Senate Bill S8786

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8786
 
                             I N  S E N A T E
 
                              March 11, 2024
                                ___________
 
 Introduced  by  Sen.  MAY  --  read  twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  requiring  health
   insurance  policies  to  include  coverage  of optional anesthesia for
   certain contraceptive and menstrual health procedures
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Clause  (v)  of  subparagraph  (E)  of  paragraph  17  of
 subsection (i) of section 3216 of  the  insurance  law,  as  amended  by
 section  3  of  part  M of chapter 57 of the laws of 2019, is amended to
 read as follows:
   (v) all FDA-approved MENSTRUAL  HEALTH  PROCEDURES  AND  contraceptive
 drugs,  devices,  and  other  products,  including  all over-the-counter
 contraceptive drugs, devices, and products as prescribed or as otherwise
 authorized under state or federal law;  voluntary  sterilization  proce-
 dures  pursuant  to  42 U.S.C. 18022 and identified in the comprehensive
 guidelines supported by the health resources and services administration
 and thereby incorporated in  the  essential  health  benefits  benchmark
 plan;  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. Except as otherwise authorized under this  clause,  a  contract
 shall  not  impose  any  restrictions or delays on the coverage required
 under this clause.   However, where the FDA has  approved  one  or  more
 therapeutic  and  pharmaceutical  equivalent,  as  defined  by  the FDA,
 versions of a contraceptive drug, device, or product, a contract is  not
 required  to  include all such therapeutic and pharmaceutical equivalent
 versions in its formulary, so long as  at  least  one  is  included  and
 covered  without cost-sharing and in accordance with this clause. If the
 covered therapeutic and pharmaceutical equivalent versions  of  a  drug,
 device, or product are not available or are deemed medically inadvisable
 a contract shall provide coverage for an alternate therapeutic and phar-
 maceutical  equivalent  version  of  the  contraceptive drug, device, or
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14820-01-4
 S. 8786                             2
 
 product without cost-sharing. (a) This coverage shall include  emergency
 contraception   without   cost  sharing  when  provided  pursuant  to  a
 prescription, or order under section sixty-eight hundred  thirty-one  of
 the education law or when lawfully provided over-the-counter. (b) If the
 attending  health  care  provider, in his or her reasonable professional
 judgment, determines that the use of a non-covered therapeutic or  phar-
 maceutical  equivalent  of  a drug, device, or product is warranted, the
 health care provider's determination shall be final. The  superintendent
 shall  promulgate  regulations  establishing  a process, including time-
 frames, for an insured, an insured's designee  or  an  insured's  health
 care  provider  to request coverage of a non-covered contraceptive drug,
 device, or product. Such regulations shall include  a  requirement  that
 insurers  use  an exception form that shall meet criteria established by
 the superintendent. (c) This coverage must allow for the  dispensing  of
 up  to  twelve  months  worth  of  a contraceptive at one time. (d) THIS
 COVERAGE SHALL INCLUDE OPTIONAL ANESTHESIA FOR  VAGINAL,  CERVICAL,  AND
 UTERINE MEDICAL PROCEDURES, INCLUDING, BUT NOT LIMITED TO, LOOP ELECTRO-
 SURGICAL  EXCISION  PROCEDURE,  COLPOSCOPY,  ABLATION,  AND INTRAUTERINE
 DEVICE INSERTION. (E) For the purposes of this clause, "over-the-counter
 contraceptive products"  shall  mean  those  products  provided  for  in
 comprehensive  guidelines supported by the health resources and services
 administration as of January twenty-first, two thousand nineteen.
   § 2. Subparagraph (A) of paragraph 16 of  subsection  (l)  of  section
 3221  of the insurance law, as amended by section 1 of part M of chapter
 57 of the laws of 2019, is amended to read as follows:
   (A) Every  group  or  blanket  policy  that  provides  medical,  major
 medical, or similar comprehensive type coverage that is issued, amended,
 renewed,  effective or delivered on or after January first, two thousand
 twenty, shall provide  coverage  for  all  of  the  following  services,
 MENSTRUAL HEALTH PROCEDURES, and contraceptive methods:
   (1)  All  FDA-approved  MENSTRUAL  HEALTH PROCEDURES AND contraceptive
 drugs, devices, and other products.    This  includes  all  FDA-approved
 over-the-counter   contraceptive   drugs,   devices,   and  products  as
 prescribed or as otherwise authorized under state or  federal  law.  The
 following applies to this coverage:
   (a)  where the FDA has approved one or more therapeutic and pharmaceu-
 tical equivalent, as defined by the FDA,  versions  of  a  contraceptive
 drug,  device,  or product, a group or blanket policy is not required to
 include all such therapeutic and pharmaceutical equivalent  versions  in
 its  formulary,  so long as at least one is included and covered without
 cost-sharing and in accordance with this paragraph;
   (b) if the covered therapeutic and pharmaceutical equivalent  versions
 of  a drug, device, or product are not available or are deemed medically
 inadvisable a group or blanket policy  shall  provide  coverage  for  an
 alternate  therapeutic  and  pharmaceutical  equivalent  version  of the
 contraceptive drug, device, or  product  without  cost-sharing.  If  the
 attending  health  care  provider, in his or her reasonable professional
 judgment, determines that the use of a non-covered therapeutic or  phar-
 maceutical  equivalent  of  a drug, device, or product is warranted, the
 health care provider's determination shall be final. The  superintendent
 shall  promulgate  regulations  establishing  a process, including time-
 frames, for an insured, an insured's designee  or  an  insured's  health
 care  provider  to request coverage of a non-covered contraceptive drug,
 device, or product. Such regulations shall include  a  requirement  that
 insurers  use  an exception form that shall meet criteria established by
 the superintendent;
 S. 8786                             3
 
