YEAR-END REPORT - 2020 Published 21-Dec-2020 HPTS Issue Brief 12-21-20.21 Health Policy Tracking Service - Issue Briefs Health Insurance Oversight Mandated Benefits This Issue Brief was authored by Jeffrey Karberg, J.D., a contributing writer and member of the Maryland bar. 12/21/2020 2020 Federal Action 2019 CONG US SRES 638 was introduced June 30, 2020. The resolution expresses the sense of the Senate that the Department of Justice should defend the Patient Protection and Affordable Care Act and halt its efforts to repeal, sabotage, or undermine health care protections for millions of people in the United States in the midst of the public health emergency relating to the Coronavirus Disease 2019 (COVID-19). 2019 CONG US HR 7286 was introduced June 22, 2020. The proposed bill seeks to amend the Social Security Act to provide coverage of comprehensive tobacco cessation services. 2019 CONG US HR 1425 was read for the second time on September 8, 2020. The proposed bill seeks to amend the Patient Protection and Affordable Care Act to provide for a Improve Health Insurance Affordability Fund to provide for certain reinsurance payments to lower premiums in the individual health insurance market. 2019 CONG US HR 3 was read for the second time on September 8, 2020. The proposed bill seeks to establish a fair price negotiation program, protect the Medicare program from excessive price increases, and establish an out-of-pocket maximum for Medicare part D enrollees, and for other purposes. 85 FR 68753-01 was published October 30, 2020. The Assistant Secretary of Defense for Health Affairs (ASD(HA)) issued this interim final rule (IFR) with request for comments to temporarily modify the TRICARE regulation by adding coverage for National Institute of Allergy and Infectious Disease (NIAID)-sponsored clinical trials for the treatment or prevention of coronavirus disease 2019 (COVID-19). This third COVID-19-related IFR builds on the efforts of the second IFR to provide beneficiaries access to emerging treatments (including vaccines) for COVID-19 by adding coverage for NIAID-sponsored COVID-19 clinical trials. This regulation implements an agreement entered into by the DoD with the National Institutes of Health (NIH) to cover such clinical trials, in accordance with statutory requirements. 2020 State Action In Arizona 2020 AZ H.B. 2428 (NS) was introduced May 19, 2020. The proposed bill seeks to require any insurer that offers Medicare supplement insurance policies to persons who are at least sixty-five years of age shall also offer Medicare supplement insurance policies to persons who are eligible for and enrolled in Medicare due to a disability or end-stage renal disease. All benefits and coverages that apply to a Medicare enrollee who is at least sixty-five years of age must also apply to a Medicare enrollee who is enrolled due to a disability or end-stage renal disease. In California 2019 CA A.B. 2277 (NS), a previously introduced bill, was amended May 2020. Existing law authorizes the department to enter contracts with managed care plans to provide Medi-Cal services. Under existing law, Medi-Cal covers early and periodic screening, diagnostic, and treatment services for individuals under 21 years of age, consistent with federal law. This bill would require any contract between the department and a Medi-Cal managed care plan to impose requirements on the Medi-Cal managed care plan to identify every enrollee who does not have a record of completing those tests at 12 and 24 months of age, and to remind the contracting health care provider who is responsible for performing a periodic health assessment of a child of the need to perform those tests. The bill would require the department to develop and implement procedures, and take enforcement action, as prescribed, to ensure that a © 2021 Thomson Reuters. No claim to original U.S. Government Works. -1- Medi-Cal managed care plan performs those duties. If a Medi-Cal managed care plan enrollee who is a child misses a required blood lead screening test at 12 and 24 months of age, the bill would require the Medi-Cal managed care plan to notify specified individuals responsible for that child, including the parent or guardian, about those missed blood lead screening tests, and would require that notification to be included as part of an annual notification on preventive services. 2019 CA A.B. 2203 (NS), a previously introduced bill, was amended July 9, 2020. Existing law requires every health care service plan contract that covers hospital, medical, or surgical expenses to include coverage for specified equipment and supplies for the management and treatment of diabetes. Existing law provides for the regulation insurers by the Department of Insurance. Existing law requires an insurance policy that covers hospital, medical, or surgical expenses to include coverage for specified equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription. Existing law requires a health an insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits to include coverage for specified diabetes management prescription items, including insulin and glucagon. If passed, this bill would prohibit a health care service plan issued on or after January 1, 2021, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $50 per 30-day supply of insulin, and no more than $100 total per month, regardless of the amount or type of insulin. The bill would apply these cost-sharing limitations until January 1, 2024. 2019 CA A.B. 2276 (NS), a previously introduced bill, was amended July 29, 2020. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law authorizes the department to enter contracts with managed care plans to provide Medi-Cal services, and imposes requirements on the Medi-Cal managed care plans, including network adequacy standards. Under existing law, Medi-Cal covers early and periodic screening, diagnostic, and treatment services for individuals under 21 years of age, consistent with federal law. This bill would require the department to ensure that a Medi-Cal beneficiary who is a child receives blood lead screening tests at specified ages consistent with state regulatory standards. The bill would require each Medi-Cal managed care plan to establish a monitoring system related to blood lead screening tests that includes standard reporting requirements, as specified, to require its contracting health care providers who are responsible for performing a periodic health assessment of a child to test each child pursuant to specified standards of care for lead testing, to inform a child's parent, parents, guardian, or other person charged with their support and maintenance with specified information, including the risks and effects of lead exposure, and to notify a child's health care provider and parent, parents, guardian, or other person charged with their support and maintenance when that child has missed a required blood lead screening test. 2019 CA A.B. 2100 (NS), a previously introduced bill, was amended August 20, 2020. By executive order, the Governor directed the department to transition pharmacy