EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0355*
SENATE BILL 355
J2, J5, J4 2lr1109
SB 828/21 – EHE & FIN
By: Senator Lam
Introduced and read first time: January 21, 2022
Assigned to: Education, Health, and Environmental Affairs and Finance
A BILL ENTITLED
AN ACT concerning 1
HIV Prevention Drugs – Prescribing and Dispensing by Pharmacists and 2
Insurance Requirements 3
FOR the purpose of authorizing pharmacists to prescribe and dispense preexposure 4
prophylaxis and postexposure prophylaxis for HIV prevention to patients under 5
certain circumstances; requiring the Maryland Medical Assistance Program to 6
provide drugs that are approved by the United States Food and Drug Administration 7
for HIV prevention; prohibiting managed care organizations, insurers, nonprofit 8
health service plans, and health maintenance organizations from requiring prior 9
authorization, step therapy, or cost–sharing for preexposure prophylaxis for HIV 10
prevention or postexposure prophylaxis for HIV prevention; and generally relating 11
to HIV prevention drugs. 12
BY repealing and reenacting, with amendments, 13
Article – Health Occupations 14
Section 12–101(x)(1)(xi) and (xii) 15
Annotated Code of Maryland 16
(2021 Replacement Volume) 17
BY adding to 18
Article – Health Occupations 19
Section 12–101(x)(1)(xiii) and 12–514 20
Annotated Code of Maryland 21
(2021 Replacement Volume) 22
BY repealing and reenacting, without amendments, 23
Article – Health – General 24
Section 15–103(a)(1) 25
Annotated Code of Maryland 26
(2019 Replacement Volume and 2021 Supplement) 27
2 SENATE BILL 355
BY repealing and reenacting, with amendments, 1
Article – Health – General 2
Section 15–103(a)(2)(xvi) and (xvii) 3
Annotated Code of Maryland 4
(2019 Replacement Volume and 2021 Supplement) 5
BY adding to 6
Article – Health – General 7
Section 15–102.3(j) and 15–103(a)(2)(xviii) 8
Annotated Code of Maryland 9
(2019 Replacement Volume and 2021 Supplement) 10
BY adding to 11
Article – Insurance 12
Section 15–856 13
Annotated Code of Maryland 14
(2017 Replacement Volume and 2021 Supplement) 15
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
That the Laws of Maryland read as follows: 17
Article – Health Occupations 18
12–101. 19
(x) (1) “Practice pharmacy” means to engage in any of the following activities: 20
(xi) Providing drug therapy management in accordance with § 21
19–713.6 of the Health – General Article; [or] 22
(xii) Prescribing and dispensing contraceptive medications and 23
self–administered contraceptive devices approved by th e U.S. Food and Drug 24
Administration; OR 25
(XIII) PRESCRIBING AND DISPE NSING PREEXPOSURE 26
PROPHYLAXIS AND POST EXPOSURE PROPHYLAXIS MEDICATIONS FOR HIV 27
APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION . 28
