HF 520

as introduced - 92nd Legislature (2021 - 2022) Posted on 02/10/2021 06:46pm

A bill for an act
relating to health insurance; establishing supply requirements for prescription
contraceptives; requiring health plans to cover contraceptives, contraceptive
services, sterilization, and related medical services, patient education, and
counseling; establishing accommodations for eligible organizations; amending
Minnesota Statutes 2020, section 256B.0625, subdivision 13; proposing coding
for new law in Minnesota Statutes, chapter 62Q.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [62Q.521] COVERAGE OF CONTRACEPTIVES AND
CONTRACEPTIVE SERVICES.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The definitions in this subdivision apply to this section.
new text end

new text begin (b) "Closely held for-profit entity" means an entity that:
new text end

new text begin (1) is not a nonprofit entity;
new text end

new text begin (2) has more than 50 percent of the value of its ownership interest owned directly or
indirectly by five or fewer individuals, or has an ownership structure that is substantially
similar; and
new text end

new text begin (3) has no publicly traded ownership interest, having any class of common equity
securities required to be registered under United States Code, title 15, section 781.
new text end

new text begin For purposes of this paragraph:
new text end

new text begin (i) ownership interests owned by a corporation, partnership, estate, or trust are considered
owned proportionately by that entity's shareholders, partners, or beneficiaries;
new text end

new text begin (ii) ownership interests owned by a nonprofit entity are considered owned by a single
owner;
new text end

new text begin (iii) ownership interests owned by an individual are considered owned, directly or
indirectly, by or for the individual's family. For purposes of this item, "family" means
brothers and sisters, including half-brothers and half-sisters, a spouse, ancestors, and lineal
descendants; and
new text end

new text begin (iv) if an individual or entity holds an option to purchase an ownership interest, the
individual or entity is considered to be the owner of those ownership interests.
new text end

new text begin (c) "Contraceptive" means a drug, device, or other product approved by the Food and
Drug Administration to prevent unintended pregnancy.
new text end

new text begin (d) "Contraceptive service" means consultation, examination, procedure, and medical
service related to the prevention of unintended pregnancy. This includes but is not limited
to voluntary sterilization procedures, patient education, counseling on contraceptives, and
follow-up services related to contraceptives or contraceptive services, management of side
effects, counseling for continued adherence, and device insertion or removal.
new text end

new text begin (e) "Eligible organization" means an organization that opposes providing coverage for
some or all contraceptives or contraceptive services on account of religious objections and
that is:
new text end

new text begin (1) organized as a nonprofit entity and holds itself as a religious organization; or
new text end

new text begin (2) organized and operates as a closely held for-profit entity, and the organization's
highest governing body has adopted, under the organization's applicable rules of governance
and consistent with state law, a resolution or similar action establishing that it objects to
covering some or all contraceptives or contraceptive services on account of the owners'
sincerely held religious beliefs.
new text end

new text begin (f) "Medical necessity" includes but is not limited to considerations such as severity of
side effects, difference in permanence and reversability of a contraceptive or contraceptive
service, and ability to adhere to the appropriate use of the contraceptive method or service,
as determined by the attending provider.
new text end

new text begin (g) "Religious organization" means an organization that is organized and operates as a
nonprofit entity and meets the requirements of section 6033(a)(3)(A)(i) or (iii) of the Internal
Revenue Code of 1986, as amended.
new text end

new text begin (h) "Therapeutic equivalent version" means a drug, device, or product that can be expected
to have the same clinical effect and safety profile when administered to a patient under the
conditions specified in the labeling, and that:
new text end

new text begin (1) is approved as safe and effective;
new text end

new text begin (2) is a pharmaceutical equivalent, (i) containing identical amounts of the same active
drug ingredient in the same dosage form and route of administration, and (ii) meeting
compendial or other applicable standards of strength, quality, purity, and identity;
new text end

new text begin (3) is bioequivalent in that:
new text end

new text begin (i) the drug, device, or product does not present a known or potential bioequivalence
problem and meet an acceptable in vitro standard; or
new text end

new text begin (ii) if the drug, device, or product does present a known or potential bioequivalence
problem, it is shown to meet an appropriate bioequivalence standard;
new text end

new text begin (4) is adequately labeled; and
new text end

new text begin (5) is manufactured in compliance with current manufacturing practice regulations.
new text end

new text begin Subd. 2. new text end

new text begin Required coverage; cost sharing prohibited. new text end

new text begin (a) A health plan must provide
coverage for all prescription contraceptives and contraceptive services.
new text end

new text begin (b) A health plan company must not impose cost-sharing requirements, including co-pays,
deductibles, or co-insurance, for contraceptives or contraceptive services.
new text end

new text begin (c) Notwithstanding paragraph (b), a health plan that is a high-deductible health plan in
conjunction with a health savings account must include cost-sharing for contraceptives and
contraceptive services at the minimum level necessary to preserve the enrollee's ability to
make tax exempt contributions and withdrawals from the health savings account, as provided
by section 223 of the Internal Revenue Code of 1986, as amended.
new text end

new text begin (d) A health plan company must not impose any referral requirements, restrictions, or
delays for contraceptives or contraceptive services.
new text end

new text begin (e) If more than one therapeutic equivalent version of a contraceptive is approved by
the FDA, a health plan must cover at least one therapeutic equivalent version, but is not
required to cover all therapeutic equivalent versions.
new text end