services for Medi-Cal managed care to a fee-for-service benefit by January 1, 2021. Existing law requires the department to convene an advisory group to receive feedback on the changes, modifications, and operational timeframes on the implementation of pharmacy benefits offered in the Medi-Cal program, and to provide regular updates on the pharmacy transition, including a description of changes in the division of responsibilities between the department and managed care plans relating to the transition of the outpatient pharmacy benefit to fee-for-service. If passed, the bill would require the department to establish the Independent Prescription Drug Medical Review System (IPDMRS), commencing on January 1, 2021, which generally models the above-described requirements of the Knox-Keene Health Care Service Plan Act. The bill would provide that any Medi-Cal beneficiary grievance involving a disputed health care service is eligible for review under the IPDMRS, and would define ‘disputed health care service’ as any outpatient prescription drug eligible for coverage and payment by the Medi-Cal program that has been denied, modified, or delayed by a decision of the department, or by one of its contracting fiscal intermediaries for the administration of the prescription drug benefit if that entity makes a final decision, in whole or in part, due to a finding that the service is not medically necessary. CA LEGIS 151 (2020) was with Secretary of State September 25, 2020. Existing law requires every health care service plan providing hospital, medical, or surgical coverage to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child under the same terms and conditions applied to other medical conditions, as specified. Existing law requires those benefits to include, among other things, outpatient services, inpatient hospital services, partial hospital services, and prescription drugs, if the plan contract or policy includes coverage for prescription drugs. If passed, this bill would revise and recast those provisions, and would instead require a health care service plan contract or disability insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. The bill would prohibit a health care service plan or disability insurer from limiting benefits or coverage for mental health and substance use disorders to short-term or acute treatment. The bill would revise the covered benefits to include basic health care services, as defined, intermediate services, and prescription drugs. CA LEGIS 216 (2020) was filed with Secretary of State September 28, 2020. Existing law authorizes the department to enter contracts with managed care plans to provide Medi?Cal services, and imposes requirements on the Medi?Cal managed care plans, including network adequacy standards. Under existing law, Medi?Cal covers early and periodic screening, diagnostic, and treatment services for individuals under 21 years of age, consistent with federal law. This bill would require a contract between the department and a Medi?Cal managed care plan to require the Medi?Cal managed care plan, on a quarterly basis, to identify every enrollee who is a child without a record of completing the blood lead screening tests, and to remind the contracting network provider of the requirement to perform the required blood lead screening tests and the requirement to provide the oral or written guidance to a parent or guardian © 2021 Thomson Reuters. No claim to original U.S. Government Works. -2- relating to risk of childhood lead poisoning. The bill would require the department to develop and implement procedures to ensure compliance with those requirements would authorize the department to impose sanctions for a violation of those requirements. 2019 CA S.B. 855 (NS) was adopted September 25, 2020. Existing law, known as the California Mental Health Parity Act, requires every health care service plan contract or disability insurance policy issued, amended, or renewed on or after July 1, 2000, that provides hospital, medical, or surgical coverage to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child under the same terms and conditions applied to other medical conditions, as specified. Existing law requires those benefits to include, among other things, outpatient services, inpatient hospital services, partial hospital services, and prescription drugs, if the plan contract or policy includes coverage for prescription drugs. This bill would revise and recast those provisions, and would instead require a health care service plan contract or disability insurance policy issued, amended, or renewed on or after January 1, 2021, to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. The bill would prohibit a health care service plan or disability insurer from limiting benefits or coverage for mental health and substance use disorders to short-term or acute treatment. The bill would revise the covered benefits to include basic health care services, as defined, intermediate services, and prescription drugs. In Delaware DE LEGIS 290 (2020) was approved September 28, 2020. The bill states that eligibility for and payment of medical assistance must be determined under policies and regulations established by the Department of Health and Social Services. Eligibility standards, recipient copay, and provider reimbursement must be set in accordance with state and federal mandates, state and federal funding levels, approved waivers, and rules and regulations established by the Department. The amount of assistance in each case of medical care must not duplicate any other coverage or payment made or available for the costs of such health services and supplies. To the extent permitted by federal requirements, no annual or lifetime numerical limitations may be placed on physical therapy or chiropractic care visits that are for the purpose of treating back pain. In Hawaii 2019 HI S.R. 14 (NS) was adopted June 30, 2020. The resolution urges Congress to pass the clinical treatment act to amend Title XIX of the social security act to require Medicaid to cover the routine costs of care for patients with life-threatening conditions who are enrolled in clinical trials. In Illinois 2019 IL H.B. 5079 (NS) was introduced February 18, 2020. The proposed legislation relates to coverage for telehealth services. The proposed bill states that certain health benefit policies or plans may not exclude from coverage a medically necessary health care service or procedure delivered by certain providers solely because the health care service or procedure is provided through telehealth (rather than requiring certain policies to meet specified criteria if they provide coverage for telehealth services). The bill also provides that an individual or group policy of accident or health insurance that provides coverage for telehealth services delivered by contracted licensed dietitian nutritionists and contracted certified diabetes educators must also provide coverage for in-home services for senior diabetes patients (rather than requiring an individual or group policy of accident or health insurance that provides coverage