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