Signed by Governor Pete Ricketts

Vote Smart's Synopsis:

Vote on an amendment of a bill that extends insurance coverage and Medicaid access to prescribed contraceptives and prohibits certain billing practices under the Medical Assistance Act.

Highlights:

• Establishes any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited benefit coverage, and any self-funded employee benefit plan to the extent not preempted under federal law that includes coverage for a self-administered hormonal contraceptive that is approved by the federal Food and Drug Administration will reimburse an in-network healthcare provider or dispensing entity on a per-unit basis for dispensing a supply of such contraceptive to a covered individual as follows (Sec. 1-1):

• For the first prescription of such contraceptive, at least up to a three-month supply, if so prescribed; and

• For subsequent refills of the same contraceptive, regardless of whether the covered individual was enrolled in the policy, contract, or plan at the time of the first prescription for such contraceptive, up to a six-month supply, if so prescribed.

• Specifies this law does not permit the following (Sec. 1-2):

• Require a health care provider to prescribe a six-month supply of a self-administered hormonal contraceptive; or

• Permit a policy, contract, or plan to impose cost-sharing for an alternative method of contraception if a covered individual changes contraceptive methods before exhausting a previously dispensed supply of a self-administered hormonal contraceptive.

• Requires in providing family planning services and supplies under the medical assistance program, the department shall ensure that a prescription for the dispensation of a covered self-administered hormonal contraceptive is provided as follows (Sec. 3-1):

• For the first prescription of such contraceptive, at least up to a three-month supply, if so prescribed; and

• For subsequent refills of the same contraceptive, regardless of whether the covered individual was enrolled in the medical assistance program at the time of the first prescription for such contraceptive, up to a six-month supply, if so prescribed.

• Specifies a multiple procedure payment reduction policy means a policy used in the federal Medicare program under Title XVIII of the federal Social Security Act for outpatient rehabilitation service codes where full payment is made for the unit or procedure with the highest rate and subsequent units and procedures are paid at a reduction of the published rates when more than one unit procedure is provided to the same patient on the same day (Sec. 4-1).

Full Bill Text