txt

CSHB 25(HSS): "An Act relating to insurance coverage for contraceptives and related services; relating to medical assistance coverage for contraceptives and related services; and providing for an effective date."

00                       CS FOR HOUSE BILL NO. 25(HSS)                                                                     
01 "An Act relating to insurance coverage for contraceptives and related services; relating                                
02 to medical assistance coverage for contraceptives and related services; and providing for                               
03 an effective date."                                                                                                     
04 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
05    * Section 1. AS 21.42 is amended by adding a new section to read:                                                  
06            Sec. 21.42.427. Coverage for contraceptives. (a) A health care insurer that                                
07       offers, issues for delivery, delivers, or renews in the state a health care insurance plan                        
08       in the group or individual market shall                                                                           
09                 (1)  provide coverage for                                                                               
10                      (A)  prescription contraceptives;                                                                  
11                      (B)  voluntary sterilization procedures; and                                                       
12 (C)  consultations, examinations, procedures, and medical                                                               
13 services that are necessary to prescribe, dispense, insert, deliver, distribute,                                        
14 administer, or remove the drugs, devices, and other products or services                                                
01            provided under this paragraph;                                                                               
02 (2)  reimburse a health care provider or dispensing entity for dispensing                                               
03 prescription contraceptives intended to last for a 12-month period for subsequent                                       
04 dispensings of the same prescription contraceptive to the insured regardless of whether                                 
05 the insured was enrolled in the health care insurance plan at the time of the first                                     
06       dispensing.                                                                                                       
07            (b)  A health care insurer may not deny coverage or reimbursement under (a)                                  
08       of this section because an insured changed contraceptive methods within a 12-month                                
09       period.                                                                                                           
10 (c)  A health care insurer may not offset the costs of compliance with (a) of                                           
11 this section and may not require copayments or deductibles for contraceptives or                                        
12       services covered under (a) of this section.                                                                       
13 (d)  A health care insurer may not restrict or delay the coverage or                                                    
14 reimbursement required under (a) of this section, including use of medical                                              
15 management techniques, such as denials, step therapy, or prior authorization, that limit                                
16 an insured's choice in accessing a full range of prescription contraceptives. Nothing in                                
17 this subsection prevents a health care insurer from enacting reasonable cost                                            
18 containment measures in relation to the coverage required under (a) of this section if                                  
19 the cost containment measure does not unreasonably limit choice in access to                                            
20 coverage. In this subsection, "cost containment" means incentivizing the use of                                         
21 generic or lower cost medications or the use of health care providers or pharmacies                                     
22       that offer services or prescriptions at a lower negotiated rate.                                                  
23 (e)  If the covered therapeutically equivalent version of a prescription                                                
24 contraceptive is not available or is considered medically inadvisable by the health care                                
25 provider of the insured, a health care insurer shall provide coverage without cost                                      
26 sharing for an alternative therapeutically equivalent version of the prescription                                       
27       contraceptive that is prescribed for the insured.                                                                 
28 (f)  A health care insurer shall provide coverage and reimbursement under (a)                                           
29 of this section to all insureds enrolled in a health care insurance plan, including                                     
30       enrolled spouses and dependents.                                                                                  
31 (g)  A health care insurer that offers, issues for delivery, delivers, or renews in                                     
01 the state a health care insurance plan in the group market to a religious employer is                                   
02 exempt from the requirements of this section with respect to the health care insurance                                  
03 plan of the religious employer if the religious employer opposes the coverage required                                  
04       under this section and is an                                                                                      
05 (1)  organization that meets the criteria set out in 26 U.S.C.                                                          
06       6033(a)(3)(A)(i) or (iii) (Internal Revenue Code of 1986), as amended; or                                         
07 (2)  eligible organization that has self-certified in the form and manner                                               
08 specified by the United States Secretary of Labor or has provided notice to the United                                  
09 States Secretary of Health and Human Services, under the requirements set out in 45                                     
10       C.F.R. 147.131(b)(1) - (3).                                                                                       
11 (h)  In this section, "prescription contraceptive" means a drug or device that                                          
12 requires a prescription and is approved by the United States Food and Drug                                              
13       Administration to prevent pregnancy.                                                                              
14    * Sec. 2. AS 39.30.090(a) is amended to read:                                                                      
15 (a)  The Department of Administration may obtain a policy or policies of group                                          
16 insurance covering state employees, persons entitled to coverage under AS 14.25.168,                                    
17 14.25.480, AS 22.25.090, AS 39.35.535, 39.35.880, or former AS 39.37.145,                                               
18 employees of other participating governmental units, or persons entitled to coverage                                    
19       under AS 23.15.136, subject to the following conditions:                                                          
20 (1)  a group insurance policy shall provide one or more of the following                                                
21 benefits: life insurance, accidental death and dismemberment insurance, weekly                                          
22 indemnity insurance, hospital expense insurance, surgical expense insurance, dental                                     
