NY State Senate Bill 2017-S9120

Archive: Last Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
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Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 20, 2018	referred to rules

2017-S9120 (ACTIVE) - Details

Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §§3221, 4303 & 3216, Ins L

2017-S9120 (ACTIVE) - Summary

Relates to insurance coverage for FDA-approved contraceptive drugs, devices and products and contraceptive education, counseling and follow up services.

2017-S9120 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S9120

SPONSOR: HANNON
 
TITLE OF BILL:

An act to amend the insurance law, in relation to requiring health
insurance policies to include coverage of all FDA-approved contraceptive
drugs, devices, and products, contraceptive education and counseling,
and related follow up services and prohibiting a health insurance policy
from imposing any cost-sharing requirements or other restrictions or
delays with respect to this coverage

 
PURPOSE:

Ensure women have access to contraception, and related counseling and
follow-up, without cost-sharing.

 
SUMMARY OF PROVISIONS:

Sections one, two and three amend Insurance Law §§ 3221(1)(16),
4303(cc), and 3216(i)(17)(E) respectively to require insurance coverage

of all FDA-approved contraceptive drugs, devices and other products. At
least one form of contraception within each method of contraception must
be provided without cost-sharing. These sections further provide that
when a prescribing health care provider recommends a particular service
or FDA-approved item based on a determination of medically necessity,
the insurer must cover that service or item without cost-sharing. Such
coverage must also allow for the dispensing of an initial three-month
supply, and the subsequent dispensing of the same contraceptive for up
to a twelve-month supply. Follow-up, education and counseling related to
contraception must also be covered without cost-sharing.

Section four provides the effective date.

 
JUSTIFICATION:

This legislation will ensure women in New York have continued access to
contraception without cost-sharing. In 2002, New York enacted the
Women's Health and Wellness Act, which required, with certain religious
exemptions, that insurers provide coverage of contraception. Under this
law, such coverage could be subject to cost-sharing. Subsequently, the
Affordable Care Act required coverage of all FDA-approved contraceptive
drugs, devices and products without cost-sharing. Since the ACA enact-
ment, the federal government has put forth guidance on how this require-
ment is to be implement. The FDA has approved 18 methods of birth
control, including emergency contraception.

In the wake of federal uncertainty regarding the Affordable Care Act,
this legislation is essential in ensuring the women of New York continue
to have access to cost-free contraception. Codifying these provisions in
state law will modernize our law, make it consistent with current prac-
tice, and most importantly, guarantee women in the state continued
coverage, without cost-sharing, of all prescribed FDA-approved methods.
This legislation also codifies Department of Financial Service regu-
lations that require coverage of an initial prescription of a three-
month supply, and the subsequent dispensing of up to a twelve-month
supply.

 
LEGISLATIVE HISTORY:
New bill.

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Effective January 1, 2019 and shall apply to all policies issued,
renewed, modified or amended after that date.

