Bill Summary – FastDemocracy

-- H 5351
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     LC000037
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                       S TATE             OF          RHODE               IS L A N D
                                         IN GENERAL ASSEMBLY
                                       JANUARY SESSION, A.D. 2023
                                             ____________
                                                A N     A CT
      RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
                 Introduced By: Representatives Alzate, Felix, Giraldo, Potter, Sanchez, Henries,
                                 Speakman, Batista, and Kazarian
                 Date Introduced: February 03, 2023
                 Referred To: House Health & Human Services
     It is enacted by the General Assembly as follows:
          SECTION 1. Sections 27-18-30 and 27-18-52 of the General Laws in Chapter 27-18
  entitled "Accident and Sickness Insurance Policies" are hereby amended to read as follows:
          27-18-30. Health insurance contracts — Infertility.
          (a) Any health insurance contract, plan, or policy delivered or issued for delivery or
  renewed in this state, except contracts providing supplemental coverage to Medicare or other
  governmental programs, that includes pregnancy-related benefits, shall provide coverage for
  medically necessary expenses of diagnosis and treatment of infertility for women between the ages
  of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in
  conjunction with in vitro fertilization (IVF), and for standard fertility-preservation services when a
 medically necessary medical treatment may directly or indirectly cause iatrogenic infertility to a
 covered person. To the extent that a health insurance contract provides reimbursement for a test or
 procedure used in the diagnosis or treatment of conditions other than infertility, the tests and
 procedures shall not be excluded from reimbursement when provided attendant to the diagnosis
 and treatment of infertility for women between the ages of twenty-five (25) and forty-two (42)
 years; provided, that a subscriber co-payment not to exceed twenty percent (20%) may be required
 for those programs and/or procedures the sole purpose of which is the treatment of infertility.
         (b) For purposes of this section, “infertility” means the condition of an otherwise
 presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
 one year.
          (c) For purposes of this section, “standard fertility-preservation services” means
  procedures consistent with established medical practices and professional guidelines published by
  the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
  other reputable professional medical organizations.
          (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
  surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
  processes.
          (e) For purposes of this section, “may directly or indirectly cause” means treatment with a
  likely side effect of infertility as established by the American Society for Reproductive Medicine,
 the American Society of Clinical Oncology, or other reputable professional organizations.
         (f) Notwithstanding the provisions of § 27-18-19 or any other provision to the contrary,
 this section shall apply to blanket or group policies of insurance.
         (g) The health insurance contract may limit coverage to a lifetime cap of one hundred
 thousand dollars ($100,000).
         (h) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
 technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
 disorders prior to their transfer to the uterus.
         27-18-52. Genetic testing.
         (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and
 providers shall be prohibited from releasing genetic information without prior written authorization
 of the individual. Written authorization shall be required for each disclosure and include to whom
 the disclosure is being made. An exception shall exist for those participating in research settings
 governed by the Federal Policy for the Protection of Human Research Subjects (also known as
 “The Common Rule”). Tests conducted purely for research are excluded from the definition, as are
 tests for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
         (b) No individual or group health insurance contract, plan, or policy delivered, issued for
 delivery, or renewed in this state which provides health insurance medical coverage that includes
 coverage for physician services in a physician’s office, and every policy which provides major
 medical or similar comprehensive-type coverage excluding disability income, long term care and
 insurance supplemental policies which only provide coverage for specified diseases or other
 supplemental policies, shall:
         (1) Use a genetic test or request for genetic tests or the results of a genetic test to reject,
 deny, limit, cancel, refuse to renew, increase the rates of, affect the terms or conditions of, or affect
 a group or an individual health insurance policy, contract, or plan;
                                            LC000037 - Page 2 of 12
          (2) Request or require a genetic test for the purpose of determining whether or not to issue
  or renew an individual’s health benefits coverage, to set reimbursement/co-pay levels or determine
  covered benefits and services;
          (3) Release the results of a genetic test without the prior written authorization of the
  individual from whom the test was obtained, except in a format whereby individual identifiers are
  removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
  of information pursuant to this section may use or disclose this information solely to carry out the
  purpose for which the information was disclosed. Authorization shall be required for each
  redisclosure; an exception shall exist for participating in research settings governed by the Federal
 Policy for the Protection of Human Research Subjects (also known as “The Common Rule”).
