Bill Text: NY A10687 | 2023-2024 | General Assembly | Introduced
Bill Title: Requires health insurance policies to include coverage of optional anesthesia for certain contraceptive and menstrual health procedures including, but not limited to, loop electrosurgical excision procedure, colposcopy, ablation, and intrauterine device insertion.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2024-08-28 - referred to insurance [A10687 Detail]
Download: New_York-2023-A10687-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 10687 IN ASSEMBLY August 28, 2024 ___________ Introduced by COMMITTEE ON RULES -- (at request of M. of A. Simone) -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring health insurance policies to include coverage of optional anesthesia for certain contraceptive and menstrual health procedures The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Clause (v) of subparagraph (E) of paragraph 17 of 2 subsection (i) of section 3216 of the insurance law, as amended by 3 section 3 of part M of chapter 57 of the laws of 2019, is amended to 4 read as follows: 5 (v) all FDA-approved menstrual health procedures and contraceptive 6 drugs, devices, and other products, including all over-the-counter 7 contraceptive drugs, devices, and products as prescribed or as otherwise 8 authorized under state or federal law; voluntary sterilization proce- 9 dures pursuant to 42 U.S.C. 18022 and identified in the comprehensive 10 guidelines supported by the health resources and services administration 11 and thereby incorporated in the essential health benefits benchmark 12 plan; patient education and counseling on contraception; and follow-up 13 services related to the drugs, devices, products, and procedures covered 14 under this clause, including, but not limited to, management of side 15 effects, counseling for continued adherence, and device insertion and 16 removal. Except as otherwise authorized under this clause, a contract 17 shall not impose any restrictions or delays on the coverage required 18 under this clause. However, where the FDA has approved one or more 19 therapeutic and pharmaceutical equivalent, as defined by the FDA, 20 versions of a contraceptive drug, device, or product, a contract is not 21 required to include all such therapeutic and pharmaceutical equivalent 22 versions in its formulary, so long as at least one is included and 23 covered without cost-sharing and in accordance with this clause. If the 24 covered therapeutic and pharmaceutical equivalent versions of a drug, 25 device, or product are not available or are deemed medically inadvisable 26 a contract shall provide coverage for an alternate therapeutic and phar- 27 maceutical equivalent version of the contraceptive drug, device, or EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD14820-01-4A. 10687 2 1 product without cost-sharing. (a) This coverage shall include emergency 2 contraception without cost sharing when provided pursuant to a 3 prescription, or order under section sixty-eight hundred thirty-one of 4 the education law or when lawfully provided over-the-counter. (b) If the 5 attending health care provider, in his or her reasonable professional 6 judgment, determines that the use of a non-covered therapeutic or phar- 7 maceutical equivalent of a drug, device, or product is warranted, the 8 health care provider's determination shall be final. The superintendent 9 shall promulgate regulations establishing a process, including time- 10 frames, for an insured, an insured's designee or an insured's health 11 care provider to request coverage of a non-covered contraceptive drug, 12 device, or product. Such regulations shall include a requirement that 13 insurers use an exception form that shall meet criteria established by 14 the superintendent. (c) This coverage must allow for the dispensing of 15 up to twelve months worth of a contraceptive at one time. (d) This 16 coverage shall include optional anesthesia for vaginal, cervical, and 17 uterine medical procedures, including, but not limited to, loop electro- 18 surgical excision procedure, colposcopy, ablation, and intrauterine 19 device insertion. (e) For the purposes of this clause, "over-the-counter 20 contraceptive products" shall mean those products provided for in 21 comprehensive guidelines supported by the health resources and services 22 administration as of January twenty-first, two thousand nineteen. 23 § 2. Subparagraph (A) of paragraph 16 of subsection (l) of section 24 3221 of the insurance law, as amended by section 1 of part M of chapter 25 57 of the laws of 2019, is amended to read as follows: 26 (A) Every group or blanket policy that provides medical, major 27 medical, or similar comprehensive type coverage that is issued, amended, 28 renewed, effective or delivered on or after January first, two thousand 29 twenty, shall provide coverage for all of the following services, 30 menstrual health procedures, and contraceptive methods: 31 (1) All FDA-approved menstrual health procedures and contraceptive 32 drugs, devices, and other products. This includes all FDA-approved 33 over-the-counter contraceptive drugs, devices, and products as 34 prescribed or as otherwise authorized under state or federal law. The 35 following applies to this coverage: 36 (a) where the FDA has approved one or more therapeutic and pharmaceu- 37 tical equivalent, as defined by the FDA, versions of a contraceptive 38 drug, device, or product, a