HP1015, LD 1476, item 1, An Act To Ensure Continued Coverage for Essential Health Care

An Act To Ensure Continued Coverage for Essential Health Care

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4320-A, as enacted by PL 2011, c. 364, §34, is amended to read:

§ 4320-A. Coverage of preventive health services

Notwithstanding any other requirements of this Title, a carrier offering a health plan subject to the federal Affordable Care Act in this State shall, at a minimum, provide coverage for and may not impose cost-sharing requirements for preventive services as required by the federal Affordable Care Act this section.

1. Preventive services. A health plan must, at a minimum, provide coverage for:

A. The evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force or equivalent rating from a successor organization;

B. With respect to the individual insured, immunizations that have a recommendation from the American Academy of Pediatrics, the American Academy of Family Physicians or the American College of Obstetricians and Gynecologists or a successor organization;

C. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the most recent version of the comprehensive guidelines for health supervision of infants, children and adolescents developed by the American Academy of Pediatrics or a successor organization; and

D. With respect to women, such additional preventive care and screenings not described in paragraph A, including:

(1) Well-woman preventive care;

(2) Contraception in accordance with subsection 2;

(3) Screening for breast cancer;

(4) Screening for cervical cancer;

(5) Screening for HIV;

(6) Screening for gestational diabetes;

(7) Folic acid supplementation;

(8) Breastfeeding services and supplies;

(9) Screening for interpersonal and domestic violence;

(10) Counseling for sexually transmitted infections;

(11) Breast cancer chemoprevention counseling; and

(12) Risk assessment for a BRCA gene mutation and genetic counseling or testing if necessary.

2. Contraceptive methods and services. Notwithstanding sections 2756, 2840-A and 4247, a health plan must, at a minimum, provide coverage for all of the following contraceptive methods and services:

A. All contraceptive drugs, devices and other products approved by the federal Food and Drug Administration, including those prescribed by the enrollee's provider or as otherwise authorized under state or federal law. If there is a therapeutic equivalent of a contraceptive drug, device or product approved by the federal Food and Drug Administration, coverage must include either the contraceptive drug, device or product originally prescribed and approved by the federal Food and Drug Administration or at least one of its therapeutic equivalents;

B. Voluntary sterilization procedures;

C. Patient education and counseling on contraception; and

D. Services related to the drugs, devices, products and procedures covered under this subsection, including, but not limited to, management of side effects, counseling for continued adherence and device insertion and removal.

A health plan may not impose any restrictions or delays on the coverage of contraceptive methods and services required under this subsection.

3. Minimum interval. The superintendent shall establish a minimum interval of not less than one year between the date on which a recommendation or guideline described in subsection 1 is issued and the plan year with respect to which the requirement in subsection 1 is effective with respect to the service described in the recommendation or guideline.

4. Review of preventive coverage recommendations. On an annual basis beginning January 1, 2019, the superintendent shall review the preventive care items, services and screenings that have a rating of A or B in the recommendations of the United States Preventive Services Task Force, that are provided for in the comprehensive guidelines supported by the federal Department of Health and Human Services, Health Resources and Services Administration or that are recommended by the American Academy of Pediatrics, the American Academy of Family Physicians or the American College of Obstetricians and Gynecologists or a successor organization. The superintendent shall identify whether there are any preventive care items, services or screenings that are not included in the minimum coverage provided by a health plan pursuant to this section and notify the joint standing committee of the Legislature having jurisdiction over health insurance matters. The joint standing committee of the Legislature having jurisdiction over health insurance matters may report out legislation to any regular session of the Legislature to amend the requirements for minimum coverage under this section based on the report from the superintendent.

Sec. 2. Application. The requirements of this Act apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2018. For purposes of this Act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.

SUMMARY

This bill incorporates current requirements under the federal Patient Protection and Affordable Care Act for coverage of preventive health services, including services for women, into state law. The bill also requires coverage of certain contraceptive methods and services. The bill directs the Superintendent of Insurance to annually review the recommendations and guidelines for coverage of preventive health services to identify any gaps in the minimum coverage provided by health plans and authorizes the joint standing committee of the Legislature having jurisdiction over health insurance matters to introduce legislation to update the requirements for minimum coverage. The requirements apply to all individual and group health insurance policies and contracts issued or renewed on or after January 1, 2018.

HP1015 LD 1476	Session - 128th Maine Legislature		LR 1256 Item 1
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