HB 89 — HEALTH COVERAGE FOR CONTRACEPTION

b r e t º o t n = .211593.3 s k m e - 5 - e a n e d r e l u [ A d A.

HB 89/a Page 5 "59A-22-42.

Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a h prescription drug benefit shall provide, [coverage for u » r prescription contraceptive drugs or devices approved by the t h g e l i food and drug administration] at a minimum, the following h r i s coverage:

h , e h (1) at least one product or form of t u g e b l e e , gh contraception in each of the contraceptive method categories n d d i = = o h identified by the federal food and drug administration;

l ] b ,d i a º r (2) a sufficient number and assortment of oral e r = t e w d m a n o contraceptive pills to reflect the variety of oral dcontraceptives mapproved :by the federal food and drug administration;

band r(3) eclinical tservices ºrelated oto tthe nprovision =or .211593.3use sof kcontraception, mincluding econsultations, -examinations, 6procedures, -ultrasound, eanesthesia, apatient neducation, ecounseling, ddevice rinsertion eand lremoval, ufollow- [up Acare d contraceptives approved by the federal food and drugside-effects administration;management.

and (3) clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, counseling, device insertion and removal, follow-up care and side-effects management.

[Coverage for food and drug administration- approved prescription contraceptive drugs or devices may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate] Except as provided in Subsection C of this section, the coverage required pursuant to this section shall not be subject to:

h (3) prior authorization or step-therapy uHB »89/a rPage 6 requirements;

or t h g e l i (4) any other restrictions or delays on the h r i s coverage.

h , e h C.

An insurer may discourage brand-name pharmacy t u g e b l e e , gh drugs or items by applying cost sharing to brand-name drugs or n d d i = = o h items when at least one generic or therapeutic equivalent is l ] b ,d i a º r covered within the same method of contraception without patient e r = t e w d m a n o cost sharing;

provided that when an insured's health care dprovider mdetermines :that a particular drug or item is medically necessary, the individual or group health insurance policy, health care plan or certificate of insurance shall cover the brand-name pharmacy drug or item without cost sharing.

b r e t º o t n = .211593.3 s k m e - 7 - e a n e d r e l u [ A d provider determines that a particular drug or item is medically necessary, the individual or group health insurance policy, health care plan or certificate of insurance shall cover the brand-name pharmacy drug or item without cost sharing.

hHB 89/a Page 7 (2) defer to the determination of the u » r insured's health care provider;

and t h g e l i (3) provide for a determination of the claim h r i s according to a time frame and in a manner that takes into h , e h account the nature of the claim and the medical exigencies t u g e b l e e , gh involved for a claim involving an urgent health care need.

n d d i = = o h E.

An insurer shall not require a prescription for l ] b ,d i a º r any drug, item or service that is available without a e r = t e w d m a n o prescription.

dF. m :

bAn rinsurer eshall tprovide ºcoverage oand tshall nreimburse =a .211593.3health scare kprovider mor edispensing -entity 8on - e a nper-unit ebasis dfor rdispensing ea lsix-month usupply [of Acontraceptives dat F.one time;

An insurer shall provide coverage and shall reimburse a health care provider or dispensing entity on a per- unit basis for dispensing a six-month supply of contraceptives at one time;

[C.] H.

The provisions of this section shall not apply to short-term travel, accident-only HHHCºhospital-indemnity-only, orlimited-benefit limited»HHHC HHHCºhospital-indemnity-only, limited-benefit»HHHC or specified-disease policies.

h I.

The provisions of this section apply to gHB o89/a tPage hr8 individual and group health insurance policies, health care g e i k plans and certificates of insurance delivered or issued for h r i s delivery after January 1, 2020.

h , t, J.

e u g e b l e e h (1) "contraceptive method categories n d d i = = o h identified by the federal food and drug administration":

l ] b ,d i a º e (a) means tubal ligation;

sterilization r i = r t e w d m a n o implant;

intrauterine device with dprogestin; m :

b e d s º o t n = .211593.3 s k m e - 9 - e a n e d r e l u [ A d progestin;

and hHB 89/a Page 9 (3) "health care provider" means an individual u » r licensed to provide health care in the ordinary course of t h g e l i business.

h r i s [D.] K.

A religious entity purchasing individual or h , e h group health insurance coverage may elect to exclude t u g e b l e e , gh prescription contraceptive drugs or devices from the health n d d i = = o h coverage purchased." l ] b ,d i a º r SECTION 4.