for telehealth services to provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the patients' homes). The bill also: • provides payment, reimbursement, and service requirements for telehealth services provided under the State's fee-for-service or managed care medical assistance programs; • provides that ‘telehealth’ includes telepsychiatry; and • provides that the Department of Healthcare and Family Services must implement the new provisions 60 days after the effective date of the amendatory Act. 2019 IL S.B. 1864 (NS) was adopted July, 2020. The bill amends the Smoke Free Illinois Act. The medical assistance program must provide coverage for routine care costs that are incurred in the course of an approved clinical trial if the medical assistance program would provide coverage for the same routine care costs not incurred in a clinical trial. ‘Routine care cost’ must be defined by the Department by rule. In Indiana 2020 IN H.B. 1080 (NS) was introduced January 7, 2020. The proposed bill seeks to amend the laws concerning group insurance for public employees, health insurance, and health maintenance organizations: • to eliminate provisions limiting mandatory coverage for colorectal cancer examinations to individuals who are at least 50 years of age or who are at high risk for colorectal cancer; and • to mandate coverage for colorectal cancer examinations according to the guidelines of the American Cancer Society that are in effect on January 1, 2020. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -3- 2020 IN S.B. 184 (NS) was adopted March 21, 2020. The bill authorizes a nonprofit agricultural organization to provide health benefit coverage that is: • sponsored by the nonprofit agricultural organization or its affiliate; • offered only to members of the nonprofit agricultural organization and their families; • deemed by the nonprofit agricultural organization to be important in assisting its members to live long and productive lives; and • offered in every county in Indiana In Iowa 2019 IA S.F. 2301 (NS) was introduced February 18, 2020. The proposed bill relates to health care benefits coverage for specified pediatric autoimmune neuropsychiatric disorders. This bill relates to health care coverage benefits for pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). The bill defines ‘PANS' as a class of acute-onset obsessive compulsive or tic disorders or other behavioral changes presenting in a child that are not otherwise explained by another known neurologic or medical disorder. ‘PANDAS' is defined as a condition in which a streptococcal infection in a child causes the abrupt onset of clinically significant obsessions, compulsions, tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and remitting course of symptom severity. The bill requires a health carrier that offers individual, group, or small group contracts, policies, or plans in this state that provide for third-party payment or prepayment of health or medical expenses to offer coverage for the diagnosis and treatment of PANS and PANDAS as recommended by a health care professional for a covered person who is age 18 or younger. In Kentucky 2020 KY H.B. 435 (NS), a previously introduced bill, was amended March 12, 2020. The bill seeks to permit a physician to provide long- term antibiotic therapy for a therapeutic purpose for a patient diagnosed with Lyme disease and not be subject to punishment by the State Board of Medical Licensure. The bill also seeks to: • require written information on laboratory testing for Lyme disease to be provided when a test is ordered; • exempt physicians from civil liability for providing information; and • health benefit plan coverage of long-term antibiotic therapy for covered persons with Lyme disease under certain circumstances. 2020 KY H.B. 12 (NS), a previously introduced bill, was amended March 17, 2020. The proposed bill seeks to require coverage for equipment, supplies, outpatient self-management training and education, including medical nutrition therapy, and all medications necessary for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes if prescribed by a health care provider legally authorized to prescribe the items. Additionally, cost sharing for a covered prescription insulin drug shall not exceed one hundred dollars per thirty day supply of each insulin prescription drug, regardless of the amount or type of insulin needed to meet the covered person's insulin needs. In Louisiana 2020 LA S.B. 202 (NS) was engrossed May 14, 2020. The bill requires health insurance coverage for a treatment provided or study conducted in a Phase I clinical trial for cancer. Previous law required a health insurance issuer to provide coverage for the costs of investigational treatments and associated protocol-related patient care if specified criteria are met. This bill retains previous criteria and extends coverage to a treatment provided or study conducted in a Phase I clinical trial for cancer. 2020 LA S.B. 204 (NS) was adopted June 11, 2020. The bill relates to health insurance coverage for cancer treatments. The bill specifically relates to participation in a clinical trial. The bill will: • require health insurance coverage for a treatment provided or study conducted in a Phase I clinical trial for cancer; • prohibit denial of coverage in certain circumstances; • require coverage of prescription drugs that target a specific mutation for a minimum initial period; and • require a physician's certification for continued coverage; to provide for applicability. 2020 LA S.B. 231 (NS) was adopted June 20, 2020. The bill relates to the Louisiana Health Plan. The bill provides coverage for preexisting conditions. The bill states that upon a finding that federal and state law no longer prohibits carriers in the individual market from rejecting applicants for health insurance coverage based on the presence of preexisting health conditions or excluding health care coverage for preexisting conditions, the commissioner may submit written notification to the Joint Legislative Committee on the Budget and the House and Senate committees on insurance of his intention to reactivate the Louisiana Health Plan. The notice must include the commissioner's reasoning for finding reactivation necessary and the proposed date for the plan to restart operations. In Massachusetts 2019 MA S.B. 2935 (NS) was introduced on October 29, 2020. If passed, the bill will require certain insurance coverage for pediatric autoimmune neuropsychiatric disorders and pediatric acute-onset neuropsychiatric syndrome. The bill will also require insurers to © 2021 Thomson Reuters. No claim to original U.S. Government Works. -4- provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome including, but not limited to, the use of intravenous immunoglobulin therapy. In Minnesota 2019 MN S.F. 3418 (NS) was introduced February 20, 2020. The proposed bill seeks to modify the mandated health benefit proposals evaluation process. The purpose of the evaluation is to provide the legislature with a complete and timely analysis of all ramifications of any mandated health benefit proposal. The evaluation must include, in addition to other relevant information, the following to the extent applicable: • scientific and medical information on the mandated health benefit proposal, on the potential for harm or benefit to the patient, and on the comparative benefit or harm from alternative forms of treatment, and must include the results of at least one professionally accepted and controlled trial comparing the medical consequences of the proposed therapy, alternative therapy, and no therapy; • public health, economic, and fiscal impacts of the mandated health benefit proposal on persons receiving health services in Minnesota, on the relative cost-effectiveness of the benefit proposal, and on the health care system in general; • the extent to which the treatment, service, equipment, or drug is generally utilized by a significant portion of the population; and • the extent to which insurance coverage for the mandated health benefit proposal is already generally available. 