12–514. 29
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 30
INDICATED. 31
(2) “CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ” MEANS 32
“UPDATED GUIDELINES FOR ANTIRETROVIRAL POSTEXPOSURE PROPHYLAXIS 33
AFTER SEXUAL, INJECTION DRUG USE, OR OTHER NONOCCUPATIONAL EXPOSURE 34 SENATE BILL 355 3
TO HIV–UNITED STATES, 2016” OR ANY SUBSEQUENT GU IDELINES PUBLISHED B Y 1
THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION. 2
(3) “CDC GUIDELINES FOR PREEX POSURE PROPHYLAXIS ” MEANS 3
“PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE 4
UNITED STATES–2017 UPDATE: A CLINICAL PRACTICE GUIDELINE” OR ANY 5
SUBSEQUENT GUIDELINE S PUBLISHED BY THE F EDERAL CENTERS FOR DISEASE 6
CONTROL AND PREVENTION. 7
(4) “POSTEXPOSURE PROPHYLA XIS” MEANS ANY DRUG 8
COMBINATION APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT IS: 9
(I) USED TO PREVENT HIV INFECTION FOLLOWING AN 10
EXPOSURE OR POTENTIA L EXPOSURE TO HIV; AND 11
(II) ADMINISTERED IN ACCOR DANCE WITH THE CDC, IN THE 12
CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS . 13
(5) “PREEXPOSURE PROPHYLAX IS” MEANS ANY DRUG COMBINATION 14
APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT I S: 15
(I) PROVIDED TO AN HIV–NEGATIVE PERSON TO P REVENT 16
HIV INFECTION; AND 17
(II) ADMINISTERED IN ACCOR DANCE WITH THE CDC, IN THE 18
CDC GUIDELINES FOR PREEX POSURE PROPHYLAXIS . 19
(6) “RYAN WHITE HIV/AIDS PROGRAM” MEANS THE PROGRAM 20
ADMINISTERED BY THE FEDERAL HEALTH RESOURCES AND SERVICES 21
ADMINISTRATION THAT PROVIDES GRANTS TO PROVIDE CARE AND TREATMENT 22
SERVICES TO INDIVIDUALS WITH HIV TO IMPROVE HEALTH OU TCOMES AND 23
REDUCE HIV TRANSMISSION AMONG HARD –TO–REACH POPULATIONS . 24
(B) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , A 25
PHARMACIST MAY PRESCRIBE AND DISPENSE UP TO A 30–DAY SUPPLY OF 26
PREEXPOSURE PROPHYLA XIS TO A PATIENT IF: 27
(I) THE PATIENT IS HIV NEGATIVE AS DOCUMENT ED BY A TEST 28
IN ACCORDANCE WITH P ARAGRAPH (3) OF THIS SUBSECTION ; 29
(II) THE PATIENT COMPLETES A SELF –SCREENING 30
ASSESSMENT TOOL AND REPORTS: 31
4 SENATE BILL 355
1. NO SIGNS OR SYMPTOMS OF ACUTE HIV INFECTION 1
FROM A CHECKLIST OF ACUTE HIV INFECTION SIGNS AND SYMPTOMS; AND 2
2. NOT TAKING ANY CONTRA INDICATED MEDICATION S; 3
(III) AT THE TIME THE PREEX POSURE PROPHYLAXIS I S 4
DISPENSED, THE PHARMACIST PROVI DES: 5
1. COUNSELING TO THE PAT IENT ON THE ONGOING USE 6
OF PREEXPOSURE PRO PHYLAXIS, INCLUDING EDUCATION REGARDING SIDE 7
EFFECTS, SAFETY DURING PREGNA NCY AND BREASTFEEDIN G, ADHERENCE TO 8
RECOMMENDED DOSING , AND THE IMPORTANCE O F TIMELY TESTING AND 9
TREATMENT , AS APPLICABLE, FOR: 10
A. HIV; 11
B. RENAL FUNCTION ; 12
C. HEPATITIS B; 13
D. HEPATITIS C; 14
E. SEXUALLY TRANSMITTED DISEASES; AND 15
F. PREGNANCY FOR INDIVID UALS OF CHILDBEARING 16
