Connecticut Seal

General Assembly

 

Committee Bill No. 586

January Session, 2017

 

LCO No. 4798

 

*04798SB00586INS*

Referred to Committee on INSURANCE AND REAL ESTATE

 

Introduced by:

 

(INS)

 

AN ACT EXPANDING MANDATED HEALTH BENEFITS FOR WOMEN, CHILDREN AND ADOLESCENTS, AND REQUIRING THAT THE COMMISSIONER OF SOCIAL SERVICES AMEND THE STATE MEDICAID PLAN TO PROVIDE EXPANDED CONTRACEPTION BENEFITS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:

(1) Domestic and interpersonal violence screening and counseling for any woman;

(2) Tobacco use intervention and cessation counseling for any woman who consumes tobacco;

(3) Well-woman visits for any woman who is younger than sixty-five years of age;

(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;

(5) Breast cancer risk assessment, genetic testing and counseling;

(6) Chlamydia infection screening for any sexually active woman;

(7) Cervical and vaginal cancer screening for any sexually active woman;

(8) Gonorrhea screening for any sexually active woman;

(9) Human immunodeficiency virus screening for any sexually active woman;

(10) Human papillomavirus screening for any woman with normal cytology results who is thirty years of age or older;

(11) Sexually transmitted infections counseling for any sexually active woman;

(12) Anemia screening for any pregnant woman and any woman who is likely to become pregnant;

(13) Folic acid supplements for any pregnant woman and any woman who is likely to become pregnant;

(14) Hepatitis B screening for any pregnant woman;

(15) Rhesus incompatibility screening for any pregnant woman and follow-up rhesus incompatibility testing for any pregnant woman who is at increased risk for rhesus incompatibility;

(16) Syphilis screening for any pregnant woman and any woman who is at increased risk for syphilis;

(17) Urinary tract and other infection screening for any pregnant woman;

(18) Breastfeeding support and counseling for any pregnant or breastfeeding woman;

(19) Breastfeeding supplies, including, but not limited to, a breast pump for any breastfeeding woman;

(20) Gestational diabetes screening for any woman who is twenty-four to twenty-eight weeks pregnant and any woman who is at increased risk for gestational diabetes; and

(21) Osteoporosis screening for any woman who is sixty years of age or older.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 2. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for:

(1) Domestic and interpersonal violence screening and counseling for any woman;

(2) Tobacco use intervention and cessation counseling for any woman who consumes tobacco;

(3) Well-woman visits for any woman who is younger than sixty-five years of age;

(4) Breast cancer chemoprevention counseling for any woman who is at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by such woman's physician or advanced practice registered nurse;

(5) Breast cancer risk assessment, genetic testing and counseling;

(6) Chlamydia infection screening for any sexually active woman;

(7) Cervical and vaginal cancer screening for any sexually active woman;

(8) Gonorrhea screening for any sexually active woman;

(9) Human immunodeficiency virus screening for any sexually active woman;

(10) Human papillomavirus screening for any woman with normal cytology results who is thirty years of age or older;

(11) Sexually transmitted infections counseling for any sexually active woman;

(12) Anemia screening for any pregnant woman and any woman who is likely to become pregnant;

(13) Folic acid supplements for any pregnant woman and any woman who is likely to become pregnant;

(14) Hepatitis B screening for any pregnant woman;

(15) Rhesus incompatibility screening for any pregnant woman and follow-up rhesus incompatibility testing for any pregnant woman who is at increased risk for rhesus incompatibility;

(16) Syphilis screening for any pregnant woman and any woman who is at increased risk for syphilis;

(17) Urinary tract and other infection screening for any pregnant woman;

(18) Breastfeeding support and counseling for any pregnant or breastfeeding woman;

(19) Breastfeeding supplies, including, but not limited to, a breast pump for any breastfeeding woman;

(20) Gestational diabetes screening for any woman who is twenty-four to twenty-eight weeks pregnant and any woman who is at increased risk for gestational diabetes; and

(21) Osteoporosis screening for any woman who is sixty years of age or older.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 3. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 4. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state that provides coverage for prescription drugs shall provide coverage for immunizations recommended by the American Academy of Pediatrics, American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 5. (NEW) (Effective January 1, 2018) (a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 6. (NEW) (Effective January 1, 2018) (a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general statutes delivered, issued for delivery, renewed, amended or continued in this state shall provide coverage for preventive care and screenings for individuals twenty-one years of age or younger in accordance with the most recent edition of the American Academy of Pediatrics' "Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents".

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493 of the general statutes.

Sec. 7. Section 38a-503e of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):

(a) Each individual health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.] shall provide coverage for the following contraceptive methods and services:

(1) All contraceptive methods approved by the federal Food and Drug Administration;

(2) All sterilization methods approved by the federal Food and Drug Administration;

(3) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive equipment and supplies approved by the federal Food and Drug Administration; and

(4) Routine follow-up care concerning contraceptive methods, equipment and supplies approved by the federal Food and Drug Administration.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.

(c) No insurance company, hospital service corporation, medical service corporation, health care center or other entity providing coverage of the type specified in subsection (a) of this section may use step therapy, as defined in section 38a-510, or require prior authorization for the benefits and services required under subsection (a) of this section.

[(b)] (d) (1) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation, or health care center may issue to a religious employer an individual health insurance policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that prescription contraceptive methods are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to the individual an individual health insurance policy that excludes coverage for prescription contraceptive methods.

