Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                                  SB 516.1
                                                  SENATE BILL NO. 516
   INTRODUCED BY J. GROSS, F. SMITH, D. SALOMON, S. FITZPATRICK, E. MCCLAFFERTY, J. WELBORN,
      B. MOLNAR, M. LANG, D. ZOLNIKOV, R. LYNCH, A. OLSEN, W. CURDY, M. DUNWELL, J. ELLIS, D.
    HAYMAN, C. POPE, S. WEBBER, D. LOGE, R. FITZGERALD, B. USHER, E. BOLDMAN, S. MORIGEAU, J.
  SMALL, L. BISHOP, J. ELLSWORTH, D. HARVEY, K. BOGNER, B. GILLESPIE, J. KASSMIER, P. FLOWERS,
      M. FOX, L. BREWSTER, A. BUCKLEY, M. THANE, C. FRIEDEL, S. O'BRIEN, G. PARRY, L. SMITH, M.
                               CUFFE, G. HERTZ, D. LENZ, W. SALES, T. VERMEIRE
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  A BILL FOR AN ACT ENTITLED: “AN ACT GENERALLY REVISING LAWS RELATED TO FERTILITY
  PRESERVATION SERVICES FOR PEOPLE DIAGNOSED WITH CANCER; REQUIRING INSURANCE
  COVERAGE OF FERTILITY PRESERVATION SERVICES; CREATING A VOLUNTARY ASSESSMENT FOR
  CANCER SCREENING EFFORTS; CREATING A SPECIAL REVENUE ACCOUNT; PROVIDING
  DEFINITIONS; AMENDING SECTIONS 2-18-704, 33-31-111, 33-35-306, 53-6-101, AND 61-3-303, MCA; AND
  PROVIDING EFFECTIVE DATES AND AN APPLICABILITY DATE.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          NEW SECTION. Section 1.          Legislative findings -- purpose. (1) The legislature finds that young
  Montanans who are diagnosed with cancer often learn, shortly before they are to begin the medical treatment
  needed to save their lives, that the treatment may result in infertility, leaving them only a small window of time in
  which to decide whether to undergo medically necessary efforts to preserve their ability to have biological
  families.
          (2)      The legislature further finds that future fertility is a top quality of life priority for many young
  cancer patients and that the possibility of infertility may cause significant distress and grief during a time when
  cancer patients are also facing not only their diagnoses but also the prospects of treatment that may include
  surgery, chemotherapy, radiation, or a combination of those approaches.
          (3)      The legislature further finds that fertility preservation is medically necessary and considered
  part of the standard of care for age-eligible oncology patients.
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68th Legislature 2023                                                                                                  SB 516.1
           (4)       It is the intent of [sections 1 through 4] to ensure that fertility preservation services for cancer
  patients are covered by insurance plans in the same manner as other medically necessary care and that cancer
  patients are made aware of the options for fertility preservation services.
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           NEW SECTION. Section 2.          Definitions. As used in [sections 1 through 4], the following definitions
  apply:
           (1)       "Iatrogenic infertility" means an impairment of fertility caused directly or indirectly by surgery,
  chemotherapy, radiation, or other medical treatment.
           (2)       "Medical treatment that may directly or indirectly cause iatrogenic infertility" means treatment
  with a potential side effect of impaired fertility, as established by a national association for practitioners of
  reproductive medicine or clinical oncology.
           (3)       "Standard fertility preservation services" means procedures consistent with established medical
  practices and professional guidelines published by a national association for practitioners of reproductive
  medicine or clinical oncology.
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           NEW SECTION. Section 3.          Coverage of fertility preservation services. (1) Each individual and
  group disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery,
  renewed, extended, or modified in this state that provides coverage for hospital, medical, or surgical services
  must cover medically necessary costs for standard fertility preservation services when an insured member is
  diagnosed with cancer and the standard of care involves medical treatment that may directly or indirectly cause
  iatrogenic infertility.
           (2)       Coverage under this section may be subject to deductibles, coinsurance, and copayment
  provisions. Special deductible, coinsurance, copayment, or other limitations that are not generally applicable to
  other hospital, medical, or surgical services covered under the plan may not be imposed on coverage for fertility
  preservation services.
           (3)       This section does not apply to disability income, hospital indemnity, accident-only, vision,
  dental, or long-term care policies.
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68th Legislature 2023                                                                                           SB 516.1
          NEW SECTION. Section 4.        Cancer screening account. (1) There is a cancer screening account in
  the state special revenue fund established in 17-2-102 to the credit of the department of public health and
  human services.