2019 MN S.F. 4462 (NS) was introduced April 14, 2020. The proposed bill relates to managed care requirements. If passed, the bill will require managed care plans and county-based purchasing plans to reimburse specified providers of the substance use disorder. The commissioner must monitor the effect of this requirement on the rate of access to substance use disorder services and residential substance use disorder rates. Capitation rates paid to managed care organizations and county-based purchasing plans must reflect the impact of this requirement. 2019 MN H.F. 4 (NS) was introduced October 12, 2020. The proposed bill, if passed, will establish prescription contraceptive supply requirements. The bill will also describe the health plan coverage required for contraceptive methods, sterilization and related medical services, patient education, and counseling; and eligible organization accommodation established. In Missouri 2020 MO H.B. 1922 (NS) was introduced January 2, 2020. The proposed bill relates to mandated coverage provisions insurance providers and health maintenance organization contracts. The proposed bill prohibits insurers from denying or altering coverage to any previously covered individual who has been diagnosed as having HIV infection or any HIV-related condition during the previous policy or contract period only because of such diagnosis. Insurers may not exclude coverage for treatment of such infection or condition with respect to any such individual. The provisions of this proposed bill do not apply to short-term major medical policies having a duration of less than one year. In New Hampshire 2019 NH H.B. 1600 (NS) was introduced January 8, 2020. If passed, the proposed bill will authorize pharmacists to dispense smoking cessation therapy pursuant to a standing order from a physician or APRN and to be reimbursed under Medicaid. 2019 NH H.B. 1281 (NS) was introduced January 8, 2020. If passed, the bill will require insurance coverage for epipens. The Insurance Department indicates this would be considered a state mandated benefit, and under federal law, the cost of coverage for this benefit for policies sold through the health insurance exchange would have to be borne by the State. The Department states the additional coverage will impact claim costs and may impact premiums costs and premium tax revenue collected by the State. 2019 NH S.B. 620 (NS), a previously introduced bill, was amended March 11, 2020. If passed, this bill will require insurers providing benefits for treatment and diagnosis of certain biologically-based mental illnesses and substance use disorders to submit an annual report to the insurance commissioner demonstrating compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Equity Act of 2008. The bill also clarifies authorization for medication-assisted treatment. 2019 NH H.B. 1287 (NS), a previously introduced bill, was amended March 11, 2020. The proposed bill relates to the duration of antibiotic therapy for tick-borne illness. Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, must provide to certificate holders of such insurance, who are residents of this state, coverage for long-term antibiotic therapy for tick-borne illness when determined to be medically necessary and ordered by a licensed infectious disease physician after making a thorough evaluation of the patient's symptoms, diagnostic test results or response to treatment. Benefits provided under this requirement must not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer. “Long-term antibiotic therapy' means the administration of oral, intramuscular, or intravenous antibiotics singly or in combination, for periods of time in excess of 4 weeks. 2019 NH H.B. 1633 (NS), a previously introduced bill, was amended March 11, 2020. If passed, this bill will require insurance coverage for further blood testing for persons who are symptomatic after a first blood test for tick-borne illness. 2019 NH S.B. 754 (NS), a previously introduced bill, was amended March 12, 2020. This bill requires the commissioner of the department of health and human services to solicit information and to contract with dental managed care organizations to provide dental care to persons under the Medicaid managed care program. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -5- 2019 NH H.B. 1280 (NS) was adopted July 16, 2020. This bill requires insurers to cap the total amount paid for insulin for covered persons. The bill also establishes a wholesale importation program for prescription drugs from Canada by or on behalf of the state. The bill requires the department of health and human services to design the program and obtain federal approval for the program. The bill also: • establishes a prescription drug affordability board to determine annual public payor spending targets for prescription drugs, develop and implement policies and procedures for the collection of prescription drug price data, implement a register of drug manufacturers for drug pricing data, and establish funding for the board by reasonable user fees and assessments; and • clarifies the pricing of generic prescription drugs under the law governing consumer protection; • clarifies the procedure for prior authorization for prescription drugs on the formulary under the managed care law; • requires insurance coverage for epinephrine autoinjectors; and • establishes the prescription drug competitive marketplace. In New Jersey 2018 NJ S.B. 2133 (NS) was adopted January 13, 2020. The bill mandates health benefits coverage for fertility preservation services under certain health insurance plans. 2020 NJ S.B. 1122 (NS) was introduced January 30, 2020. If passed, the proposed bill will mandate health benefits coverage for preimplantation genetic screening under certain health insurance plans. ‘Preimplantation genetic screening’ means a laboratory procedure that is used in conjunction with in vitro fertilization to test an embryo for abnormal chromosomes before it is transferred to the uterus. The benefits must be provided to the same extent as for other pregnancy-related procedures under the contract, except that the services provided must be performed at facilities that conform to standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists. The same copayments, deductibles and benefit limits must apply to the diagnosis and treatment of infertility pursuant to this section as those applied to other medical or surgical benefits under the contract. 