         (4) Request or require information as to whether an individual has ever had a genetic test,
 or participated in genetic testing of any kind, whether for clinical or research purposes.
         (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
 RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related
 genotypes, mutations, phenotypes or karyotypes for clinical purposes. Those purposes include
 predicting risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or
 prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be
 included provided there is an approved release by a parent or guardian. Tests for metabolites are
 covered only when they are undertaken with high probability that an excess of deficiency of the
 metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
 mean routine physical measurement, a routine chemical, blood, or urine analysis or a test for drugs
 or for HIV infections.
         (d) Any health insurance contract, plan, or policy delivered or issued for delivery or
 renewed in this state, except contracts providing supplemental coverage to Medicare or other
 governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
 expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)
 and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
 in vitro fertilization (IVF). For purposes of this section:
         (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
 with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
 to the uterus;
         (2) "Infertility" means the condition of an otherwise presumably healthy individual who is
 unable to conceive or sustain a pregnancy during a period of one year.
         SECTION 2. Sections 27-19-23 and 27-19-44 of the General Laws in Chapter 27-19
                                           LC000037 - Page 3 of 12
  entitled "Nonprofit Hospital Service Corporations" are hereby amended to read as follows:
           27-19-23. Coverage for infertility.
           (a) Any nonprofit hospital service contract, plan, or insurance policies delivered, issued for
  delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
  or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
  for medically necessary expenses of diagnosis and treatment of infertility for women between the
  ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis
  (PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation
  services when a medically necessary medical treatment may directly or indirectly cause iatrogenic
 infertility to a covered person. To the extent that a nonprofit hospital service corporation provides
 reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than
 infertility, those tests and procedures shall not be excluded from reimbursement when provided
 attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
 (25) and forty-two (42) years; provided, that a subscriber copayment, not to exceed twenty percent
 (20%), may be required for those programs and/or procedures the sole purpose of which is the
 treatment of infertility.
          (b) For purposes of this section, “infertility” means the condition of an otherwise
 presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
 one year.
          (c) For purposes of this section, “standard fertility-preservation services” means
 procedures consistent with established medical practices and professional guidelines published by
 the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
 other reputable professional medical organizations.
          (d) For purposes of this section, “iatrogenic infertility” means an impairment of fertility by
 surgery, radiation, chemotherapy, or other medical treatment affecting reproductive organs or
 processes.
          (e) For purposes of this section, “may directly or indirectly cause” means treatment with a
 likely side effect of infertility as established by the American Society for Reproductive Medicine,
 the American Society of Clinical Oncology, or other reputable professional organizations.
          (f) The health insurance contract may limit coverage to a lifetime cap of one hundred
 thousand dollars ($100,000).
          (g) For purposes of this section, "preimplantation genetic diagnosis" or "PGD" means a
 technique used in conjunction with in vitro fertilization (IVF) to test embryos for specific genetic
 disorders prior to their transfer to the uterus.
                                            LC000037 - Page 4 of 12
          27-19-44. Genetic testing.
          (a) Except as provided in chapter 37.3 of title 5, insurance administrators, health plans and
  providers shall be prohibited from releasing genetic information without prior written authorization
  of the individual. Written authorization shall be required for each disclosure and include to whom
  the disclosure is being made. An exception shall exist for those participating in research settings
  governed by the federal policy for the protection of human research subjects (also known as “The
  Common Rule”). Tests conducted purely for research are excluded from the definition, as are tests
  for somatic (as opposed to heritable) mutations, and testing for forensic purposes.
