8) tests per thirty (30) day period or per calendar month. |
28 | (1) Insurers shall not be permitted to limit members to a smaller number of these OTC |
29 | COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week). |
30 | (2) Insurers shall count each test separately if multiple tests are sold in one package. |
31 | (e) To comply with this section, insurers must provide direct coverage for OTC COVID- |
32 | 19 tests to members by reimbursing sellers directly without requiring members to provide upfront |
33 | payment and seek reimbursement. |
34 | (1) Insurers shall establish a network of pharmacies or retailers online and in convenient |
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1 | locations in Rhode Island, where members will be able to receive tests for free. |
2 | (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer |
3 | must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests, |
4 | though an adequate number of retail locations, including both in-person and online locations. |
5 | (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other |
6 | retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve |
7 | dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)). |
8 | (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on |
9 | behalf of other covered members in the same household. |
10 | (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal |
11 | use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through |
12 | various permissible activities; provided that, such steps do not create significant barriers for |
13 | members to obtain these tests. |
14 | (h) Insurers shall inform enrollees in writing of the coverage available under this section. |
15 | (i) The health insurance commissioner shall promulgate any regulations and issue any |
16 | guidance as the commissioner deems necessary for the efficient administration and enforcement of |
17 | this section. |
18 | (j) Insurers who do not comply with this section shall be considered non-compliant with § |
19 | 27-19-78. |
20 | (k) This section shall not apply to insurance coverage providing benefits for: |
21 | (1) Hospital confinement indemnity; |
22 | (2) Disability income; |
23 | (3) Accident only; |
24 | (4) Long-term care; |
25 | (5) Medicare supplement; |
26 | (6) Limited benefit health; |
27 | (7) Specified disease indemnity; |
28 | (8) Sickness or bodily injury or death by accident or both; and |
29 | (9) Other limited benefit policies. |
30 | SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service |
31 | Corporations" is hereby amended by adding thereto the following section: |
32 | 27-20-77. Over-the-counter COVID-19 tests. |
33 | (a) Every individual or group health insurance contract, plan or policy issued for delivery |
34 | or renewed in this state on or after July 1, 2022, which provides medical coverage that includes |
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1 | coverage for physician services in a physician's office, and every policy which provides major |
2 | medical or similar comprehensive-type coverage, shall include coverage for FDA approved over- |
3 | the-counter ("OTC") COVID-19 tests. |
4 | (b) As used in this section, FDA approved OTC COVID-19 test means an over-the-counter |
5 | diagnostic test kit that serves to detect active COVID-19 infections and for which the United States |
6 | Food and Drug Administration has issued an authorization. The term includes: |
7 | (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain |
8 | reaction (PCR) test, which provides results after a sample is received by a laboratory; |
9 | (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which |
10 | provides results in minutes; and |
11 | (3) Any other OTC test developed in the future that serves to detect active COVID-19 and |
12 | receives FDA authorization. |
13 | (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained |
14 | without involvement of a health care provider. The coverage must be provided without imposing |
15 | any cost-sharing requirements, prior authorization, or other medical management requirements. |
16 | (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member |
17 | to fewer than eight (8) tests per thirty (30) day period or per calendar month. |
18 | (1) Insurers shall not be permitted to limit members to a smaller number of these OTC |
19 | COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week). |
20 | (2) Insurers shall count each test separately if multiple tests are sold in one package. |
21 | (e) To comply with this section, insurers must provide direct coverage for OTC COVID- |
22 | 19 tests to members by reimbursing sellers directly without requiring members to provide upfront |
23 | payment and seek reimbursement. |
24 | (1) Insurers shall establish a network of pharmacies or retailers online and in convenient |
25 | locations in Rhode Island, where members will be able to receive tests for free. |
26 | (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer |
27 | must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests, |
28 | though an adequate number of retail locations, including both in-person and online locations. |
29 | (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other |
30 | retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve |
31 | dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)). |