CAPACITY; AND 17
2. ORAL AND WRITTEN NOTI CE TO THE PATIENT TH AT, 18
IF THE PHARMACIST HAS DISPENSED A COMBINED 60–DAY SUPPLY TO THE PATIENT, 19
THE PATIENT MUST BE SEEN BY A HEALTH CAR E PROVIDER TO RECEIV E ANY 20
SUBSEQUENT PRESCRIPT IONS FOR PREEXPOSURE PROPHYLAXIS ; 21
(IV) THE PHARMACIST RECORD S THE PRESCRIBING AND 22
DISPENSING OF THE PR EEXPOSURE PROPHYLAXI S IN ANY ELECTRONIC HEALTH 23
RECORD M AINTAINED ON THE PAT IENT BY THE PHARMACI ST; 24
(V) THE PHARMACIST PROVID ES THE PATIENT WITH A COPY OF 25
THE RECORD OF THE EN COUNTER THAT INCLUDE S THE PATIENT ’S COMPLETED 26
SELF–SCREENING ASSESSMENT TOOL AND THE PREEXPO SURE PROPHYLAXIS 27
PRESCRIBED AND DISPENSED OR THE BASIS FOR NOT DISPENSING A PREEXPO SURE 28
PROPHYLAXIS ; AND 29
(VI) THE PHARMACIST PROVID ES: 30 SENATE BILL 355 5
1. NOTICE TO THE PATIENT ’S PRIMARY CARE PROVI DER 1
OF THE ENCOUNTER WIT H THE PATIENT; OR 2
2. IF THE PATIENT DOES N OT HAVE A PRIMARY CA RE 3
PROVIDER OR REFUSES TO PROVIDE T HE NAME OF A PRIMARY CARE PROVIDER , THE 4
PATIENT WITH A LIST OF PHYSICIANS , CLINICS, OR OTHER HEALTH CARE 5
PROVIDERS IN THE AREA THAT REC EIVE FUNDING , EITHER DIRECTLY OR 6
INDIRECTLY, FROM THE RYAN WHITE HIV/AIDS PROGRAM TO CONTACT 7
REGARDIN G ONGOING CARE FOR P REEXPOSURE PROPHYLAX IS. 8
(2) THE PHARMACIST MAY NO T: 9
(I) ALLOW THE PATIENT TO REFUSE OR WAIVE ANY 10
CONSULTATION REQUIRE D UNDER PARAGRAPH (1) OF THIS SUBSECTION ; 11
(II) PRESCRIBE MORE THAN A COMBINED 60–DAY SUPPLY OF 12
PREEXPOSURE PROPHYLAXIS TO THE S AME PATIENT WITHIN A 2–YEAR PERIOD; OR 13
(III) DISPENSE MORE THAN A COMBINED 60–DAY SUPPLY TO A 14
PATIENT WITHOUT A PR ESCRIPTION FROM A HE ALTH CARE PROVIDER . 15
(3) (I) BEFORE PRESCRIBING AND DISPENSING A PREEXPO SURE 16
PROPHYLAXIS TO A PA TIENT UNDER PARAGRAP H (1) OF THIS SUBSECTION , THE 17
PHARMACIST SHALL REQ UIRE THE PATIENT TO : 18
1. SUBMIT EVIDENCE OF TH E PATIENT’S NEGATIVE HIV 19
TEST RESULT OBTAINED WITHIN THE IMMEDIATE LY PRECEDING 7 DAYS FROM AN 20
HIV ANTIGEN/ANTIBODY TEST OR ANT IBODY–ONLY TEST OR FROM A RAPID , 21
POINT–OF–CARE FINGERSTICK BLO OD TEST THAT IS APPR OVED BY THE U.S. FOOD 22
AND DRUG ADMINISTRATION ; OR 23
2. SUBMIT TO AN HIV TEST ORDERED BY THE 24
PHARMACIST . 25
(II) 1. IF A PHARMACIST ORDER S AN HIV TEST FOR A 26
PATIENT UNDER SUBPAR AGRAPH (I)2 OF THIS PARAGRAPH AN D THE TEST RESULTS 27
ARE NOT TRANSMITTED DIRECTLY TO THE PHAR MACIST, THE PHARMACIST SHALL 28
VERIFY THE TEST RESU LTS TO THE PHARMACIS T’S SATISFACTION. 29
2. IF A PHAR MACIST ORDERS AN HIV TEST FOR A 30
PATIENT UNDER SUBPAR AGRAPH (I)2 OF THIS PARAGRAPH AN D THE PATIENT TESTS 31
POSITIVE FOR HIV INFECTION, THE PHARMACIST SHALL REFER THE PATIENT TO A 32 6 SENATE BILL 355
HEALTH CARE PROVIDER AND PROVIDE A LIST O F HEALTH CARE PROVID ERS AND 1