2020 NJ A.B. 4387 (NS) was introduced July 6, 2020. The proposed bill seeks to expand NJ FamilyCare to ensure healthcare benefits are available to all uninsured children under 19 years of age who live in New Jersey; appropriates $3 million for outreach, enrollment, and retention regarding NJ FamilyCare. 2020 NJ S.B. 3030 (NS) was introduced October 8, 2020. The proposed bill is entitled the ‘Reproductive Freedom Act.’ If passed, the bill states that it will be the policy of the state to: • explicitly guarantee, to every individual, the fundamental right to reproductive autonomy, which includes the right to contraception, the right to abortion, and the right to carry a pregnancy to term; • enable all qualified health care professionals to provide abortion services in the State; • require all insurance carriers to provide coverage both for abortion care and for a long-term supply of contraceptives; and • invalidate, and prohibit the future adoption of, all laws, rules, regulations, ordinances, resolutions, policies, standards, or parts thereof, that conflict with the provisions or the express or implied purposes of this bill. 2020 NJ A.B. 1708 (NS), a previously introduced bill, was amended October 26, 2020. If passed, the proposed bill will require workers' compensation and health insurance coverage for the medical use of cannabis under certain circumstances. 2020 NJ A.B. 3869 (NS), a previously introduced bill, was amended October 22, 2020. If passed, the bill will require opioid antidote prescriptions for certain patients. Subject to certain specified conditions, if a health care practitioner issues a prescription for an opioid drug which is a controlled dangerous substance to a patient, the prescriber shall additionally issue the patient a prescription for an opioid antidote if any of the following conditions is present: • the patient has a history of substance use disorder; • the prescription for the opioid drug is for a daily dose of more than 90 morphine milligram equivalents; or • the patient holds a current, valid prescription for a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance or the patient was dispensed a benzodiazepine drug that is a Schedule III or Schedule IV controlled dangerous substance within the preceding 45 days. 2020 NJ S.B. 3116 (NS) was introduced November 5, 2020. If passed, the bill will waive shared responsibility tax payments for certain individuals without minimum essential health benefits coverage during coronavirus disease 2019 pandemic. This bill provides that, for any month during which the public health emergency declared by the Governor in Executive Order 103 of 2020 concerning the coronavirus disease 2019 pandemic, or an extension or replacement of that Executive Order, is in effect the State shared responsibility tax shall not be imposed with respect to any applicable individual for that month if the taxpayer: • receives unemployment benefits; or • is experiencing a substantial loss of income. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -6- In New York 2019 NY A.B. 8883 (NS) was introduced December 18, 2019. The proposed bill requires the commissioner to plan, promote, establish, develop, coordinate, evaluate, and conduct programs and services of prevention, diagnosis, examination, care, treatment, rehabilitation, training, and research for the benefit of the mentally ill. The programs must include but not be limited to in-patient, out- patient, partial hospitalization, day care, emergency, rehabilitative, and other appropriate treatments and services provided, however, that the commissioner, in conjunction with the commissioner of the office for people with developmental disabilities, shall be authorized to waive rules and regulations of the office of mental health and of the department of health, respectively, to address barriers to collaboration by mental health providers and providers of home care services under this section, including barriers related to medical assistance reimbursement, service procedures, care coordination and direct care worker training applicable to such providers, provided further that regulations pertaining to patient safety may not be waived, nor shall any regulations be waived if such waiver would risk patient safety. 2019 NY A.B. 10540 (NS), a proposed bill, was amended July 9, 2020. The proposed bill relates to providing supports and services for youth suffering from adverse childhood experiences. The proposed bill states that covered health care services also contains special provisions for youth at risk for or experiencing adverse childhood experiences. Covered services must also include: • children's mental health rehabilitation services including, but not limited to, those covered by medical assistance pursuant to title eleven of article five of the social services law, community psychiatric support and treatment services, and psychosocial rehabilitation services, assuming such children's mental health rehabilitation services are provided by individuals acting within their lawful scope of practice as established under the education law; and • trauma informed care that includes the identification of and appropriate reaction and treatment to adverse childhood experiences. 2019 NY A.B. 11028 (NS) was introduced October 7, 2020. If passed, the bill will require health insurance providers to cover the costs of colorectal cancer screenings and follow-up examinations for positive screenings for individuals age 45 and older. The coverage must include an annual screening using the stool-based fecal immunochemical test or the guaiac-based fecal occult blood test. If the results of such test are positive for signs of cancer, coverage shall also be provided for a follow-up visual examination. 2019 NY S.B. 9063 (NS) was introduced October 23, 2020. The proposed bill relates to coverage of mental health and alcohol and substance use services under the child health insurance plan. ‘Covered health care services' is defined as the services of physicians, optometrists, nurses, nurse practitioners, midwives and other related professional personnel which are provided on an outpatient basis, including routine well-child visits; diagnosis and treatment of illness and injury; early and periodic screening, diagnosis and treatment for eligible children under the age of six and for other eligible children to ascertain physical and mental disabilities. 2019 NY S.B. 9062 (NS) was introduced October 23, 2020. The proposed bill relates to coverage of early and periodic screening, diagnosis and treatment under the child health insurance plan to ascertain physical and mental disabilities. 