ENGROSSED ORIGINAL
1 A BILL
2
3 ___________
4
5
6 IN THE COUNCIL OF DISTRICT OF COLUMBIA
7
8 _________________
9
10 To amend An Act To provide for regulation of certain insurance rates in the District of
11 Columbia, and for other purposes to prohibit insurers from taking adverse action against a
12 health care practitioner who provides certain healthcare; and to amend the Women’s
13 Health and Cancer Rights Federal Law Conformity Act of 2000 to require insurance
14 companies to cover certain health care procedures and services without imposing cost-
15 sharing requirements.
16
17 BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
18 act may be cited as the “Insurance Regulation Amendment Act of 2024”.
19 Sec. 2. An Act To provide for regulation of certain insurance rates in the District of
20 Columbia, and for other purposes, approved May 20, 1948 (62 Stat. 242; D.C. Official Code §
21 31-2701 et seq.), is amended by adding a new section 3a to read as follows:
22 “Sec. 3a. Additional requirements for insurers.
23 “(a) A medical malpractice insurer or a medical professional liability insurer shall not
24 take an adverse action, including refusing to issue or renew a medical malpractice or medical
25 professional liability policy, charging a higher rate for a medical malpractice or medical
26 professional liability policy, canceling or terminating a medical malpractice or medical
27 professional liability policy, or imposing any sanctions, fines, penalties, or rate increases, against
28 a health care practitioner based solely on the fact that:
1
 ENGROSSED ORIGINAL
29 “(1) The health care practitioner provided, facilitated, aided, or assisted or
30 attempted to provide, facilitate, aid, or assist (collectively “assistance”) a patient or client with
31 reproductive health care or gender-affirming care, except to the extent that the assistance is
32 prohibited under District law; or
33 “(2) The health care practitioner’s license, registration, or certification in another
34 state had been revoked, suspended, or restricted based solely on the provision or facilitation of
35 assistance to a patient or client with reproductive health care or gender-affirming care, except to
36 the extent that the provision or facilitation of assistance of such care is prohibited under District
37 law.
38 “(b) This section shall apply regardless of where the patient or client resides, including if
39 the patient or client is a resident of a state where the provision or facilitation of certain
40 reproductive health care or gender-affirming care is illegal.
41 “(c) Nothing in this section shall prohibit a medical malpractice insurer or a medical
42 professional liability insurer from taking an adverse action against a health care practitioner for
43 providing care that would otherwise constitute professional misconduct in the District.
44 “(d) For the purposes of this section, the term:
45 “(1) “Gender-affirming care” shall have the same meaning as provided in section
46 102(12A) of the Human Rights Act of 1977, effective December 13, 1977 (D.C. Law 2-38; D.C.
47 Official Code § 2-1401.02(12A)).
2
 ENGROSSED ORIGINAL
48 “(2) “Health care practitioner” means an individual, groups of individuals,
49 partnership, or corporation, including a health care facility, that is licensed, certified, or
50 otherwise authorized by law to provide professional health care services in the District to an
51 individual.
52 “(3) “Medical professional liability insurer” means an insurer licensed to provide
53 insurance coverage for claims brought against health care practitioners.
54 “(4) “Reproductive health care” means all supplies, care, and services of a
55 medical, behavioral health, mental health, surgical, psychiatric, therapeutic, diagnostic,
56 preventative, rehabilitative, or supportive nature, including medication, relating to pregnancy,
57 contraception, assisted reproduction, pregnancy loss management, or the termination of a
58 pregnancy, in accordance with the applicable standard of care as defined by major medical
59 professional organizations and agencies with expertise in the relevant field.
60 “(e) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure
61 Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), shall issue
62 rules to implement the provisions of this section.”.
63 Sec. 3. The Women’s Health and Cancer Rights Federal Law Conformity Act of 2000,
64 effective April 3, 2001 (D.C. Law 13-254; D.C. Official Code § 31-3831 et seq.), is amended as
65 follows:
66 (a) Section 2 (D.C. Official Code § 31-3831) is amended by adding new paragraphs (9),
67 (10), and (11) to read as follows:
3
 ENGROSSED ORIGINAL
68 “(9) “Vasectomy” means a medical procedure to cut or seal the vas deferens tubes
69 that carry a person’s sperm to permanently prevent pregnancy.
70 “(10) “Voluntary sterilization” means a vasectomy, tubal ligation, or any medical
71 procedure to permanently prevent pregnancy.
72 “(11) “Voluntary sterilization procedures and services” means consultations,
73 procedures, or follow-up appointments related to a voluntary sterilization, including up to 2
74 voluntary sterilization reversals.”.
75 (b) Section 5c(a)(1) (D.C. Official Code § 31-3834.03(a)(1)) is amended to read as
76 follows:
77 “(1) Voluntary sterilization procedures and services;”.
78 (c) A new section 5c-1 is added to read as follows:
79 “Sec, 5c-1. Coverage of additional reproductive services.
80 “(a)(1) An individual health plan or group health plan shall provide coverage for
81 abortion-care services, including follow-up services, to an enrollee.