          (2)      The account consists of:
          (a)      money collected from the donation provided for in 61-3-303(6)(d);
          (b)      other gifts and donations to the department for cancer screening efforts; and
          (c)      interest and income earned on the account.
          (3)      Money in the account must be used by the department of public health and human services to
  support cancer screening efforts.
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          Section 5. Section 2-18-704, MCA, is amended to read:
          "2-18-704.   Mandatory provisions. (1) An insurance contract or plan issued under this part must
  contain provisions that permit:
          (a)      the member of a group who retires from active service under the appropriate retirement
  provisions of a defined benefit plan provided by law or, in the case of the defined contribution plan provided in
  Title 19, chapter 3, part 21, a member with at least 5 years of service and who is at least age 50 while in
  covered employment to remain a member of the group until the member becomes eligible for medicare under
  the federal Health Insurance for the Aged Act, 42 U.S.C. 1395, unless the member is a participant in another
  group plan with substantially the same or greater benefits at an equivalent cost or unless the member is
  employed and, by virtue of that employment, is eligible to participate in another group plan with substantially the
  same or greater benefits at an equivalent cost;
          (b)      the surviving spouse of a member to remain a member of the group as long as the spouse is
  eligible for retirement benefits accrued by the deceased member as provided by law unless the spouse is
  eligible for medicare under the federal Health Insurance for the Aged Act or unless the spouse has or is eligible
  for equivalent insurance coverage as provided in subsection (1)(a);
          (c)      the surviving children of a member to remain members of the group as long as they are eligible
  for retirement benefits accrued by the deceased member as provided by law unless they have equivalent
  coverage as provided in subsection (1)(a) or are eligible for insurance coverage by virtue of the employment of
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68th Legislature 2023                                                                                                SB 516.1
  a surviving parent or legal guardian.
           (2)        An insurance contract or plan issued under this part must contain the provisions of subsection
  (1) for remaining a member of the group and also must permit:
           (a)        the spouse of a retired member the same rights as a surviving spouse under subsection (1)(b);
           (b)        the spouse of a retiring member to convert a group policy as provided in 33-22-508; and
           (c)        continued membership in the group by anyone eligible under the provisions of this section,
  notwithstanding the person's eligibility for medicare under the federal Health Insurance for the Aged Act.
           (3)        (a) A state insurance contract or plan must contain provisions that permit a legislator to remain
  a member of the state's group plan until the legislator becomes eligible for medicare under the federal Health
  Insurance for the Aged Act if the legislator:
           (i)        terminates service in the legislature and is a vested member of a state retirement system
  provided by law; and
           (ii)       notifies the department of administration in writing within 90 days of the end of the legislator's
  legislative term.
           (b)        A former legislator may not remain a member of the group plan under the provisions of
  subsection (3)(a) if the person:
           (i)        is a member of a plan with substantially the same or greater benefits at an equivalent cost; or
           (ii)       is employed and, by virtue of that employment, is eligible to participate in another group plan
  with substantially the same or greater benefits at an equivalent cost.
           (c)        A legislator who remains a member of the group under the provisions of subsection (3)(a) and
  subsequently terminates membership may not rejoin the group plan unless the person again serves as a
  legislator.
           (4)        (a) A state insurance contract or plan must contain provisions that permit continued
  membership in the state's group plan by a member of the judges' retirement system who leaves judicial office
  but continues to be an inactive vested member of the judges' retirement system as provided by 19-5-301. The
  judge shall notify the department of administration in writing within 90 days of the end of the judge's judicial
  service of the judge's choice to continue membership in the group plan.
           (b)        A former judge may not remain a member of the group plan under the provisions of this
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68th Legislature 2023                                                                                             SB 516.1
  subsection (4) if the person:
          (i)       is a member of a plan with substantially the same or greater benefits at an equivalent cost;
          (ii)      is employed and, by virtue of that employment, is eligible to participate in another group plan
  with substantially the same or greater benefits at an equivalent cost; or
          (iii)     becomes eligible for medicare under the federal Health Insurance for the Aged Act.
          (c)       A judge who remains a member of the group under the provisions of this subsection (4) and
  subsequently terminates membership may not rejoin the group plan unless the person again serves in a
  position covered by the state's group plan.
          (5)       A person electing to remain a member of the group under subsection (1), (2), (3), or (4) shall
  pay the full premium for coverage and for that of the person's covered dependents.