CLINICS IN THE AREA IN WHICH TH E PHARMACY IS LOCATE D THAT RECEIVE 2
FUNDING, EITHER DIRECTLY OR I NDIRECTLY, FROM THE RYAN WHITE HIV/AIDS 3
PROGRAM. 4
(C) (1) A PHARMACIST MAY PRESCRIBE AND DISPENSE A COMPLETE 5
COURSE OF POSTEXPOSU RE PROPHYLAXIS TO A PATIENT IF THE PHARM ACIST: 6
(I) SCREENS THE PATIENT A ND DETERMINES : 7
1. THE EXPOSURE TO HIV OCCURRED WITHIN THE 8
IMMEDIATELY PRECEDIN G 72 HOURS; AND 9
2. THE PATIENT OTHERWISE MEETS THE CLINICAL 10
CRITERIA FOR POSTEXP OSURE PROPHYLAXIS CO NSISTENT WITH THE CDC 11
GUIDELINES FOR POSTEXPOSURE PRO PHYLAXIS; 12
(II) 1. PROVIDES HIV TESTING THAT IS CLAS SIFIED AS 13
WAIVED UNDER THE FED ERAL CLINICAL LABORATORY IMPROVEMENT 14
AMENDMENTS OF 1988; OR 15
2. EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS 16
SUBSECTION, OBTAINS THE CONSENT OF THE PATIENT TO SUBMIT TO AN HIV TEST 17
CONSISTENT WITH THE CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ; 18
(III) PROVIDES COUNSELING T O THE PATIENT ON : 19
1. THE USE OF POSTEXPOSU RE PROPHYLAXIS 20
CONSISTENT WITH THE CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS , 21
INCLUDING EDUCATION REGARDING SIDE EFFEC TS, SAFETY DURING PREGNA NCY 22
AND BREASTFEEDING , ADHERENCE TO RECOMME NDED DOSING , AND THE 23
IMPORTANCE OF TIMELY TESTING AND TREATMEN T, AS APPLICABLE, FOR HIV AND 24
SEXUALLY TRANSMITTED DISEASES; AND 25
2. THE AVAILABILI TY OF PREEXPOSURE PR OPHYLAXIS 26
FOR INDIVIDUALS WHO ARE AT SUBSTANTIAL R ISK OF CONTRACTING HIV; AND 27
(IV) PROVIDES: 28
1. NOTICE TO THE PATIENT ’S PRIMARY CARE PROVI DER 29
OF THE POSTEXPOSURE PROPHYLAXIS TREATMEN T; OR 30
2. IF THE PATIENT DOES N OT HAVE A PRIMARY CARE 31 SENATE BILL 355 7
PROVIDER OR REFUSES TO PROVIDE THE NAME OF A HEALTH CARE PRO VIDER, THE 1
PATIENT WITH A LIST OF PHYSICIANS , CLINICS, OR OTHER HEALTH CARE 2
PROVIDERS IN THE AREA THAT REC EIVE FUNDING , EITHER DIRECTLY OR 3
INDIRECTLY, FROM THE RYAN WHITE HIV/AIDS PROGRAM TO CONTACT 4
REGARDING FOLLOW –UP CARE FOR POSTEXPO SURE PROPHYLAXIS . 5
(2) A PHARMACIST MAY NOT A LLOW A PATIENT TO RE FUSE OR WAIVE 6
A CONSULTATION REQUI RED UNDER PARAGRAPH (1) OF THIS SUBSECTION . 7
(3) IF THE PATIENT REFUSE S TO CONSENT TO AN HIV TEST UNDER 8
PARAGRAPH (1)(II)2 OF THIS SUBSECTION B UT OTHERWISE MEETS T HE CRITERIA 9
FOR POSTEXPOSURE PRO PHYLAXIS UNDER THIS SUBSECTION, THE PHARMACIST 10
MAY PRESCRIBE AND DISPENSE POSTEXPOSUR E PROPHYLAXIS TO THE PATIENT. 11
(D) (1) (I) A PHARMACIST SHALL COM PLETE A TRAINING PROGRAM 12
ON THE USE OF PREEXP OSURE PROPHYLAXIS AN D POSTEXPOSURE PROPH YLAXIS 13
THAT IS APPROVED BY THE BOARD BEFORE PRESCRIBING AND DISPENSING 14
PREEXPOSURE PROPHYLA XIS OR POSTEXPOSURE PROPHYLAXIS TO A PAT IENT. 15
(II) THE TRAINING PROGRAM REQUIRED UNDER 16
SUBPARAGRAPH (I) OF THIS PARAGRAPH SH ALL INCLUDE INFORMAT ION ABOUT 17