2017-S9120 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9120
 
                             I N  S E N A T E
 
                               June 20, 2018
                                ___________
 
 Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
   printed to be committed to the Committee on Rules
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  policies to include coverage of all FDA-approved contracep-
   tive drugs, devices, and products, contraceptive education  and  coun-
   seling, and related follow up services and prohibiting a health insur-
   ance  policy  from  imposing  any  cost-sharing  requirements or other
   restrictions or delays with respect to this coverage
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  16  of  subsection  (l) of section 3221 of the
 insurance law, as added by chapter 554 of the laws of 2002,  is  amended
 to read as follows:
   (16)  (A)  Every  group  or blanket policy which provides coverage for
 prescription drugs shall [include coverage for the cost of contraceptive
 drugs or devices approved by the federal food and drug administration or
 generic equivalents approved as substitutes by such food and drug admin-
 istration under the prescription  of  a  health  care  provider  legally
 authorized  to  prescribe  under  title  eight of the education law. The
 coverage required by this section shall  be  included  in  policies  and
 certificates only through the addition of a rider.
   (A)] PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES AND CONTRACEP-
 TIVE METHODS:
   (1)  ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER PRODUCTS
 PROVIDED  FOR  IN  COMPREHENSIVE  GUIDELINES  SUPPORTED  BY  THE  HEALTH
 RESOURCES  AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A PHYSI-
 CIAN OR OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY  AUTHORIZED  TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.  THE FOLLOWING APPLIES
 TO THIS COVERAGE:
   (A)  WHERE  THE  FDA  HAS  APPROVED ONE OR MORE FORMS OF CONTRACEPTION
 WITHIN A METHOD OF CONTRACEPTION IDENTIFIED BY THE FDA, A GROUP OR BLAN-
 KET POLICY IS NOT REQUIRED TO INCLUDE ALL SUCH FORMS IN  ITS  FORMULARY,
 SO LONG AS AT LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD06579-19-8

 S. 9120                             2
 
   (B)  IF  THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE  EDUCATION  LAW
 RECOMMENDS A PARTICULAR SERVICE OR FDA-APPROVED ITEM BASED ON A DETERMI-
 NATION  OF MEDICAL NECESSITY WITH RESPECT TO THAT INDIVIDUAL, A GROUP OR
 BLANKET POLICY MUST COVER THAT SERVICE OR ITEM WITHOUT COST-SHARING;
   (C)  THIS  COVERAGE MUST ALLOW FOR THE DISPENSING OF AN INITIAL THREE-
 MONTH SUPPLY.  FOR  SUBSEQUENT  DISPENSING  OF  THE  SAME  CONTRACEPTIVE
 PRESCRIBED  BY  THE  PHYSICIAN  OR  OTHER  LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE  EDUCATION  LAW
 AND  COVERED  UNDER THE SAME POLICY OR RENEWAL THEREOF, AN INSURER SHALL
 ALLOW COVERAGE FOR THE DISPENSING OF THE ENTIRE PRESCRIBED SUPPLY, UP TO
 TWELVE MONTHS, AT THE SAME TIME;
   (2) PATIENT EDUCATION AND COUNSELING ON  CONTRACEPTION  WITHOUT  COST-
 SHARING; AND
   (3)  FOLLOW-UP  SERVICES  RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
 PROCEDURES COVERED UNDER THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED  TO,
 MANAGEMENT  OF  SIDE  EFFECTS,  COUNSELING  FOR CONTINUED ADHERENCE, AND
 DEVICE INSERTION AND REMOVAL WITHOUT COST-SHARING.
   (B) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT REASONABLE
 MEDICAL MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS  OR
 SERVICES PROVIDED HEREIN.
   (C)  Notwithstanding  any  other provision of this subsection, a reli-
 gious employer may request a contract without coverage for federal  food
 and drug administration approved contraceptive methods that are contrary
 to  the  religious  employer's  religious  tenets. If so requested, such
 contract shall be provided without coverage for  contraceptive  methods.
 This  paragraph  shall not be construed to deny an enrollee coverage of,
 and timely access to, contraceptive methods.
   (1) For purposes of this subsection,  a  "religious  employer"  is  an
 entity for which each of the following is true:
   (a) The inculcation of religious values is the purpose of the entity.
   (b)  The  entity  primarily  employs  persons  who share the religious
 tenets of the entity.
   (c) The entity serves primarily persons who share the religious tenets
 of the entity.
   (d) The entity is a nonprofit organization  as  described  in  Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
   (2) Every religious employer that invokes the exemption provided under
 this  paragraph  shall  provide  written notice to prospective enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(B) (i)] (D) (1) Where a group policyholder makes an election not  to
 purchase  coverage for contraceptive drugs or devices in accordance with
 subparagraph [(A)] (C) of this paragraph each certificateholder  covered
 under  the policy issued to that group policyholder shall have the right
 to directly purchase the rider  required  by  this  paragraph  from  the
 insurer  which  issued  the  group  policy at the prevailing small group
 community rate for such rider whether or not the employee is part  of  a
 small group.
   [(ii)]  (2)  Where  a  group  policyholder  makes  an  election not to
 purchase coverage for contraceptive drugs or devices in accordance  with
 subparagraph [(A)] (C) of this paragraph, the insurer that provides such
 coverage shall provide written notice to certificateholders upon enroll-
 ment  with  the  insurer of their right to directly purchase a rider for
 coverage for the cost of contraceptive  drugs  or  devices.  The  notice