group or blanket policy is not required to 39 include all such therapeutic and pharmaceutical equivalent versions in 40 its formulary, so long as at least one is included and covered without 41 cost-sharing and in accordance with this paragraph; 42 (b) if the covered therapeutic and pharmaceutical equivalent versions 43 of a drug, device, or product are not available or are deemed medically 44 inadvisable a group or blanket policy shall provide coverage for an 45 alternate therapeutic and pharmaceutical equivalent version of the 46 contraceptive drug, device, or product without cost-sharing. If the 47 attending health care provider, in his or her reasonable professional 48 judgment, determines that the use of a non-covered therapeutic or phar- 49 maceutical equivalent of a drug, device, or product is warranted, the 50 health care provider's determination shall be final. The superintendent 51 shall promulgate regulations establishing a process, including time- 52 frames, for an insured, an insured's designee or an insured's health 53 care provider to request coverage of a non-covered contraceptive drug, 54 device, or product. Such regulations shall include a requirement that 55 insurers use an exception form that shall meet criteria established by 56 the superintendent;A. 10687 3 1 (c) this coverage shall include emergency contraception without cost- 2 sharing when provided pursuant to a prescription or order under section 3 sixty-eight hundred thirty-one of the education law or when lawfully 4 provided over the counter; [and] 5 (d) this coverage must allow for the dispensing of up to twelve months 6 worth of a contraceptive at one time; and 7 (e) this coverage shall include optional anesthesia for vaginal, 8 cervical, and uterine medical procedures, including, but not limited to, 9 loop electrosurgical excision procedure, colposcopy, ablation, and 10 intrauterine device insertion; 11 (2) Voluntary sterilization procedures pursuant to 42 U.S.C. 18022 and 12 identified in the comprehensive guidelines supported by the health 13 resources and services administration and thereby incorporated in the 14 essential health benefits benchmark plan; 15 (3) Patient education and counseling on contraception; and 16 (4) Follow-up services related to the drugs, devices, products, and 17 procedures covered under this paragraph, including, but not limited to, 18 management of side effects, counseling for continued adherence, and 19 device insertion and removal. 20 § 3. The opening paragraph and subparagraph (A) of paragraph 1 of 21 subsection (cc) of section 4303 of the insurance law, as amended by 22 section 2 of part M of chapter 57 of the laws of 2019, are amended to 23 read as follows: 24 Every contract that provides medical, major medical, or similar 25 comprehensive type coverage that is issued, amended, renewed, effective 26 or delivered on or after January first, two thousand twenty, shall 27 provide coverage for all of the following services, menstrual health 28 procedures, and contraceptive methods: 29 (A) All FDA-approved menstrual health procedures and contraceptive 30 drugs, devices, and other products. This includes all FDA-approved 31 over-the-counter contraceptive drugs, devices, and products as 32 prescribed or as otherwise authorized under state or federal law. The 33 following applies to this coverage: 34 (i) where the FDA has approved one or more therapeutic and pharmaceu- 35 tical equivalent, as defined by the FDA, versions of a contraceptive 36 drug, device, or product, a contract is not required to include all such 37 therapeutic and pharmaceutical equivalent versions in its formulary, so 38 long as at least one is included and covered without cost-sharing and in 39 accordance with this subsection; 40 (ii) if the covered therapeutic and pharmaceutical equivalent versions 41 of a drug, device, or product are not available or are deemed medically 42 inadvisable a contract shall provide coverage for an alternate therapeu- 43 tic and pharmaceutical equivalent version of the contraceptive drug, 44 device, or product without cost-sharing. If the attending health care 45 provider, in his or her reasonable professional judgment, determines 46 that the use of a non-covered therapeutic or pharmaceutical equivalent 47 of a drug, device, or product is warranted, the health care provider's 48 determination shall be final. The superintendent shall promulgate regu- 49 lations establishing a process, including timeframes, for an insured, an 50 insured's designee or an insured's health care provider to request 51 coverage of a non-covered contraceptive drug, device, or product. Such 52 regulations shall include a requirement that insurers use an exception 53 form that shall meet criteria established by the superintendent; 54 (iii) this coverage shall include emergency contraception without 55 cost-sharing when provided pursuant to a prescription or order underA. 10687 4 1 section sixty-eight hundred thirty-one of the education law or when 2 lawfully provided over the counter; [and] 3 (iv) this coverage must allow for the dispensing of up to twelve 4 months worth of a contraceptive at one time; and 5 (v) this coverage shall include optional anesthesia for vaginal, 6 cervical, and uterine medical procedures, including, but not limited to, 7 loop electrosurgical excision procedure, colposcopy, ablation, and 8 intrauterine device insertion; 9 § 4. This act shall take effect immediately.