32 | (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on |
33 | behalf of other covered members in the same household. |
34 |
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1 | (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal |
2 | use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through |
3 | various permissible activities; provided that, such steps do not create significant barriers for |
4 | members to obtain these tests. |
5 | (h) Insurers shall inform enrollees in writing of the coverage available under this section. |
6 | (i) The health insurance commissioner shall promulgate any regulations and issue any |
7 | guidance as the commissioner deems necessary for the efficient administration and enforcement of |
8 | this section. |
9 | (j) Insurers who do not comply with this section shall be considered non-compliant with § |
10 | 27-20-74. |
11 | (k) This section shall not apply to insurance coverage providing benefits for: |
12 | (1) Hospital confinement indemnity; |
13 | (2) Disability income; |
14 | (3) Accident only; |
15 | (4) Long-term care; |
16 | (5) Medicare supplement; |
17 | (6) Limited benefit health; |
18 | (7) Specified disease indemnity; |
19 | (8) Sickness or bodily injury or death by accident or both; and |
20 | (9) Other limited benefit policies. |
21 | SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance |
22 | Organizations" is hereby amended by adding thereto the following section: |
23 | 27-41-94. Over-the-counter COVID-19 tests. |
24 | (a) Every individual or group health insurance contract, plan or policy issued for delivery |
25 | or renewed in this state on or after July 1, 2022, which provides medical coverage that includes |
26 | coverage for physician services in a physician's office, and every policy which provides major |
27 | medical or similar comprehensive-type coverage, shall include coverage for FDA approved over- |
28 | the-counter ("OTC") COVID-19 tests. |
29 | (b) As used in this section, "FDA approved OTC COVID-19 test" means an over-the- |
30 | counter diagnostic test kit that serves to detect active COVID-19 infections and for which the |
31 | United States Food and Drug Administration has issued an authorization. The term includes: |
32 | (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain |
33 | reaction (PCR) test, which provides results after a sample is received by a laboratory; |
34 | (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which |
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1 | provides results in minutes; and |
2 | (3) Any other OTC test developed in the future that serves to detect active COVID-19 and |
3 | receives FDA authorization. |
4 | (c) Insurers must cover FDA approved OTC COVID-19 tests, including tests obtained |
5 | without involvement of a health care provider. The coverage must be provided without imposing |
6 | any cost-sharing requirements, prior authorization, or other medical management requirements. |
7 | (d) Insurers shall not limit the number of OTC COVID-19 tests covered for each member |
8 | to fewer than eight (8) tests per thirty (30) day period or per calendar month. |
9 | (1) Insurers shall not be permitted to limit members to a smaller number of these OTC |
10 | COVID-19 tests over a shorter period (for example, limiting individuals for two (2) tests per week). |
11 | (2) Insurers shall count each test separately if multiple tests are sold in one package. |
12 | (e) To comply with this section, insurers must provide direct coverage for OTC COVID- |
13 | 19 tests to members by reimbursing sellers directly without requiring members to provide upfront |
14 | payment and seek reimbursement. |
15 | (1) Insurers shall establish a network of pharmacies or retailers online and in convenient |
16 | locations in Rhode Island, where members will be able to receive tests for free. |
17 | (2) In providing OTC COVID-19 tests through the direct coverage program, an insurer |
18 | must take reasonable steps to ensure that members have adequate access to OTC COVID-19 tests, |
19 | though an adequate number of retail locations, including both in-person and online locations. |
20 | (3) Insurers shall permit members to elect to purchase OTC COVID-19 tests from other |
21 | retailers outside the network. In such cases, the insurer shall reimburse the member at least twelve |
22 | dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars ($12.00)). |
23 | (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on |
24 | behalf of other covered members in the same household. |
25 | (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal |
26 | use and not for resale. Insurers may act to prevent, detect, and address fraud and abuse through |
27 | various permissible activities; provided that, such steps do not create significant barriers for |
28 | members to obtain these tests. |
29 | (h) Insurers shall inform enrollees in writing of the coverage available under this section. |
30 | (i) The health insurance commissioner shall promulgate any regulations and issue any |
31 | guidance as the commissioner deems necessary for the efficient administration and enforcement of |
32 | this section. |
33 | (j) Insurers who do not comply with this section shall be considered non-compliant with § |
34 | 27-41-91. |