82 “(2) No individual health plan or group health plan shall impose any deductible,
83 coinsurance, copayment, or other cost-sharing requirement, on an enrollee for the coverage
84 required by this section; except, that an individual health plan or group health plan may require a
85 deductible, co-payment, or cost sharing for an enrollee covered by a high deductible health plan,
86 as defined in 26 U.S.C. § 223(c)(2), if required by federal law.
4
 ENGROSSED ORIGINAL
87 “(b) No individual health plan or group health plan covered under subsection (a) of this
88 section shall impose any medically unnecessary restrictions or delays on the coverage required
89 by this section.
90 “(c) Coverage for services under this section shall be provided without discrimination on
91 the basis of age, ancestry, disability, domestic partner status, gender, gender expression, gender
92 identity, genetic information, marital status, national origin, race, religion, sex, or sexual
93 orientation.
94 “(d) This section shall not apply to health insurance coverage through Medicaid, the DC
95 Healthcare Alliance program, or the Immigrant Children’s program.
96 “(e) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure
97 Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), shall issue
98 rules to implement the provisions of this section.”.
99 (d) Section 5d (D.C. Official Code § 31-2834.04) is amended as follows:
100 (1) Subsection (a) is amended as follows:
101 (A) Paragraph (1) is amended by striking the phrase “and services under
102 sections 5a, 5b, 5c, and 5f.” and inserting the phrase “and services, abortion-care services, or
103 voluntary sterilization procedures and services under sections 5a, 5b, 5c, 5c-1, 5f, and 5g.” in its
104 place.
5
 ENGROSSED ORIGINAL
105 (B) Paragraph (2) is amended by striking the phrase “and services” and
106 inserting the phrase “and services, abortion-care services, or voluntary sterilization procedures
107 and services” in its place.
108 (2) Subsection (c) is amended as follows:
109 (A) The lead-in language is amended by striking the phrase “sections 5a,
110 5b, 5c, or 5f" and inserting the phrase “sections 5a, 5b, 5c, 5f, or 5g” in its place.
111 (B) Paragraph (1) is amended by striking the phrase “or services” and
112 inserting the phrase “or services, or voluntary sterilization procedures and services” in its place.
113 (C) Paragraph (2) is amended by striking the phrase “or services” and
114 inserting the phrase “or services, or voluntary sterilization procedures and services” in its place.
115 (3) Subsection (d) is amended as follows:
116 (A) Paragraph (1) is amended by striking the phrase “or services” and
117 inserting the phrase “or services, or voluntary sterilization procedures and services” in its place.
118 (B) Paragraph (2) is amended by striking the phrase “5a, 5b, 5c, or 5f” and
119 inserting the phrase “5a, 5b, 5c, 5f, or 5g” in its place.
120 (e) Section 5e (D.C. Official Code § 31-3834.05) is amended as follows:
121 (1) Subsection (a) is amended as follows:
122 (A) The lead-in language is amended by striking the phrase “sections 5a,
123 5b, or 5c” and inserting the phrase “sections 5a, 5b, 5c, 5c-1, 5f, or 5g” in its place.
6
 ENGROSSED ORIGINAL
124 (B) Paragraph (1) is amended by striking the phrase “contraceptive drugs,
125 devices, products, and services” and inserting the phrase “contraceptive and fertility enhancing
126 drugs, devices, products, and services, abortion-care services, and voluntary sterilization
127 procedures and services” in its place.
128 (C) Paragraph (2) is amended by striking the phrase “sections 5a, 5b, or
129 5c” and inserting the phrase “sections 5a, 5b, 5c, 5c-1, 5f, and 5g” in its place.
130 (2) Subsection (c) is amended by striking the phrase “and services described in
131 sections 5a, 5b, or 5c” and inserting the phrase “and services, abortion-care services, and
132 voluntary sterilization procedures and services described in sections 5a, 5b, 5c, 5c-1, 5f, and 5g”
133 in its place.
134 (f) A new section 5g is added to read as follows:
135 “Sec. 5g. Coverage of voluntary sterilization procedures and services.
136 “(a) Except as otherwise provided in subsection (b) of this section, an individual health
137 plan or group health plan shall provide coverage for voluntary sterilization procedures and
138 services and shall not impose any cost-sharing requirements or impose any medically
139 unnecessary restrictions or delays.
140 “(b) An individual health plan or group health plan may require a deductible, co-
141 payment, or cost sharing for coverage of voluntary sterilization procedures and services for an
142 enrollee covered by a high deductible health plan, as defined in 26 U.S.C. § 223(c)(2), if required
143 by federal law.
7
 ENGROSSED ORIGINAL
144 “(c) The Mayor, pursuant to Title I of the District of Columbia Administrative Procedure
145 Act, approved October 21, 1968 (82 Stat. 1204; D.C. Official Code § 2-501 et seq.), shall issue
146 rules to implement the provisions of this section.”.
147 Sec. 4. Fiscal impact statement.
148 The Council adopts the fiscal impact statement in the committee report as the fiscal
149 impact statement required by 4a of the General Legislative Procedures Act of 1975, approved
150 October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a).
151 Sec. 5. Effective date.
152 This act shall take effect following approval by the Mayor (or in the event of veto by the
153 Mayor, action by the Council to override the veto) and a 30-day period of congressional review
154 as provided in sections 602(c)(1) of the District of Columbia Home Rule Act, approved
155 December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)).
8