[(c)] (e) Any health insurance policy issued pursuant to subsection [(b)] (d) of this section shall provide written notice to each insured or prospective insured that prescription contraceptive methods are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

[(d)] (f) Nothing in this section shall be construed as authorizing an individual health insurance policy to exclude coverage for prescription drugs ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes.

[(e)] (g) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan. The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.

[(f)] (h) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization" as defined in 26 USC 3121 or a church-affiliated organization.

Sec. 8. Section 38a-530e of the general statutes is repealed and the following is substituted in lieu thereof (Effective January 1, 2018):

(a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state [that provides coverage for outpatient prescription drugs approved by the federal Food and Drug Administration shall not exclude coverage for prescription contraceptive methods approved by the federal Food and Drug Administration.] shall provide coverage for the following contraceptive methods and services:

(1) All contraceptive methods approved by the federal Food and Drug Administration;

(2) All sterilization methods approved by the federal Food and Drug Administration;

(3) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive equipment and supplies approved by the federal Food and Drug Administration; and

(4) Routine follow-up care concerning contraceptive methods, equipment and supplies approved by the federal Food and Drug Administration.

(b) No such policy shall impose a coinsurance, copayment, deductible or other out-of-pocket expense for the benefits and services required under subsection (a) of this section. The provisions of this subsection shall not apply to a high deductible health plan as that term is used in subsection (f) of section 38a-493.

(c) No insurance company, hospital service corporation, medical service corporation, health care center or other entity providing coverage of the type specified in subsection (a) of this section may use step therapy, as defined in section 38a-510, or require prior authorization for the benefits and services required under subsection (a) of this section.

[(b)] (d) (1) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center may issue to a religious employer a group health insurance policy that excludes coverage for prescription contraceptive methods that are contrary to the religious employer's bona fide religious tenets.

(2) Notwithstanding any other provision of this section, upon the written request of an individual who states in writing that prescription contraceptive methods are contrary to such individual's religious or moral beliefs, any insurance company, hospital service corporation, medical service corporation or health care center may issue to or on behalf of the individual a policy or rider thereto that excludes coverage for prescription contraceptive methods.

[(c)] (e) Any health insurance policy issued pursuant to subsection [(b)] (d) of this section shall provide written notice to each insured or prospective insured that prescription contraceptive methods are excluded from coverage pursuant to said subsection. Such notice shall appear, in not less than ten-point type, in the policy, application and sales brochure for such policy.

[(d)] (f) Nothing in this section shall be construed as authorizing a group health insurance policy to exclude coverage for prescription drugs ordered by a health care provider with prescriptive authority for reasons other than contraceptive purposes.

[(e)] (g) Notwithstanding any other provision of this section, any insurance company, hospital service corporation, medical service corporation or health care center that is owned, operated or substantially controlled by a religious organization that has religious or moral tenets that conflict with the requirements of this section may provide for the coverage of prescription contraceptive methods as required under this section through another such entity offering a limited benefit plan. The cost, terms and availability of such coverage shall not differ from the cost, terms and availability of other prescription coverage offered to the insured.

[(f)] (h) As used in this section, "religious employer" means an employer that is a "qualified church-controlled organization" as defined in 26 USC 3121 or a church-affiliated organization.

Sec. 9. (NEW) (Effective January 1, 2018) (a) The Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for the following contraceptive methods and services:

(1) All contraceptive methods approved by the federal Food and Drug Administration;

(2) All sterilization methods approved by the federal Food and Drug Administration;

(3) Counseling in (A) contraceptive methods approved by the federal Food and Drug Administration, and (B) the proper use of contraceptive equipment and supplies approved by the federal Food and Drug Administration; and

(4) Routine follow-up care concerning contraceptive methods, equipment and supplies approved by the federal Food and Drug Administration.

(b) The commissioner shall not use step therapy or require prior authorization for the methods and services required under subsection (a) of this section.

This act shall take effect as follows and shall amend the following sections:

Section 1

January 1, 2018

New section

Sec. 2

January 1, 2018

New section

Sec. 3

January 1, 2018

New section

Sec. 4

January 1, 2018

New section

Sec. 5

January 1, 2018

New section

Sec. 6

January 1, 2018

New section

Sec. 7

January 1, 2018

38a-503e

Sec. 8

January 1, 2018

38a-530e

Sec. 9

January 1, 2018

New section

Statement of Purpose:

To: (1) Expand mandated health benefits for women, children and adolescents; (2) expand mandated contraception benefits; and (3) require the Commissioner of Social Services to amend the Medicaid state plan to provide expanded contraception benefits.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]

Co-Sponsors:

SEN. FLEXER, 29th Dist.; REP. CONLEY, 40th Dist.

REP. LINEHAN, 103rd Dist.; REP. LUXENBERG, 12th Dist.

REP. MCCARTHY VAHEY, 133rd Dist.; REP. PORTER, 94th Dist.

REP. SIMMONS, 144th Dist.; REP. HADDAD, 54th Dist.

SEN. OSTEN, 19th Dist.; REP. GRESKO, 121st Dist.

REP. ARCE, 4th Dist.; REP. SANTIAGO, 130th Dist.

REP. REYES, 75th Dist.; REP. SOTO, 39th Dist.

REP. JOHNSON, 49th Dist.; REP. ELLIOTT, 88th Dist.

REP. PAOLILLO, 97th Dist.; REP. LEMAR, 96th Dist.

REP. DE LA CRUZ, 41st Dist.; REP. REED, 102nd Dist.

REP. D'AGOSTINO, 91st Dist.; SEN. MOORE, 22nd Dist.

S.B. 586