 S. 9120                             3
 
 shall  also  advise the certificateholders of the additional premium for
 such coverage.
   [(C)]  (E) Nothing in this paragraph shall be construed as authorizing
 a group or blanket policy which provides coverage for prescription drugs
 to exclude coverage for prescription drugs prescribed for reasons  other
 than contraceptive purposes.
   [(D) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   § 2. Subsection (cc) of section 4303 of the insurance law, as added by
 chapter 554 of the laws of 2002, is amended to read as follows:
   (cc) (1) Every contract which provides coverage for prescription drugs
 shall [include coverage for the cost of contraceptive drugs  or  devices
 approved  by  the federal food and drug administration or generic equiv-
 alents approved as substitutes by  such  food  and  drug  administration
 under  the  prescription of a health care provider legally authorized to
 prescribe under title eight of the education law. The coverage  required
 by  this  section  shall  be included in contracts and certificates only
 through the addition of a rider.
   (1)] PROVIDE COVERAGE FOR ALL OF THE FOLLOWING SERVICES AND CONTRACEP-
 TIVE METHODS:
   (A) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER  PRODUCTS
 PROVIDED  FOR  IN  COMPREHENSIVE  GUIDELINES  SUPPORTED  BY  THE  HEALTH
 RESOURCES AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A  PHYSI-
 CIAN  OR  OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.  THE FOLLOWING APPLIES
 TO THIS COVERAGE:
   (I) WHERE THE FDA HAS APPROVED ONE  OR  MORE  FORMS  OF  CONTRACEPTION
 WITHIN  A  METHOD  OF CONTRACEPTION IDENTIFIED BY THE FDA, A CONTRACT IS
 NOT REQUIRED TO INCLUDE ALL SUCH FORMS IN ITS FORMULARY, SO LONG  AS  AT
 LEAST ONE IS INCLUDED AND COVERED WITHOUT COST-SHARING;
   (II)  IF THE TREATING PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE  EDUCATION  LAW
 RECOMMENDS A PARTICULAR SERVICE OR FDA-APPROVED ITEM BASED ON A DETERMI-
 NATION  OF MEDICAL NECESSITY WITH RESPECT TO THAT INDIVIDUAL, A CONTRACT
 MUST COVER THAT SERVICE OR ITEM WITHOUT COST-SHARING;
   (III) THIS COVERAGE MUST ALLOW FOR THE DISPENSING OF AN INITIAL THREE-
 MONTH SUPPLY.  FOR  SUBSEQUENT  DISPENSING  OF  THE  SAME  CONTRACEPTIVE
 PRESCRIBED  BY  THE  PHYSICIAN  OR  OTHER  LICENSED HEALTH CARE PROVIDER
 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE  EDUCATION  LAW
 AND  COVERED  UNDER THE SAME POLICY OR RENEWAL THEREOF, AN INSURER SHALL
 ALLOW COVERAGE FOR THE DISPENSING OF THE ENTIRE PRESCRIBED SUPPLY, UP TO
 TWELVE MONTHS, AT THE SAME TIME;
   (B) PATIENT EDUCATION AND COUNSELING ON  CONTRACEPTION  WITHOUT  COST-
 SHARING; AND
   (C)  FOLLOW-UP  SERVICES  RELATED TO THE DRUGS, DEVICES, PRODUCTS, AND
 PROCEDURES COVERED UNDER THIS SUBSECTION, INCLUDING, BUT NOT LIMITED TO,
 MANAGEMENT OF SIDE EFFECTS,  COUNSELING  FOR  CONTINUED  ADHERENCE,  AND
 DEVICE INSERTION AND REMOVAL WITHOUT COST-SHARING.
   (2) NOTHING IN THIS PARAGRAPH SHALL BE CONSTRUED TO PREVENT REASONABLE
 MEDICAL  MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS OR
 SERVICES PROVIDED HEREIN.
   (3) Notwithstanding any other provision of this  subsection,  a  reli-
 gious  employer may request a contract without coverage for federal food
 and drug administration approved contraceptive methods that are contrary