A new section of Chapter 59A, Article 22 NMSA e r = t e w d m a n o 1978 is enacted to read:

d"COVERAGE mEXCLUSION.--Coverage :of vasectomy and male condoms pursuant to Section 3 of this 2019 act is excluded for high-deductible individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met." SECTION 5.

b r e t º o t n = .211593.3 s k m e - 10 - e a n e d r e l u [ A dnew "[NEWsection MATERIAL] COVERAGE EXCLUSION.--Coverage of vasectomyChapter and59A, maleArticle condoms23 pursuantNMSA to1978 Section 3 of this 2019 act is excludedenacted forto high-deductibleread: individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met." SECTION 5.

A"COVERAGE newFOR sectionCONTRACEPTION.-- ofA. Chapter 59A, Article 23 NMSA is enacted to read:

"[NEW MATERIAL ] COVERAGE FOR CONTRACEPTION.-- A.

(1) at least one product or form of h contraception in each of the contraceptive method categories uHB »89/a rPage 10 identified by the federal food and drug administration;

t h g e l i (2) a sufficient number and assortment of oral h r i s contraceptive pills to reflect the variety of oral h , e h contraceptives approved by the federal food and drug t u g e b l e e , gh administration;

and n d d i = = o h (3) clinical services related to the provision l ] b ,d i a º r or use of contraception, including consultations, examinations, eprocedures, rultrasound, =anesthesia, tpatient eeducation, wcounseling, ddevice minsertion aand nremoval, ofollow- procedures,up ultrasound,care anesthesia,and patientside-effects education,management. d m :

b r e t º o t n = .211593.3 s k m e - 11 - e a n e d r e l u [ A d counseling, device insertion and removal, follow-up care and side-effects management.

provided that when an h insured's health care provider determines that a particular uHB »89/a rPage 11 drug or item is medically necessary, the individual or group t h g e l i health insurance policy, health care plan or certificate of h r i s health insurance shall cover the brand-name pharmacy drug or h , e h item without cost sharing.

A determination of medical t u g e b l e e , gh necessity may include considerations such as severity of side n d d i = = o h effects, differences in permanence or reversibility of l ] b ,d i a º r contraceptives and ability to adhere to the appropriate use of e r = t e w d m a n o the drug or item, as determined by the attending provider.

dD. m :

b r e t º o t n = .211593.3 s k m e - 12 - e a n e d r e l u [ A d D.

An insurer shall not require a prescription for any drug, item or service that is available without a h prescription.

gHB o89/a tPage hr12 F.

An individual or group health insurance policy, g e i k health care plan or certificate of health insurance shall h r i s provide coverage and shall reimburse a health care provider or h , t, dispensing entity on a per unit basis for dispensing a six-six-month e u g e b l e e h month supply of contraceptives;

provided that the n d d i = = o h contraceptives are prescribed and self-administered.

l ] b ,d i a º e G.

r i = r t e w d m a n o (1) require a health care provider to dprescribe msix :months of contraceptives at one time;

b e d s º o t n = .211593.3 s k m e - 13 - e a n e d r e l u [ A d prescribe six months of contraceptives at one time;

The provisions of this section shall not apply to short-term travel, accident-only, HHHCºlimitedhospital-indemnity-only, benefit»HHHClimited-benefit HHHCºhospital-indemnity-only, limited-benefit»HHHC or specified-disease health benefits plans.

h (a) means tubal ligation;

sterilization u » r implant;

intrauterine device with tHB h89/a gPage e13 l i progestin;

h r i s combined oral contraceptives;

extended or continuous use oral h , e h contraceptives;

t u g e b l e e , gh vaginal ring;

sponge with n d d i = = o h spermicide;

male and female l ] b ,d i a º r condoms;

e r = t e w d m a n o levonorgestrel emergency contraception;

and any additional dcontraceptive mmethod :categories approved by the federal food and drug administration;

b r e t º o t n = .211593.3 s k m e - 14 - e a n e d r e l u [ A d contraceptive method categories approved by the federal food and drug administration;

A religious entity purchasing individual or group health insurance coverage may elect to exclude prescription contraceptive drugs or items from the health insurance coverage purchased." h SECTION 6.

A new section of Chapter 59A, Article 23 NMSAHB u89/a »Page r14 NMSA 1978 is enacted to read:

t"COVERAGE h g e l i "[NEW MATERIAL ] COVERAGE EXCLUSION.--Coverage of vasectomy h r i s and male condoms pursuant to Section 5 of this 2019 act is h , e h excluded for high-deductible individual or group health t u g e b l e e , gh insurance policies, health care plans or certificates of n d d i = = o h insurance with health savings accounts delivered or issued for l ] b ,d i a º r delivery in this state until an insured's deductible has been e r = t e w d m a n o met." dSECTION m7. :

b r e t º o t n = .211593.3 s k m e - 15 - e a n e d r e l u [ A d SECTION 7.