2019 NY A.B. 11145 (NS) was introduced November 6, 2020. The proposed bill relates to prohibiting the application of fail-first or step therapy protocols to coverage for the diagnosis and treatment of mental health conditions. The bill requires insurers providing coverage for inpatient hospital care or coverage for physician services shall provide coverage for the diagnosis and treatment of mental health conditions and: • where the policy provides coverage for inpatient hospital care, benefits for inpatient care in a hospital as defined by subdivision ten of section 1.03 of the mental hygiene law and benefits for outpatient care provided in a facility issued an operating certificate by the commissioner of mental health pursuant to the provisions of article thirty-one of the mental hygiene law, or in a facility operated by the office of mental health or, for care provided in other states, to similarly licensed or certified hospitals or facilities; and • where the policy provides coverage for physician services, it must include benefits for outpatient care provided by a psychiatrist or psychologist licensed to practice in this state, a licensed clinical social worker who meets certain specified requirements a nurse practitioner licensed to practice in this state, or a professional corporation or university faculty practice corporation thereof, including outpatient drug coverage. In New Hampshire 2019 NH H.B. 1287 (NS) was introduced January 8, 2020. The proposed bill requires insurance coverage for long-term antibiotic therapy for tick-borne illness. The Department of Health and Human Services indicates tick borne disease are required by law to be reported to the Division of Public Health Services (DPHS). The Department assumes mandated coverage of long-term antibiotic therapy will result in increased utilization of such treatments. The DPHS states such therapy has been associated with serious, sometimes deadly complications, including antimicrobial resistant infections. Many of the adverse outcomes associated with long-term treatment are conditions that are required to be reported by law to DPHS. The Department assumes the proposed legislation would increase resource demands on the DPHS to investigate and prevent the spread of antimicrobial resistant organisms and to track other outcomes of long-term antibiotic treatment. In Ohio 2019 OH H.B. 339 (NS) was enrolled September 23, 2020. The bill enacts the ‘Insurance Code Correction Act’ to make technical and corrective changes to the laws governing insurance. The bill makes technical changes to the statute requiring each individual and group © 2021 Thomson Reuters. No claim to original U.S. Government Works. -7- health insuring corporation policy, contract, or agreement providing basic health care services that is delivered, issued for delivery, or renewed to provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder. A health insuring corporation must not terminate an individual's coverage, or refuse to deliver, execute, issue, amend, adjust, or renew coverage to an individual solely because the individual is diagnosed with or has received treatment for an autism spectrum disorder. In Oklahoma 2019 OK S.B. 1694 (NS) was engrossed March 11, 2020. The bill creates the Oklahoma Health Insurance Mandate Legislation Actuarial Analysis Act. The bill also requires certain bills to be sent to the Legislative Actuary. The bill states that before to the introduction of any bill or joint resolution mandating a health plan to provide coverage, the applicable legislative staff, on behalf of the member of the Legislature who intends to be the primary author of the bill, must present an exact copy of the proposed bill to the Legislative Actuary. The Actuary must determine whether the proposed bill is a mandate bill having a fiscal impact on insurance premiums or a mandate bill not having a fiscal impact on insurance premiums and provide a written certification of that determination to the member. If the proposed bill is then introduced into the Legislature, it must have attached the certification of the Actuary. If the bill is certified as a mandate bill having a fiscal impact, its introduction shall be limited by the provisions of the act. 2019 OK S.B. 1718 (NS) was adopted May 19, 2020. The bill modifies mandated coverage for mental health and substance use disorders. Health benefits plans not impose a nonquantitative treatment limitation with respect to mental health and substance use disorders in any classification of benefits unless, under the terms of the health benefit plan as written and in operation, any processes, strategies, evidentiary standards or other factors used in applying the nonquantitative treatment limitation to mental health disorders in the classification are comparable to and applied no more stringently than to medical and surgical benefits in the same classification. The bill also: • prohibits an insurer from imposing more stringent treatment limitations on mental health conditions and substance use disorders than comparable benefits; • prohibits certain treatment limitations; • requires all health plans to meet certain requirements; and • requires insurers to submit annual report. In Pennsylvania 2019 PA S.B. 1215 (NS) was introduced June 23, 2020. The proposed bill seeks to amend an act entitled ‘An act relating to insurance; amending, revising, and consolidating the law providing for the incorporation of insurance companies, and the regulation, supervision, and protection of home and foreign insurance companies, Lloyds associations, reciprocal and inter-insurance exchanges, and fire insurance rating bureaus, and the regulation and supervision of insurance carried by such companies, associations, and exchanges, including insurance carried by the State Workmen's Insurance Fund; providing penalties; and repealing existing laws,’ in health insurance coverage parity and nondiscrimination, providing for nondiscrimination of chiropractic services. 2019 PA H.B. 2558 (NS) was introduced May 28, 2020. The proposed bill seeks to: • provide for health insurance coverage for certain children of insured parents; and • provide for coverage for essential health benefits; and • prohibit lifetime and annual limits on essential health benefits and for exclusions for preexisting conditions. 2019 PA H.R. 942 (NS) was introduced July 14, 2020. The bill is a Resolution directing the Legislative Budget and Finance Committee to conduct a study of the availability and accessibility of obstetrical services in Pennsylvania. The resolution directs the committee to report on its study and include in the report examination of the availability of obstetricians and nurse midwives and other health care professionals needed for the care of expectant mothers, the adequacy of access to the full spectrum of prenatal, obstetrical and postpartum care for each region of this Commonwealth and by insurance status, the adequacy of insurer or managed care provider networks for obstetrical services, identification of any standards of care ratios for the number of physicians and nurse midwives per number of expectant mothers and births and comparison to Pennsylvania data, adequacy of insurance coverage for expectant mothers, comparison of the range of Pennsylvania Medical Assistance payments for obstetrical care to Medical Assistance payments made in other states and comparison of Pennsylvania fees paid for obstetrical care by other health care insurers or payors. 