 S. 9120                             4
 
 to the religious employer's religious  tenets.  If  so  requested,  such
 contract  shall  be provided without coverage for contraceptive methods.
 This paragraph shall not be construed to deny an enrollee  coverage  of,
 and timely access to, contraceptive methods.
   (A)  For  purposes  of  this  subsection, a "religious employer" is an
 entity for which each of the following is true:
   (i) The inculcation of religious values is the purpose of the entity.
   (ii) The entity primarily employs  persons  who  share  the  religious
 tenets of the entity.
   (iii)  The  entity  serves  primarily  persons who share the religious
 tenets of the entity.
   (iv) The entity is a nonprofit organization as  described  in  Section
 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended.
   (B) Every religious employer that invokes the exemption provided under
 this  paragraph  shall  provide  written notice to prospective enrollees
 prior to enrollment with the plan, listing the contraceptive health care
 services the employer refuses to cover for religious reasons.
   [(2)](4) (A) Where a group contractholder makes  an  election  not  to
 purchase  coverage for contraceptive drugs or devices in accordance with
 paragraph [one] THREE of this subsection, each  enrollee  covered  under
 the contract issued to that group contractholder shall have the right to
 directly purchase the rider required by this subsection from the insurer
 or  health  maintenance  organization which issued the group contract at
 the prevailing small group community rate for such rider whether or  not
 the employee is part of a small group.
   (B)  Where  a  group  contractholder makes an election not to purchase
 coverage for contraceptive drugs or devices in accordance with paragraph
 [one] THREE of this subsection, the insurer or health maintenance organ-
 ization that provides such coverage  shall  provide  written  notice  to
 enrollees  upon enrollment with the insurer or health maintenance organ-
 ization of their right to directly purchase a rider for coverage for the
 cost of contraceptive drugs or devices. The notice shall also advise the
 enrollees of the additional premium for such coverage.
   [(3)](5) Nothing in this subsection shall be construed as  authorizing
 a  contract  which  provides  coverage for prescription drugs to exclude
 coverage for  prescription  drugs  prescribed  for  reasons  other  than
 contraceptive purposes.
   [(4) Such coverage may be subject to reasonable annual deductibles and
 coinsurance  as  may  be deemed appropriate by the superintendent and as
 are consistent with those established for other drugs or devices covered
 under the policy.]
   § 3. Clauses (iii) and (iv) of subparagraph (E)  of  paragraph  17  of
 subsection (i) of section 3216 of the insurance law, as amended by chap-
 ter  219  of the laws of 2011, are amended and a new clause (v) is added
 to read as follows:
   (iii) with respect to children,  including  infants  and  adolescents,
 evidence-informed preventive care and screenings provided for in compre-
 hensive guidelines supported by the health resources and services admin-
 istration; [and]
   (iv)  with  respect  to  women,  such  additional  preventive care and
 screenings not described  in  item  (i)  of  this  subparagraph  and  as
 provided  for  in  comprehensive  guidelines  supported  by  the  health
 resources and services administration[.]; AND
   (V) ALL FDA-APPROVED CONTRACEPTIVE DRUGS, DEVICES, AND OTHER  PRODUCTS
 PROVIDED  FOR  IN  COMPREHENSIVE  GUIDELINES  SUPPORTED  BY  THE  HEALTH
 RESOURCES AND SERVICES ADMINISTRATION (HRSA), AS PRESCRIBED BY A  PHYSI-