FINANCIAL ASSISTANCE PROGRAMS FOR PREEXPO SURE PROPHYLAXIS AND 18
POSTEXPOSURE PROPHYL AXIS. 19
(2) THE BOARD SHALL CONSULT W ITH THE STATE BOARD OF 20
PHYSICIANS, THE STATE BOARD OF NURSING, AND OTHER RELEVANT 21
STAKEHOLDERS , INCLUDING THE MARYLAND CENTER FOR HIV CARE SERVICES, 22
WHEN DEVELOPING OR A PPROVING TRAINING PR OGRAMS THAT MEET THE 23
REQUIREMENTS OF THIS SUBSECTION. 24
(E) THE BOARD, IN CONSULTATION WITH THE STATE BOARD OF 25
PHYSICIANS AND THE STATE BOARD OF NURSING, SHALL ADOPT REGULATI ONS 26
ESTABLISHING PROCEDU RES FOR CREATING AND DISSEMINATING A LIST OF 27
ENTITIES THAT RECEIV E FUNDING, EITHER DIRECTLY OR I NDIRECTLY, FROM THE 28
RYAN WHITE HIV/AIDS PROGRAM. 29
Article – Health – General 30
15–103. 31
(a) (1) The Secretary shall administer the Maryland Medical Assistance 32
Program. 33
(2) The Program: 34 8 SENATE BILL 355
(xvi) Beginning on January 1, 2021, shall provide, subject to the 1
limitations of the State budget and § 15–855(b)(2) of the Insurance Article, and as permitted 2
by federal law, services for pediatric autoimmune neuropsychiatric disorders associated 3
with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, 4
including the use of intravenous immunoglobulin therapy, for eligible Program recipients, 5
if pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections 6
and pediatric acute onset neuropsychiatric syndrome are coded for billing and diagnosis 7
purposes in accordance with § 15–855(d) of the Insurance Article; [and] 8
(xvii) Beginning on January 1, 2022, may not include, subject to federal 9
approval and limitations of the State budget, a frequency limitation on covered dental 10
prophylaxis care or oral health exams that requires the dental prophylaxis care or oral 11
health exams to be provided at an interval greater than 120 days within a plan year; AND 12
(XVIII) SHALL PROVIDE , SUBJECT TO THE LIMIT ATIONS OF 13
THE STATE BUDGET , MEDICALLY APPROPRIAT E DRUGS THAT ARE APP ROVED BY 14
THE U.S. FOOD AND DRUG ADMINISTRATION FOR HIV PREVENTION , INCLUDING: 15
1. PREEXPOSURE PROPHYLAX IS; AND 16
2. POSTEXPOSURE PROPHYLA XIS, AS DEFINED IN § 17
12–513 OF THE HEALTH OCCUPATIONS ARTICLE. 18
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 19
as follows: 20
Article – Health – General 21
15–102.3. 22
(J) THE PROVISIONS OF § 15–856 OF THE INSURANCE ARTICLE APPLY TO 23
MANAGED CARE ORGANIZ ATIONS IN THE SAME M ANNER AS THEY APPLY TO 24
CARRIERS. 25
Article – Insurance 26
15–856. 27
(A) (1) IN THIS SECTION THE FOLLOWING WORDS HAVE THE MEANINGS 28
INDICATED. 29
(2) “POSTEXPOSURE PROPHYLA XIS” MEANS ANY DRUG 30
COMBINATION APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT I S: 31
SENATE BILL 355 9
(I) USED TO PREVENT HIV INFECTION FOLLOWING AN 1