COVERAGE FOR [PRESCRIPTION CONTRACEPTIVE DRUGS OR DEVICES] CONTRACEPTION.-- A.

Each individual and group health maintenance organization contract delivered or issued for delivery in this state that provides a prescription drug benefit shall provide, [coverage for prescription contraceptive drugs or devices approved by the food and drug administration] at a minimum, the following coverage:

(2) a sufficient number and assortment of oral contraceptive pills to reflect the variety of oral contraceptives approved by the federal food and drug h administration;

and u » r (3) clinical services related to the provision t h g e l i or use of contraception, including consultations, examinations, h r i s procedures, ultrasound, anesthesia, patient education, h , e h counseling, device insertion and removal, follow-upfollow- careHB and89/a tPage u15 gup ecare band l e e , gh side-effects management.

n d d i = = o h B.

[CoverageExcept foras foodprovided andin drugSubsection administration-C lof ]this bsection, ,dthe icoverage arequired ºpursuant rto approvedthis prescriptionsection contraceptiveshall drugsnot or devices may be e r = t e w d m a n o subject toto: deductibles and coinsurance consistent with those d m :

b r e t º o t n = .211593.3 s k m e - 16 - e a n e d r e l u [ A d imposed on other benefits under the same contract] Except as provided in Subsection C of this section, the coverage required pursuant to this section shall not be subject to:

provided that when an enrollee's health care provider determines that a particular drug or item is medically necessary, the individual or group h health maintenance organization contract shall cover the brand-brand-name u » r name pharmacy drug or item without cost sharing.

Medical t h g e l i necessity may include considerations such as severity of side h r i s effects, differences in permanence or reversibility of h , e h contraceptives and ability to adhere to the appropriate use of t u g e b l e e , gh the drug or item, as determined by the attending provider.

n d d i = = o h D.

An individual or group health maintenance lHB ]89/a bPage ,d16 i a º r organization contract shall grant an enrollee an expedited e r = t e w d m a n o hearing to appeal any adverse determination made relating to dthe mprovisions :of this section.

b r e t º o t n = .211593.3 s k m e - 17 - e a n e d r e l u [ A d the provisions of this section.

An individual or group health maintenance h organization contract shall provide coverage and shall u » r reimburse a health care provider or dispensing entity on a per-per-unit t h g e l i unit basis for dispensing a six-month supply of contraceptives h r i s at one time;

provided that the contraceptives are prescribed h , e h and self-administered.

t u g e b l e e , gh G.

nHB d89/a dPage i17 = = o h (1) require a health care provider to l ] b ,d i a º r prescribe six months of contraceptives at one time;

or e(2) rpermit =an tindividual eor wgroup dhealth mmaintenance aorganization ncontract oto (2)limit permitcoverage or impose cost sharing for an individualalternate ormethod groupof healthcontraception dif man :enrollee changes contraceptive methods before exhausting a previously dispensed supply.

bH. r e t º o t n = .211593.3 s k m e - 18 - e a n e d r e l u [ A d maintenance organization contract to limit coverage or impose cost sharing for an alternate method of contraception if an enrollee changes contraceptive methods before exhausting a previously dispensed supply.

HHHCºH.The provisions of this section shall not apply to short-term travel, accident-only, hospital-indemnity-only, limited-benefit or specified disease health benefits plans.

TheI. provisions of this section shall not apply to short-term travel, accident-only, hospital-indemnity- only, limited-benefit or specified disease health benefits plans.»HHHC HHHCºH»HHHC HHHCºI»HHHC.

HHHCºI»HHHCJ. HHHCºJ»HHHC.

h (a) means tubal ligation;

sterilization u » r implant;

intrauterine device with t h g e l i progestin;

h r i s combined oral contraceptives;

extended or continuous use oral h , e h contraceptives;

t u g e b l e e , gh vaginal ring;

sponge with n d d i = = o h spermicide;

male and female l ] b ,d i a º r condoms;

e r = t e w d m a n o levonorgestrel emergency contraception;

and any additional dHB m89/a :Page 18 contraceptive method categories approved by the federal food and drug administration;

b r e t º o t n = .211593.3 s k m e - 19 - e a n e d r e l u [ A d contraceptive method categories approved by the federal food and drug administration;

[C.]K. HHHCºJ»HHHC HHHCºK»HHHC.