   (c) this coverage shall include emergency contraception without  cost-
 sharing  when provided pursuant to a prescription or order under section
 sixty-eight hundred thirty-one of the education  law  or  when  lawfully
 provided over the counter; [and]
   (d) this coverage must allow for the dispensing of up to twelve months
 worth of a contraceptive at one time; AND
   (E)  THIS  COVERAGE  SHALL  INCLUDE  OPTIONAL  ANESTHESIA FOR VAGINAL,
 CERVICAL, AND UTERINE MEDICAL PROCEDURES, INCLUDING, BUT NOT LIMITED TO,
 LOOP  ELECTROSURGICAL  EXCISION  PROCEDURE,  COLPOSCOPY,  ABLATION,  AND
 INTRAUTERINE DEVICE INSERTION;
   (2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and
 identified  in  the  comprehensive  guidelines  supported  by the health
 resources and services administration and thereby  incorporated  in  the
 essential health benefits benchmark plan;
   (3) Patient education and counseling on contraception; and
   (4)  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.
   § 3. The opening paragraph and subparagraph  (A)  of  paragraph  1  of
 subsection  (cc)  of  section  4303  of the insurance law, as amended by
 section 2 of part M of chapter 57 of the laws of 2019,  are  amended  to
 read as follows:
   Every  contract  that  provides  medical,  major  medical,  or similar
 comprehensive type coverage that is issued, amended, renewed,  effective
 or  delivered  on  or  after  January  first, two thousand twenty, shall
 provide coverage for all of the  following  services,  MENSTRUAL  HEALTH
 PROCEDURES, and contraceptive methods:
   (A)  All  FDA-approved  MENSTRUAL  HEALTH PROCEDURES AND contraceptive
 drugs, devices, and other products.    This  includes  all  FDA-approved
 over-the-counter   contraceptive   drugs,   devices,   and  products  as
 prescribed or as otherwise authorized under state or  federal  law.  The
 following applies to this coverage:
   (i)  where the FDA has approved one or more therapeutic and pharmaceu-
 tical equivalent, as defined by the FDA,  versions  of  a  contraceptive
 drug, device, or product, a contract is not required to include all such
 therapeutic  and pharmaceutical equivalent versions in its formulary, so
 long as at least one is included and covered without cost-sharing and in
 accordance with this subsection;
   (ii) if the covered therapeutic and pharmaceutical equivalent versions
 of a drug, device, or product are not available or are deemed  medically
 inadvisable a contract shall provide coverage for an alternate therapeu-
 tic  and  pharmaceutical  equivalent  version of the contraceptive drug,
 device, or product without cost-sharing. If the  attending  health  care
 provider,  in  his  or  her reasonable professional judgment, determines
 that the use of a non-covered therapeutic or  pharmaceutical  equivalent
 of  a  drug, device, or product is warranted, the health care provider's
 determination shall be final. The superintendent shall promulgate  regu-
 lations establishing a process, including timeframes, for an insured, an
 insured's  designee  or  an  insured's  health  care provider to request
 coverage of a non-covered contraceptive drug, device, or  product.  Such
 regulations  shall  include a requirement that insurers use an exception
 form that shall meet criteria established by the superintendent;
   (iii) this coverage  shall  include  emergency  contraception  without
 cost-sharing  when  provided  pursuant  to a prescription or order under
 S. 8786                             4
 
 section sixty-eight hundred thirty-one of  the  education  law  or  when
 lawfully provided over the counter; [and]
   (iv)  this  coverage  must  allow  for  the dispensing of up to twelve
 months worth of a contraceptive at one time; AND
   (V) THIS COVERAGE  SHALL  INCLUDE  OPTIONAL  ANESTHESIA  FOR  VAGINAL,
 CERVICAL, AND UTERINE MEDICAL PROCEDURES, INCLUDING, BUT NOT LIMITED TO,
 LOOP  ELECTROSURGICAL  EXCISION  PROCEDURE,  COLPOSCOPY,  ABLATION,  AND
 INTRAUTERINE DEVICE INSERTION;
   § 4. This act shall take effect immediately.