          (b) No nonprofit health service corporation subject to the provisions of this chapter shall:
         (1) Use a genetic test or request for a genetic test or the results of a genetic test or other
 genetic information to reject, deny, limit, cancel, refuse to renew, increase the rates of, affect the
 terms or conditions of, or affect a group or an individual’s health insurance policy, contract, or
 plan;
         (2) Request or require a genetic test for the purpose of determining whether or not to issue
 or renew a group, individual health benefits coverage to set reimbursement/co-pay levels or
 determine covered benefits and services;
         (3) Release the results of a genetic test without the prior written authorization of the
 individual from whom the test was obtained, except in a format by which individual identifiers are
 removed, encrypted, or encoded so that the identity of the individual is not disclosed. A recipient
 of information pursuant to this section may use or disclose the information solely to carry out the
 purpose for which the information was disclosed. Authorization shall be required for each
 redisclosure. An exception shall exist for participation in research settings governed by the federal
 policy for the protection of human research subjects (also known as “The Common Rule”);
         (4) Request or require information as to whether an individual has ever had a genetic test,
 or participated in genetic testing of any kind, whether for clinical or research purposes.
         (c) For the purposes of this section, “genetic testing” is the analysis of an individual’s DNA,
 RNA, chromosomes, proteins and certain metabolites in order to detect heritable disease-related
 genotypes, mutations, phenotypes or karyotypes for clinical purposes. These purposes include
 predicating risk of disease, identifying carriers, establishing prenatal and clinical diagnosis or
 prognosis. Prenatal, newborn and carrier screening, as well as testing in high risk families may be
 included provided there is an approved release by a parent or guardian. Tests for metabolites are
 covered only when they are undertaken with high probability that an excess of deficiency of the
 metabolite indicates the presence of heritable mutations in single genes. “Genetic testing” does not
 mean routine physical measurement, a routine chemical, blood, or urine analysis, or a test for drugs
                                          LC000037 - Page 5 of 12
  or for HIV infection.
           (d) Any health insurance contract, plan, or policy delivered or issued for delivery or
  renewed in this state, except contracts providing supplemental coverage to Medicare or other
  governmental programs, that includes pregnancy-related benefits, shall provide coverage for the
  expenses of diagnosis and treatment of infertility for women between the ages of twenty-five (25)
  and forty-two (42) years, including preimplantation genetic diagnosis (PGD) in conjunction with
  in vitro fertilization (IVF). For purposes of this section:
           (1) "Preimplantation genetic diagnosis" or "PGD" means a technique used in conjunction
  with in vitro fertilization (IVF) to test embryos for specific genetic disorders prior to their transfer
 to the uterus;
          (2) "Infertility" means the condition of an otherwise presumably healthy individual who is
 unable to conceive or sustain a pregnancy during a period of one year.
          SECTION 3. Section 27-20-20 and 27-20-39 of the General Laws in Chapter 27-20 entitled
 "Nonprofit Medical Service Corporations" are hereby amended to read as follows:
          27-20-20. Coverage for infertility.
          (a) Any nonprofit medical service contract, plan, or insurance policies delivered, issued for
 delivery, or renewed in this state, except contracts providing supplemental coverage to Medicare
 or other governmental programs, that includes pregnancy-related benefits, shall provide coverage
 for the medically necessary expenses of diagnosis and treatment of infertility for women between
 the ages of twenty-five (25) and forty-two (42) years, including preimplantation genetic diagnosis
 (PGD) in conjunction with in vitro fertilization (IVF), and for standard fertility-preservation
 services when a medically necessary medical treatment may directly or indirectly cause iatrogenic
 infertility to a covered person. To the extent that a nonprofit medical service corporation provides
 reimbursement for a test or procedure used in the diagnosis or treatment of conditions other than
 infertility, those tests and procedures shall not be excluded from reimbursement when provided
 attendant to the diagnosis and treatment of infertility for women between the ages of twenty-five
 (25) and forty-two (42) years; provided, that subscriber copayment, not to exceed twenty percent
 (20%), may be required for those programs and/or procedures the sole purpose of which is the
 treatment of infertility.
          (b) For purposes of this section, “infertility” means the condition of an otherwise
 presumably healthy individual who is unable to conceive or sustain a pregnancy during a period of
 one year.
          (c) For purposes of this section, “standard fertility-preservation services” means
 procedures consistent with established medical practices and professional guidelines published by
                                           LC000037 - Page 6 of 12
  the American Society for Reproductive Medicine, the American Society of Clinical Oncology, or
  other reputable professional medical organizations.
          (d) For purposes of this section, “iatrogenic infert