          (6)       An insurance contract or plan issued under this part that provides for the dispensing of
  prescription drugs by an out-of-state mail service pharmacy, as defined in 37-7-702:
          (a)       must permit any member of a group to obtain prescription drugs from a pharmacy located in
  Montana that is willing to match the price charged to the group or plan and to meet all terms and conditions,
  including the same professional requirements that are met by the mail service pharmacy for a drug, without
  financial penalty to the member; and
          (b)       may only be with an out-of-state mail service pharmacy that is registered with the board under
  Title 37, chapter 7, part 7, and that is registered in this state as a foreign corporation.
          (7)       An insurance contract or plan issued under this part must include coverage for:
          (a)       treatment of inborn errors of metabolism, as provided for in 33-22-131;
          (b)       therapies for Down syndrome, as provided in 33-22-139;
          (c)       treatment for children with hearing loss as provided in 33-22-128(1) and (2);
          (d)       fertility preservation services as required under [section 3];
          (d)(e)    the care and treatment of mental illness in accordance with the provisions of Title 33, chapter
  22, part 7; and
          (e)(f)    telehealth services, as provided for in 33-22-138.
          (8)       (a) An insurance contract or plan issued under this part that provides coverage for an individual
  in a member's family must provide coverage for well-child care for children from the moment of birth through 7
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68th Legislature 2023                                                                                               SB 516.1
  years of age. Benefits provided under this coverage are exempt from any deductible provision that may be in
  force in the contract or plan.
          (b)      Coverage for well-child care under subsection (8)(a) must include:
          (i)      a history, physical examination, developmental assessment, anticipatory guidance, and
  laboratory tests, according to the schedule of visits adopted under the early and periodic screening, diagnosis,
  and treatment services program provided for in 53-6-101; and
          (ii)     routine immunizations according to the schedule for immunization recommended by the
  advisory committee on immunization practices of the U.S. department of health and human services.
          (c)      Minimum benefits may be limited to one visit payable to one provider for all of the services
  provided at each visit as provided for in this subsection (8).
          (d)      For purposes of this subsection (8):
          (i)      "developmental assessment" and "anticipatory guidance" mean the services described in the
  Guidelines for Health Supervision II, published by the American academy of pediatrics; and
          (ii)     "well-child care" means the services described in subsection (8)(b) and delivered by a
  physician or a health care professional supervised by a physician.
          (9)      Upon renewal, an insurance contract or plan issued under this part under which coverage of a
  dependent terminates at a specified age must continue to provide coverage for any dependent, as defined in
  the insurance contract or plan, until the dependent reaches 26 years of age. For insurance contracts or plans
  issued under this part, the premium charged for the additional coverage of a dependent, as defined in the
  insurance contract or plan, may be required to be paid by the insured and not by the employer.
          (10)     Prior to issuance of an insurance contract or plan under this part, written informational
  materials describing the contract's or plan's cancer screening coverages must be provided to a prospective
  group or plan member.
          (11)     The state employee group benefit plans and the Montana university system group benefits
  plans must provide coverage for hospital inpatient care for a period of time as is determined by the attending
  physician and, in the case of a health maintenance organization, the primary care physician, in consultation
  with the patient to be medically necessary following a mastectomy, a lumpectomy, or a lymph node dissection
  for the treatment of breast cancer.
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68th Legislature 2023                                                                                               SB 516.1
          (12)     (a) The state employee group benefit plans and the Montana university system group benefits
  plans must provide coverage for outpatient self-management training and education for the treatment of
  diabetes. Any education must be provided by a licensed health care professional with expertise in diabetes.
          (b)      Coverage must include a $250 benefit for a person each year for medically necessary and
  prescribed outpatient self-management training and education for the treatment of diabetes.
          (c)      The state employee group benefit plans and the Montana university system group benefits
  plans must provide coverage for diabetic equipment and supplies that at a minimum includes insulin, syringes,
  injection aids, devices for self-monitoring of glucose levels (including those for the visually impaired), test strips,
  visual reading and urine test strips, one insulin pump for each warranty period, accessories to insulin pumps,
  one prescriptive oral agent for controlling blood sugar levels for each class of drug approved by the United
  States food and drug administration, and glucagon emergency kits.
          (d)      Nothing in subsection (12)(a), (12)(b), or (12)(c) prohibits the state or the Montana university
  group benefit plans from providing a greater benefit or an alternative benefit of substantially equal value, in
  which case subsection (12)(a), (12)(b), or (12)(c), as appropriate, does not apply.
          (e)      Annual copayment and deductible provisions are subject to the same terms and conditions
  applicable to all other co