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.