23       expense insurance, audiovisual insurance, or other medical care insurance;                                        
24 (2)  each eligible employee of the state, the spouse and the unmarried                                                  
25 children chiefly dependent on the eligible employee for support, and each eligible                                      
26 employee of another participating governmental unit shall be covered by the group                                       
27 policy, unless exempt under regulations adopted by the commissioner of                                                  
28       administration;                                                                                                   
29                 (3)  a governmental unit may participate under a group policy if                                        
30 (A)  its governing body adopts a resolution authorizing                                                                 
31            participation and payment of required premiums;                                                              
01 (B)  a certified copy of the resolution is filed with the                                                               
02            Department of Administration; and                                                                            
03 (C)  the commissioner of administration approves the                                                                    
04            participation in writing;                                                                                    
05 (4)  in procuring a policy of group health or group life insurance as                                                   
06 provided under this section or excess loss insurance as provided in AS 39.30.091, the                                   
07 Department of Administration shall comply with the dual choice requirements of                                          
08 AS 21.86.310, and shall obtain the insurance policy from an insurer authorized to                                       
09 transact business in the state under AS 21.09, a hospital or medical service corporation                                
10 authorized to transact business in this state under AS 21.87, or a health maintenance                                   
11 organization authorized to operate in this state under AS 21.86; an excess loss                                         
12 insurance policy may be obtained from a life or health insurer authorized to transact                                   
13 business in this state under AS 21.09 or from a hospital or medical service corporation                                 
14       authorized to transact business in this state under AS 21.87;                                                     
15 (5)  the Department of Administration shall make available bid                                                          
16 specifications for desired insurance benefits or for administration of benefit claims and                               
17 payments to (A) all insurance carriers authorized to transact business in this state                                    
18 under AS 21.09 and all hospital or medical service corporations authorized to transact                                  
19 business under AS 21.87 who are qualified to provide the desired benefits; and (B)                                      
20 insurance carriers authorized to transact business in this state under AS 21.09, hospital                               
21 or medical service corporations authorized to transact business under AS 21.87, and                                     
22 third-party administrators licensed to transact business in this state and qualified to                                 
23 provide administrative services; the specifications shall be made available at least once                               
24 every five years; the lowest responsible bid submitted by an insurance carrier, hospital                                
25 or medical service corporation, or third-party administrator with adequate servicing                                    
26 facilities shall govern selection of a carrier, hospital or medical service corporation, or                             
27 third-party administrator under this section or the selection of an insurance carrier or a                              
28 hospital or medical service corporation to provide excess loss insurance as provided in                                 
29       AS 39.30.091;                                                                                                     
30 (6)  if the aggregate of dividends payable under the group insurance                                                    
31 policy exceeds the governmental unit's share of the premium, the excess shall be                                        
01       applied by the governmental unit for the sole benefit of the employees;                                           
02 (7)  a person receiving benefits under AS 14.25.110, AS 22.25,                                                          
03 AS 39.35, or former AS 39.37 may continue the life insurance coverage that was in                                       
04 effect under this section at the time of termination of employment with the state or                                    
05       participating governmental unit;                                                                                  
06                 (8)  a person electing to have insurance under (7) of this subsection                                   
07       shall pay the cost of this insurance;                                                                             
08                 (9)  for each permanent part-time employee electing coverage under                                      
09       this section, the state shall contribute one-half the state contribution rate for permanent                       
10 full-time state employees, and the permanent part-time employee shall contribute the                                    
11       other one-half;                                                                                                   
12 (10)  a person receiving benefits under AS 14.25, AS 22.25, AS 39.35,                                                   
13 or former AS 39.37 may obtain auditory, visual, and dental insurance for that person                                    
14 and eligible dependents under this section; the level of coverage for persons over 65                                   
15 shall be the same as that available before reaching age 65 except that the benefits                                     
16 payable shall be supplemental to any benefits provided under the federal old age,                                       
17 survivors, and disability insurance program; a person electing to have insurance under                                  
18 this paragraph shall pay the cost of the insurance; the commissioner of administration                                  
19       shall adopt regulations implementing this paragraph;                                                              
20 (11)  a person receiving benefits under AS 14.25, AS 22.25, AS 39.35,                                                   
21 or former AS 39.37 may obtain long-term care insurance for that person and eligible                                     
22 dependents under this section; a person who elects insurance under this paragraph                                       
23 shall pay the cost of the insurance premium; the commissioner of administration shall                                   
24       adopt regulations to implement this paragraph;                                                                    
25 (12)  each licensee holding a current operating agreement for a vending                                                 
26 facility under AS 23.15.010 - 23.15.210 shall be covered by the group policy that                                       
27       applies to governmental units other than the state;                                                           
28 (13)  a group health insurance policy covering employees of a                                                       
29       participating governmental unit is subject to the requirements of AS 21.42.427.                               