A new section of the Health Maintenance h Organization Law is enacted to read:

u"COVERAGE » r "[NEW MATERIAL] COVERAGE EXCLUSION.--Coverage of vasectomy t h g e l i and male condoms pursuant to Section 7 of this 2019 act is h r i s excluded for high-deductible individual or group health h , e h maintenance organization contracts with health savings accounts t u g e b l e e , gh delivered or issued for delivery in this state until an n d d i = = o h enrollee's deductible has been met." l ] b ,d i a º r SECTION 9.

A new section of the Nonprofit Health Care eHB r89/a =Page t19 e w d m a n o Plan Law is enacted to read:

d"COVERAGE mFOR :CONTRACEPTION.-- A.

b r e t º o t n = .211593.3 s k m e - 20 - e a n e d r e l u [ A d "[NEW MATERIAL] COVERAGE FOR CONTRACEPTION.-- A.

and (3) clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, counseling, device insertion and removal, follow-upfollow- up care and side-effects management.

h B.

Except as provided in Subsection C of this g o t hr section, the coverage required pursuant to this section shall g e i k not be subject to:

h r i s (1) cost sharing for subscribers;

h , t, (2) utilization review;

e u g e b l e e h (3) prior authorization or step-therapy n d d i = = o h requirements;

or l ] b ,d i a º e (4) any restrictions or delays on the rHB i89/a =Page r20 t e w d m a n o coverage.

dC. m :

bA ehealth dcare splan ºmay odiscourage tbrand-name npharmacy =drugs .211593.3or sitems kby mapplying ecost -sharing 21to -brand- ename adrugs nor eitems dwhen rat eleast lone ugeneric [or Atherapeutic dequivalent C.is covered within the same method category of contraception without cost sharing by the subscriber;

A health care plan may discourage brand-name pharmacy drugs or items by applying cost sharing to brand-name drugs or items when at least one generic or therapeutic equivalent is covered within the same method category of contraception without cost sharing by the subscriber;

The process for h requesting an expedited hearing pursuant to this subsection u » r shall:

t h g e l i (1) be easily accessible, transparent, h r i s sufficiently expedient and not unduly burdensome on a h , e h subscriber, the subscriber's representative or the subscriber's t u g e b l e e , gh health care provider;

n d d i = = o h (2) defer to the determination of the lHB ]89/a bPage ,d21 i a º r subscriber's health care provider;

and e(3) rprovide =for ta edetermination wof dthe mclaim aaccording nto oa (3)time provideframe forand in a determinationmanner that takes into account the nature of the claim dand mthe :medical exigencies involved for a claim involving an urgent health care need.

b r e t º o t n = .211593.3 s k m e - 22 - e a n e d r e l u [ A d according to a time frame and in a manner that takes into account the nature of the claim and the medical exigencies involved for a claim involving an urgent health care need.

or (2) permit a health care plan to limit coverage or impose cost sharing for an alternate method of h contraception if a subscriber changes contraceptive methods u » r before exhausting a previously dispensed supply.

t h g e l i H.

The provisions of this section shall not apply h r i s to short-term travel, accident-only, HHHCºhospital-indemnity-only, limitedlimited-benefit benefit»HHHC h , e h HHHCºhospital-indemnity-only, limited-benefit»HHHC or t u g e b l e e , gh specified-disease health care plans.

n d d i = = o h I.

The provisions of this section apply to health l ] b ,d i a º r care plans delivered or issued for delivery after January 1, eHB r89/a =Page t22 e w d m a n o 2020.

dJ. m :

b r e t º o t n = .211593.3 s k m e - 23 - e a n e d r e l u [ A d J.

h (2) "cost sharing" means a deductible, u » r copayment or coinsurance that a subscriber is required to pay t h g e l i in accordance with the terms of a health care plan;

and h r i s (3) "health care provider" means an individual h , e h licensed to provide health care in the ordinary course of t u g e b l e e , gh business.

n d d i = = o h K.

A religious entity purchasing individual or lHB ]89/a bPage ,d23 i a º r group health care plan coverage may elect to exclude e r = t e w d m a n o prescription contraceptive drugs or items from the health dinsurance mcoverage :purchased." SECTION 10.

b r e t º o t n = .211593.3 s k m e - 24 - e a n e d r e l u [ A d insurance coverage purchased." SECTION 10.

"[NEW"COVERAGE MATERIAL ] COVERAGE EXCLUSION.--Coverage of vasectomy and male condoms pursuant to Section 9 of this 2019 act is excluded for high-deductible health care plans with health savings accounts until a covered person's deductible has been met." SECTION 11.

-HB 2589/a -Page h24 u25 » r t h g e l i h r i s h , e h t u g e b l e e , gh n d d i = = o h l ] b ,d i a º r e r = t e w d m a n o d m :

b r e t º o t n = .211593.3 s k m e e a n e d r e l u [ A d