HB 1957 — Preserving coverage of preventive services without cost sharing.

ENGROSSEDH-2128.2 SUBSTITUTE HOUSE BILL 1957 State of Washington 68th Legislature 2024 Regular Session By House Health Care & Wellness (originally sponsored by Representatives Riccelli, Macri, Ryu, Leavitt, Senn, Reed, Ormsby, Callan, Doglio, Fosse, Goodman, Lekanoff, Wylie, Pollet, and Davis)Davis READPrefiled FIRST12/15/23. TIME 01/16/24.

Read first time 01/08/24.

Referred to Committee on Health Care & Wellness.

(1) A nongrandfathered health plan issued on or after ((June 7, 2018)) the effective date of this section, must, at a minimum, provide coverage for the ((same)) following preventive services ((required to be covered under 42 U.S.C.

1 ESHBHB 1957 prevention is considered in effect after the recommendation has been adopted by the director of the centers for disease control and prevention, and a recommendation is considered to be for routine use if the recommendation is listed on the immunization schedules of the centers for disease control and prevention;

(2) ((The)) A nongrandfathered health plancarrier mustis not required to provide coverage for theany preventiveitems or services requiredspecified toin beany coveredrecommendation underor guideline described in subsection (1) of this section consistentif witha federalrecommendation rulesor andguideline guidanceis relatedrevised to coverageno oflonger include the preventive servicesitem or service as defined in effectsubsection on(1) Januaryof 8,this 2024.section.

(3) AAnnually, nongrandfathereda health plancarrier mustshall providedetermine coveragewhether forany theadditional preventiveitems or services requiredmust to be covered underwithout subsectioncost-sharing (1)requirements ofor thiswhether sectionany foritems plan years that begin on or afterservices theare dateno thatlonger isrequired oneto yearbe aftercovered. the date the recommendation or guideline is issued.

(4) A nongrandfathered health plan is no longer required to provide coverage for particular items or services specified in the recommendations or guidelines described in subsection (1) of this section if such a recommendation or guideline is revised by the recommending entities described in subsection (1) of this section to no longer include the preventive item or service as defined in subsection (1) of this section.

(5) Annually, a health carrier shall determine whether any additional items or services must be covered without cost-sharing requirements or whether any items or services are no longer required to be covered as provided in subsections (2) and (3) of this section.

(6)(a)(4)(a) Except as provided in (b) of this subsection, the health plan may not impose cost-sharing requirements for the preventive services required to be covered under subsection (1) of this section when the services are provided by an in-network provider.

If a plan p.does not have in its network a provider who can provide an item or service described in subsection (1) of this section, the plan must cover the item or service when performed by an out-of-network provider and may not impose cost sharing with respect to the item or service.

2 ESHB 1957 does not have in its network a provider who can provide an item or service described in subsection (1) of this section, the plan must cover the item or service when performed by an out-of-network provider and may not impose cost sharing with respect to the item or service.

300gg-13 is found invalid, for a health plan offered as a qualifying health plan for a health savings account, the carrier may apply cost sharing to coverage of the services thatcovered haveunder beenthis invalidatedsection only at the minimum level necessary to preserve the enrollee's ability to claim taxp. exempt contributions and withdrawals from the enrollee's health savings account under internal revenue service laws and regulations.

(7)2 AHB carrier1957 maytax useexempt reasonablecontributions medicaland managementwithdrawals techniquesfrom to determine the frequency,enrollee's method,health treatment,savings oraccount settingunder forinternal anrevenue item or service describedlaws in subsection (1) of this section to the extent not specified in the relevant recommendation or guideline, federal rules and guidanceregulations. related to the coverage of preventive services in effect on January 8, 2024, and any rules adopted by the insurance commissioner.

(8)(5) TheA insurancecarrier commissionermay shalluse enforcereasonable thismedical sectionmanagement consistenttechniques withto federaldetermine rules((,the guidance,frequency, andmethod, casetreatment, lawor insetting effectfor onan Decemberitem 31,or 2016,service applicabledescribed in subsection (1) of this section to 42the U.S.C.extent not specified in the relevant recommendation or guideline.

300gg-13(6) (2016)))The insurance commissioner shall enforce this section ((consistent with federal rules, guidance, and guidancecase law in effect on JanuaryDecember 8,31, 2024.2016, applicable to 42 U.S.C.

(9)300gg-13 The(2016))). insurance commissioner may adopt rules necessary to implement this section, consistent with federal statutes, rules, and guidance in effect on January 8, 2024.

(7) The insurance commissioner may also adopt rulesrules: related to any future preventive services recommendations and guidelines issued by the United States preventive health services task force, the advisory committee on immunization practices of the centers for disease control, and the health resources services administration or related federal rules or guidance.

(a) Necessary to implement this section;

and (b) Related to any subsequent preventive services recommendations and guidelines described in subsection (1) of this section.

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