2019 PA S.B. 983 (NS), a previously introduced bill, was amended September 21, 2020. The proposed bill is known as the Newborn Child Testing Act, providing for definitions and for Newborn Child Screening and Follow-up Program. The bill also provides for mandated screening and follow-up. 2019 PA H.B. 2950 (NS) was introduced October 21, 2020. The proposed bill is an act prohibiting discrimination in certain insurance policies based on certain drugs. In Rhode Island © 2021 Thomson Reuters. No claim to original U.S. Government Works. -8- 2019 RI H.B. 7219 (NS) introduced January 22, 2020. If passed, this act would require health insurance coverage for annual pediatric mental health examinations when determined to be medically necessary and ordered by a physician or pediatrician and/or any court order with jurisdiction of children from the age of ten years up to age eighteen years for policies issued on or after January 1, 2021. 2019 RI H.B. 7987 (NS) was introduced March 11, 2020. If passed, this act would require every individual or group health insurance contract effective on or after January 1, 2021, to provide coverage to the insured and the insured's spouse and dependents for all FDA- approved contraceptive drugs, devices and other products, voluntary sterilization procedures, patient education and counseling on contraception and follow-up services as well as Medicaid coverage for a twelve month supply for Medicaid recipients. 2019 RI S.B. 2525 (NS), a previously introduced bill, was amended June 17, 2020. If passed, this bill will have the health insurance commissioner adopt a uniform set of medical criteria for prior authorization and create required forms to be used by a health insurer, including telemedicine coverage. The proposed bill states that during the COVID-19 crisis it has become clear that patients and providers benefit substantially from having access to telemedicine services that are covered by health insurers on the same basis as in- person services. Additionally, There is a need to embrace efforts that will encourage patients, health insurers and healthcare providers to support the use of telemedicine, and that will also encourage all state agencies to evaluate and amend their policies and rules to remove any regulatory barriers prohibiting the use of telemedicine services or reimbursing for such services on a discriminatory basis relative to in-person services. In South Carolina 2019 SC H.B. 4214 (NS), a previously introduced bill, was amended February 20, 2020. If passed, this bill will add a uniform definition for autism spectrum disorder (ASD) in the South Carolina Intellectual Disability, Related Disabilities, Head Injuries, and Spinal Cord Injuries Act. Additionally, this amended bill would expand the required insurance coverage by deleting existing age limits. Furthermore, the bill expands the definition of insurer to include admitted and non-admitted insurers and expands the definition of the health insurance plan to include all health insurance policies and health benefit plans for the purposes of ASD coverage. Further, this bill removes the age limits for diagnoses to be eligible for coverage and the age limit for coverage. Additionally, behavioral therapy is no longer subject to a maximum spending limit. In Vermont 2019 VT H.B. 663 (NS) was adopted October 5, 2020. The bill is an act relating to increasing the supply of nurses and primary care providers in Vermont. This bill proposes to require health insurance plans to cover all methods and forms of contraceptives without cost-sharing. It would also require school districts to make free over-the-counter contraceptives available to all secondary school students and would direct the Department of Health to coordinate with stakeholders to make free over-the-counter contraceptives available in a variety of settings statewide. In Virginia 2020 VA H.B. 1320 (NS) was introduced January 8, 2020. The proposed bill states that beginning October 1, 2020, the Joint Legislative Audit and Review Commission (JLARC) shall prepare demographic statements at the request of the Speaker of the House of Delegates, the Minority Leader of the House of Delegates, the Majority Leader of the Senate, and the Minority Leader of the Senate. Each eligible requester may request the preparation of a demographic statement for up to five bills per regular session of the General Assembly, or more at the discretion of the Director of JLARC. Demographic statements requested during special sessions of the General Assembly may be prepared at the discretion of the Director of JLARC. The Commission shall have the power to assess, analyze, and evaluate the social and economic costs and benefits of any proposed mandated health insurance benefit or mandated provider that is not included in the essential health benefits required by federal law to be provided under a health care plan, including the mandate's predicted effect on health care coverage premiums and related costs, net costs or savings to the health care system, and other relevant issues, and report its findings with respect to the proposed mandate to the Health Insurance Reform Commission. 2020 VA H.B. 808 (NS) was prefiled January 7, 2020. If passed, the bill will require every hospital in Virginia to provide treatment or transfer services to survivors of sexual assault pursuant to a plan approved by the Department of Health. The bill also: • establishes specific requirements for providers of services to pediatric survivors of sexual assault; • requires the Criminal Injuries Compensation Fund to pay the costs of services provided to survivors of sexual assault; • establishes the Task Force on Services for Survivors of Sexual Assault to facilitate the development of services for survivors of sexual assault; and • establishes the Sexual Assault Forensic Examiner Program to increase the number of qualified sexual assault forensic services providers available in Virginia. 2020 VA S.B. 317 (NS), a previously introduced bill, was amended January 23, 2020. If passed, the bill will require each hospital that provides inpatient psychiatric services to develop and implement a protocol for linking individuals who will be discharged from inpatient psychiatric care with in-home follow-up services, which may be provided by a licensed home health organization, community services board, or other appropriate service provider. 2020 VA H.B. 1428 (NS) was enrolled March 3, 2020. The bill creates the Virginia Health Benefit Exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange will facilitate the purchase and sale of © 2021 Thomson Reuters. No claim to original U.S. Government Works. -9- qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange must make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan, which is the largest plan in the largest product in the Commonwealth's small group market as supplemented in order to provide coverage for the items and services within the statutory essential health benefits categories. 