30    * Sec. 3. AS 39.30.091 is amended to read:                                                                         
31 Sec. 39.30.091. Authorization for self-insurance and excess loss insurance.                                           
01 Notwithstanding AS 21.86.310 or AS 39.30.090, the Department of Administration                                          
02 may provide, by means of self-insurance, one or more of the benefits listed in                                          
03 AS 39.30.090(a)(1) for state employees eligible for the benefits by law or under a                                      
04 collective bargaining agreement and for persons receiving benefits under AS 14.25,                                      
05 AS 22.25, AS 39.35, or former AS 39.37, and their dependents. The department shall                                      
06 procure any necessary excess loss insurance under AS 39.30.090. A self-insured                                      
07 group medical plan covering active state employees provided under this section is                                   
08       subject to the requirements of AS 21.42.427.                                                                  
09    * Sec. 4. AS 47.07.065 is amended by adding new subsections to read:                                               
10            (b)  The department shall pay for                                                                            
11 (1)  prescription contraceptives intended to last for a 12-month period                                                 
12 for subsequent dispensings of the same prescription contraceptive if prescribed to and                                  
13 requested by the recipient, regardless of whether the recipient was receiving medical                                   
14       assistance at the time of the first dispensing; and                                                               
15 (2)  consultations, examinations, procedures, and medical services that                                                 
16       are necessary to                                                                                                  
17 (A)  prescribe, dispense, insert, distribute, or administer                                                             
18            prescription contraceptives; or                                                                              
19                      (B)  remove prescription contraceptives.                                                           
20 (c)  Nothing in this section requires itemized reimbursement when a service is                                          
21       reimbursable as part of a bundled or composite rate.                                                              
22 (d)  In this section, "prescription contraceptive" means a drug or device that                                          
23 requires a prescription and is approved by the United States Food and Drug                                              
24       Administration to prevent pregnancy.                                                                              
25    * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to                          
26 read:                                                                                                                   
27 MEDICAID STATE PLAN INSTRUCTIONS; NOTICE TO REVISOR OF                                                                  
28 STATUTES. The Department of Health and Social Services shall immediately amend and                                      
29 submit for federal approval a state plan for medical assistance coverage consistent with                                
30 AS 47.07.065(b) - (d), added by sec. 4 of this Act. The Department of Health and Social                                 
31 Services shall apply to the United States Department of Health and Human Services for any                               
01 waivers necessary to implement AS 47.07.065(b) - (d), added by sec. 4 of this Act. The                                  
02 commissioner of health and social services shall notify the revisor of statutes in writing if the                       
03 United States Department of Health and Human Services approves the provisions of                                        
04 AS 47.07.065(b) - (d), added by sec. 4 of this Act.                                                                     
05    * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to                          
06 read:                                                                                                                   
07 CONDITIONAL EFFECT. AS 47.07.065(b) - (d), added by sec. 4 of this Act, take                                            
08 effect only if the commissioner of health and social services notifies the revisor of statutes in                       
09 writing under sec. 5 of this Act, on or before January 1, 2018, that the provisions of                                  
10 AS 47.07.065(b) - (d), added by sec. 4 of this Act, have been approved by the United States                             
11 Department of Health and Human Services.                                                                                
12    * Sec. 7. If AS 47.07.065(b) - (d), added by sec. 4 of this Act, take effect, they take effect on                  
13 the day after the date the commissioner of health and social services makes a certification to                          
14 the revisor of statutes under secs. 5 and 6 of this Act.                                                                
15    * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect January 1, 2018.