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1 | (k) This section shall not apply to insurance coverage providing benefits for: |
2 | (1) Hospital confinement indemnity; |
3 | (2) Disability income; |
4 | (3) Accident only; |
5 | (4) Long-term care; |
6 | (5) Medicare supplement; |
7 | (6) Limited benefit health; |
8 | (7) Specified disease indemnity; |
9 | (8) Sickness or bodily injury or death by accident or both; and |
10 | (9) Other limited benefit policies. |
11 | SECTION 5. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human |
12 | Services" is hereby amended by adding thereto the following section: |
13 | 42-7.2-21. Over-the-counter COVID-19 tests. |
14 | (a) Rhode Island Medicaid and its contracted managed care entities shall provide coverage |
15 | for FDA approved over-the-counter (OTC) COVID-19 tests through the pharmacy benefit. |
16 | (b) As used in this section, FDA approved OTC COVID-19 test means an over-the-counter |
17 | diagnostic test kit that serves to detect active COVID-19 infections and for which the United States |
18 | Food and Drug Administration has issued an authorization. The term includes: |
19 | (1) A COVID-19 self-collection kit, including, but not limited to, a polymerase chain |
20 | reaction (PCR) test, which provides results after a sample is received by a laboratory; |
21 | (2) A COVID-19 self-test kit, including, but not limited to, a rapid antigen test, which |
22 | provides results in minutes; and |
23 | (3) Any other OTC test developed in the future that serves to detect active COVID-19 and |
24 | receives FDA authorization. |
25 | (c) Rhode Island Medicaid and its contracted managed care entities must cover FDA |
26 | approved OTC COVID-19 tests, including tests obtained without involvement of a health care |
27 | provider. The coverage must be provided without imposing any cost-sharing requirements, prior |
28 | authorization, or other medical management requirements. |
29 | (d) Rhode Island Medicaid and its contracted managed care entities shall not limit the |
30 | number of OTC COVID-19 tests covered for each member to fewer than eight (8) tests per thirty |
31 | (30) day period or per calendar month. |
32 | (1) Rhode Island Medicaid and its contracted managed care entities shall not be permitted |
33 | to limit members to a smaller number of these OTC COVID-19 tests over a shorter period (for |
34 | example, limiting individuals for two (2) tests per week). |
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1 | (2) Rhode Island Medicaid and its contracted managed care entities shall count each test |
2 | separately if multiple tests are sold in one package. |
3 | (e) To comply with this section, Rhode Island Medicaid and its contracted managed care |
4 | entities must provide direct coverage for OTC COVID-19 tests to members by reimbursing sellers |
5 | directly without requiring members to provide upfront payment and seek reimbursement. |
6 | (1) Rhode Island Medicaid and its contracted managed care entities shall establish a |
7 | network of pharmacies or retailers online and in convenient locations in Rhode Island, where |
8 | members will be able to receive tests for free. |
9 | (2) In providing OTC COVID-19 tests through the direct coverage program, Rhode Island |
10 | Medicaid and its contracted managed care entities must take reasonable steps to ensure that |
11 | members have adequate access to OTC COVID-19 tests, though an adequate number of retail |
12 | locations, including both in-person and online locations. |
13 | (3) Rhode Island Medicaid and its contracted managed care entities shall permit members |
14 | to elect to purchase OTC COVID-19 tests from other retailers outside the network. In such cases, |
15 | Rhode Island Medicaid and its contracted managed care entities shall reimburse the member at least |
16 | twelve dollars ($12.00) per individual test (or the cost of the test, if less than twelve dollars |
17 | ($12.00)). |
18 | (f) The direct coverage program shall permit members to obtain OTC COVID-19 tests on |
19 | behalf of other covered members in the same household. |
20 | (g) OTC COVID-19 tests obtained pursuant to this section shall be for at-home personal |
21 | use and not for resale. Rhode Island Medicaid and its contracted managed care entities may act to |
22 | prevent, detect, and address fraud and abuse through various permissible activities; provided that, |
23 | such steps do not create significant barriers for members to obtain these tests. |
24 | (h) Rhode Island Medicaid and its contracted managed care entities shall inform enrollees |
25 | in writing of the coverage available under this section. |
26 | (i) The secretary shall promulgate any regulations and issue any guidance as the secretary |
27 | deems necessary for the efficient administration and enforcement of this section. |
28 | SECTION 6. This act shall take effect on January 1, 2023. |
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LC004496 | |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES | |
*** | |
1 | This act would mandate that health insurance companies and Medicaid provide coverage |
2 | for FDA approved COVID-19 home testing kits. |
3 | This act would take effect on January 1, 2023. |
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LC004496 | |
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