2020 VA S.B. 423 (NS) was adopted April 10, 2020. The bill requires health insurers, health maintenance organizations, and corporations providing health care coverage subscription contracts to provide coverage for hearing aids and related services for children 18 years of age or younger when an otolaryngologist recommends such hearing aids and related services. The coverage includes one hearing aid per hearing-impaired ear, up to a cost of $1,500, every 24 months. The measure applies to policies, contracts, and plans delivered, issued for delivery, or renewed on and after January 1, 2021. 2020 VA S.B. 732 (NS) was adopted April 9, 2020. The bill creates the Virginia health benefit exchange, which will be established and operated by a new division within the State Corporation Commission (SCC). The Exchange must facilitate the purchase and sale of qualified health plans and qualified dental plans to qualified individuals and qualified employers. The Exchange must also make qualified plans available to qualified individuals and qualified employers by July 1, 2023, unless the SCC postpones this date. The measure authorizes the SCC to review and approve accident and sickness insurance premium rates applicable to health benefit plans in the individual and small group markets and health benefit plans providing health insurance coverage in the individual market through certain non-employer group plans. The Exchange will be funded by an assessment on health insurers, which is limited to three percent of total monthly premiums, except the SCC may, after a public hearing, adjust the rate as necessary to ensure the Exchange is fully funded. A health plan will not be required to cover any state-mandated health benefit if federal law does not require it to be covered as part of the essential benefits package. The essential health benefits are items and services included in the benchmark health insurance plan. 2020 VA H.B. 5046 (NS) was enrolled October 7, 2020. The bill relates to telemedicine services. The bill directs the Board of Medical Assistance Services to amend the state plan for medical assistance services to provide for payment of medical assistance for medically necessary health care services provided through telemedicine services, regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. The bill also requires each: • insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; • corporation providing individual or group accident and sickness subscription contracts; and • health maintenance organization providing a health care plan for health care services to provide coverage for telemedicine services regardless of the originating site and whether the patient is accompanied by a health care provider at the time such services are provided. In Washington 2019 WA S.B. 6400 (NS), a previously introduced bill, was amended February 12, 2020. The proposed bill relates to mitigating inequity in the health insurance market caused by health plans that exclude certain mandated benefits. For the purpose of mitigating inequity in the health insurance market, unless waived by the commissioner, the commissioner must assess a fee on any health carrier offering a health plan or student health plan if the health plan or student health plan excludes, under state or federal law, any essential health benefit or coverage that is otherwise required or mandated by this title or rules adopted by the commissioner. 2019 WA S.B. 6087 (NS) was enrolled March 11, 2020. The bill relates to imposing cost sharing requirements for coverage of insulin products. The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for diabetes, its treatment and supplies, and self-management training and education is crucial to prevent or delay the short and long-term complications of diabetes and its attendant costs. A health plan issued or renewed on or after January 1, 2021, providing coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that an enrollee is required to pay for a covered insulin drug at an amount not to exceed one hundred dollars per thirty-day supply of the drug. Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing paid by an enrollee must be applied toward the enrollee's deductible obligation. 2019 WA H.B. 2554 (NS) was enrolled March 12, 2020. The bill relates to mitigating inequity in the health insurance market caused by health plans that exclude certain mandated benefits. 2019 WA S.B. 6086 (NS) was adopted March 31, 2020. The bill will increase access to medications for opioid use disorder. The legislature recognizes that access to pharmacies may be difficult for vulnerable populations. To increase access to medications while ensuring patient safety the legislature intends to create a new credential to allow for a pharmacy license to be extended to a remote dispensing site where technology is used to dispense medications. © 2021 Thomson Reuters. No claim to original U.S. Government Works. -10- 2019 WA H.B. 2662 (NS) was adopted April 3, 2020. The bill establishes a cost of insulin work group. The work group must review and design strategies to reduce the cost of and total expenditures on insulin in this state. Strategies the work group must consider include, but are not limited to, a state agency becoming a licensed drug wholesaler, a state agency becoming a registered pharmacy benefit manager, and a state agency purchasing prescription drugs on behalf of the state directly from other states or in coordination with other states. 2019 WA H.B. 2642 (NS) was adopted April 3, 2020. The bill relates to removing health coverage barriers to accessing substance use disorder treatment services. For the purposes of promoting standardized training for behavioral health professionals and facilitating communications between behavioral health agencies, executive agencies, managed care organizations, private health plans, and plans offered through the public employees' benefits board, the state will adopt a single standard set of criteria to define medical necessity for substance use disorder treatment and to define substance use disorder levels of care. The criteria selected must be comprehensive, widely understood and accepted in the field, and based on continuously updated research and evidence. In West Virginia 2020 WV H.B. 4162 (NS) was introduced January 14, 2020. The proposed bill seeks to require Medicaid and insurance coverage for treatment of pediatric autoimmune neuropsychiatric disorders. 2020 WV S.B. 291 (NS) was adopted March 25, 2020. The bill requires the Public Employees Insurance Agency and other health insurance providers to provide mental health parity between behavioral health, mental health, substance use disorders. © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service Produced by Thomson Reuters Accelus Regulatory Intelligence 14-Mar-2021 © 2021 Thomson Reuters. No claim to original U.S. Government Works. -11-