EXPOSURE OR A POTENTIAL EXPOS URE TO HIV; AND 2
(II) ADMINISTERED IN ACCO RDANCE WITH CDC GUIDELINES 3
FOR POSTEXPOSURE PRO PHYLAXIS, AS DEFINED IN § 12–514 OF THE HEALTH 4
OCCUPATIONS ARTICLE. 5
(3) “PREEXPOSURE PROPHYLAX IS” MEANS ANY DRUG COMBI NATION 6
APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT IS: 7
(I) PROVIDED TO AN HIV–NEGATIVE PERSON TO P REVENT HIV 8
INFECTION; AND 9
(II) ADMINISTERED IN ACCO RDANCE WITH THE CDC 10
GUIDELINES FOR PREEX POSURE PROPHYLAXIS , AS DEFINED IN § 12–514 OF THE 11
HEALTH OCCUPATIONS ARTICLE. 12
(B) (1) EXCEPT AS PROVIDED IN PARAGRAP H (2) OF THIS SUBSECTION , 13
THIS SECTION APPLIES TO: 14
(I) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 15
PROVIDE COVERAGE FOR PRESCRIPTION DRUGS U NDER INDIVIDUAL , GROUP, OR 16
BLANKET HEALTH INSUR ANCE POLICIES OR CON TRACTS THAT ARE ISS UED OR 17
DELIVERED IN THE STATE; AND 18
(II) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 19
COVERAGE FOR PRESCRI PTION DRUGS UNDER IN DIVIDUAL OR GROUP CO NTRACTS 20
THAT ARE ISSUED OR D ELIVERED IN THE STATE. 21
(2) THIS SECTION DOES NOT APPLY TO A GRANDFATHERED P LAN, AS 22
DEFINED IN § 1251 OF THE AFFORDABLE CARE ACT. 23
(C) AN ENTITY SUBJECT TO TH IS SECTION MAY NOT R EQUIRE PRIOR 24
AUTHORIZATION OR STEP THERAPY OR IMPOSE ANY COST –SHARING 25
REQUIREMENTS , INCLUDING COPAYMENTS , COINSURANCE , OR DEDUCTIBLES , FOR: 26
(1) PREEXPOSURE PROPHYLA XIS FOR HIV PREVENTION ; OR 27
(2) POSTEXPOSURE PROPHYL AXIS FOR HIV PREVENTION . 28
(D) AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE ANY 29
COST–SHARING REQUIREMENTS , INCLUDING COPAYMENTS , COINSURANCE , OR 30
DEDUCTIBLES , FOR MEDICALLY NECES SARY AND APPROPRIATE SERVICES RELATED 31 10 SENATE BILL 355
TO THE USE OF POSTEX POSURE PROPHYLAXIS O R PREEXPOSURE PROPHY LAXIS, 1
INCLUDING: 2
(1) HIV TESTING; 3
(2) KIDNEY FUNCTION TEST ING; 4
(3) ONGOING FOLLOW –UP AND MONITORING EV ERY 3 MONTHS; 5
(4) PREGNANCY TESTING ; 6
(5) PROVIDER OFFICE AND TELEHEALTH VISITS FO R PRESCRIBING 7
AND MEDICATION MANAG EMENT; 8
(6) SEROLOGIC LABORATORY TESTING FOR HEPATITI S B AND 9
HEPATITIS C VIRUSES; 10
(7) TESTING FOR OTHER SE XUALLY TRANSMITTED I NFECTIONS, 11
INCLUDING THREE–SITE TESTING FOR GONORRHEA AND CHLAMY DIA; AND 12
(8) VACCINATIONS FOR HEP ATITIS B. 13
SECTION 3. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall 14
apply to all policies, contracts, and health benefit plans that are not grandfathered plans 15
as defined in § 1251 of the Affordable Care Act issued, delivered, or renewed in the State 16
on or after January 1, 2023. 17
SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 18
effect January 1, 2023. 19
SECTION 5. AND BE IT FURTHER ENACTED, That, except as provided in Section 20
4 of this Act, this Act shall take effect October 1, 2022. 21