 S. 9120                             5

 CIAN  OR  OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW; PATIENT EDUCATION  AND
 COUNSELING  ON  CONTRACEPTION;  AND  FOLLOW-UP  SERVICES  RELATED TO THE
 DRUGS,  DEVICES,  PRODUCTS,  AND  PROCEDURES  COVERED UNDER THIS CLAUSE,
 INCLUDING, BUT NOT LIMITED TO, MANAGEMENT OF  SIDE  EFFECTS,  COUNSELING
 FOR  CONTINUED  ADHERENCE,  AND  DEVICE  INSERTION AND REMOVAL. HOWEVER,
 WHERE THE FDA HAS APPROVED ONE OR MORE FORMS OF CONTRACEPTION  WITHIN  A
 METHOD  OF CONTRACEPTION IDENTIFIED BY THE FDA, VERSIONS OF A CONTRACEP-
 TIVE DRUG, DEVICE, OR PRODUCT, A CONTRACT IS NOT REQUIRED TO INCLUDE ALL
 SUCH METHODS IN ITS FORMULARY, SO LONG AS AT LEAST ONE IS  INCLUDED  AND
 COVERED WITHOUT COST-SHARING.  PROVIDED, HOWEVER, IF THE TREATING PHYSI-
 CIAN  OR  OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW RECOMMENDS A PARTICULAR
 SERVICE OR FDA-APPROVED ITEM  BASED  ON  THE  DETERMINATION  OF  MEDICAL
 NECESSITY  WITH  RESPECT  TO THAT INDIVIDUAL, A CONTRACT MUST COVER THAT
 SERVICE OR ITEM WITHOUT COST-SHARING. THIS COVERAGE MUST ALLOW  FOR  THE
 DISPENSING  OF  AN INITIAL THREE-MONTH SUPPLY. FOR SUBSEQUENT DISPENSING
 OF THE SAME CONTRACEPTIVE PRESCRIBED BY THE PHYSICIAN OR OTHER  LICENSED
 HEALTH  CARE  PROVIDER LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT
 OF THE EDUCATION LAW AND COVERED UNDER THE SAME POLICY OR RENEWAL THERE-
 OF, AN INSURER SHALL ALLOW COVERAGE FOR THE  DISPENSING  OF  THE  ENTIRE
 PRESCRIBED  SUPPLY,  UP  TO TWELVE MONTHS, AT THE SAME TIME.  NOTHING IN
 THIS SUBPARAGRAPH SHALL  BE  CONSTRUED  TO  PREVENT  REASONABLE  MEDICAL
 MANAGEMENT OR UTILIZATION REVIEW OF DRUGS, DEVICES, PRODUCTS OR SERVICES
 PROVIDED HEREIN.
   §  4.  This  act shall take effect January 1, 2019, and shall apply to
 contracts and policies issued, renewed, modified or amended on or  after
 such date.

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Senate Bill S9120

Sponsored By

Archive: Last Bill Status - In Senate Committee Rules Committee

2017-S9120 (ACTIVE) - Details

2017-S9120 (ACTIVE) - Summary

2017-S9120 (ACTIVE) - Sponsor Memo

2017-S9120 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S9120

Share this bill

Sponsored By

Kemp Hannon

Archive: Last Bill Status - In Senate Committee Rules Committee

2017-S9120 (ACTIVE) - Details

2017-S9120 (ACTIVE) - Summary

2017-S9120 (ACTIVE) - Sponsor Memo

2017-S9120 (ACTIVE) - Bill Text download pdf

Comments