new text begin (f) For each health plan, a health plan company must list the contraceptives and
contraceptive services that are covered without cost-sharing in a manner that is easily
accessible to enrollees, health care providers, and representatives of health care providers.
The list for each health plan must be promptly updated to reflect changes to the coverage.
new text end

new text begin (g) If an enrollee's attending provider recommends a particular contraceptive or
contraceptive service based on a determination of medical necessity for that enrollee, the
health plan must cover that contraceptive or contraceptive service without cost-sharing. The
health plan company issuing the health plan must defer to the attending provider's
determination that the particular contraceptive or contraceptive service is medically necessary
for the enrollee.
new text end

new text begin Subd. 3. new text end

new text begin Religious employers; exempt new text end

new text begin (a) A religious employer is not required to cover
contraceptives or contraceptive services if the employer has religious objections to the
coverage. A religious employer that chooses to not provide coverage for some or all
contraceptives and contraceptive services must notify employees as part of the hiring process
and all employees at least 30 days before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (b) If the religious employer provides coverage for some contraceptives or contraceptive
services, the notice must provide a list of the contraceptives or contraceptive services the
employer refuses to cover.
new text end

new text begin Subd. 4. new text end

new text begin Accommodation for eligible organizations. new text end

new text begin (a) A health plan established or
maintained by an eligible organization complies with the requirements of subdivision 2 to
provide coverage of contraceptives and contraceptive services if the eligible organization
provides notice to any health plan company the eligible organization contracts with that it
is an eligible organization and that the eligible organization has a religious objection to
coverage for all or a subset of contraceptives or contraceptive services.
new text end

new text begin (b) The notice from an eligible organization to a health plan company under paragraph
(a) must include the name of the eligible organization, a statement that it objects to coverage
for some or all of contraceptives or contraceptive services, including a list of the contraceptive
services the eligible organization objects to, if applicable, and the health plan name. The
notice must be executed by a person authorized to provide notice on behalf of the eligible
organization.
new text end

new text begin (c) An eligible organization must provide a copy of the notice under paragraph (b) to
prospective employees as part of the hiring process and total employees at least 30 days
before:
new text end

new text begin (1) an employee enrolls in the health plan; or
new text end

new text begin (2) the effective date of the health plan, whichever occurs first.
new text end

new text begin (d) A health plan company that receives a copy of the notice under paragraph (a) with
respect to a health plan established or maintained by an eligible organization must:
new text end

new text begin (1) expressly exclude coverage for some or all contraceptives or contraceptive services
from the health plan;
new text end

new text begin (2) provide separate payments for any contraceptive or contraceptive service required
to be covered under subdivision 2 for enrollees as long as the enrollee remains enrolled in
the health plan; and
new text end

new text begin (3) arrange for an issuer or other entity to provide payments for contraceptive services
for plan participants and beneficiaries without imposing any cost-sharing requirements, or
imposing a premium fee or other charge, or any portion thereof directly or indirectly, on
the eligible organization, the group health plan, or plan participants or beneficiaries.
new text end

new text begin (e) The health plan company must not impose any cost-sharing requirements, including
co-pays, deductibles, or co-insurance, or directly or indirectly impose any premium, fee, or
other charge for contraceptive services or contraceptives on the eligible organization, health
plan, or enrollee.
new text end

new text begin (f) On January 1, 2022, and every year thereafter a health plan company must notify the
commissioner, in a manner to be determined by the commissioner, regarding the number
of eligible organizations granted an accommodation under this subdivision.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 2.

new text begin [62Q.522] COVERAGE FOR PRESCRIPTION CONTRACEPTIVES;
SUPPLY REQUIREMENTS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope of coverage. new text end

new text begin Except as otherwise provided in section 62Q.521,
subdivision 3, all health plans that provide prescription coverage must comply with the
requirements of this section.
new text end

new text begin Subd. 2. new text end

new text begin Definition. new text end

new text begin For purposes of this section, "prescription contraceptive" means
any drug or device that requires a prescription and is approved by the Food and Drug
Administration to prevent pregnancy. Prescription contraceptive does not include an
emergency contraceptive drug that prevents pregnancy when administered after sexual
contact.
new text end

new text begin Subd. 3. new text end

new text begin Required coverage. new text end

new text begin (a) Health plan coverage for a prescription contraceptive
must provide a 12-month supply for any prescription contraceptive, regardless of whether
the enrollee was covered by the health plan at the time of the first dispensing.
new text end

new text begin (b) The prescribing health care provider must determine the appropriate number of
months to prescribe the prescription contraceptives for, up to 12 months.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective January 1, 2022, and applies to coverage
offered, sold, issued, or renewed on or after that date.
new text end

Sec. 3.

Minnesota Statutes 2020, section 256B.0625, subdivision 13, is amended to read:

Subd. 13.

Drugs.

(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.

(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner new text begin or as provided in paragraph (g) new text end .

(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:

(1) is not a therapeutic option for the patient;

(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and

(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.

(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.

(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.

(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.

deleted text begin (g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
deleted text end

new text begin (g) Medical assistance coverage for a prescription contraceptive must provide a 12-month
supply for any prescription contraceptive. The prescribing health care provider must
determine the appropriate number of months to prescribe the prescription contraceptives
for, up to 12 months.
new text end

new text begin For purposes of this paragraph, "prescription contraceptive" means any drug or device that
requires a prescription and is approved by the Food and Drug Administration to prevent
pregnancy. Prescription contraceptive does not include an emergency contraceptive drug
approved to prevent pregnancy when administered after sexual contact.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section applies to medical assistance and MinnesotaCare
coverage effective January 1, 2022.
new text end