Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0023 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
3	3
4	4
5		-	2023 -- S 0023 SUBSTITUTE B
	5	+	2023 -- S 0023 SUBSTITUTE A
6	6		========
7		-	LC000285/SUB B
	7	+	LC000285/SUB A
8	8		========
9	9		S T A T E O F R H O D E I S L A N D
10	10		IN GENERAL ASSEMBLY
11	11		JANUARY SESSION, A.D. 2023
12	12		____________
13	13
14	14		A N A C T
15	15		RELATING TO INSURANCE -- INDIVIDUAL HEALTH INSURANCE COVERAGE
16	16		Introduced By: Senators Miller, Goodwin, Pearson, Gallo, Euer, Ruggerio, DiMario,
17	17		Valverde, Acosta, and Zurier
18	18		Date Introduced: January 18, 2023
19	19		Referred To: Senate Health & Human Services
20	20
21	21
22	22		It is enacted by the General Assembly as follows:
23	23		SECTION 1. Sections 27-18.5-3, 27-18.5-4, 27-18.5-5, 27-18.5-6 and 27-18.5-10 of the 1
24	24		General Laws in Chapter 27-18.5 entitled "Individual Health Insurance Coverage" are hereby 2
25	25		amended to read as follows: 3
26	26		27-18.5-3. Guaranteed availability to certain individuals. 4
27	27		(a) Notwithstanding any of the provisions of this title to the contrary Subject to subsections 5
28	28		(b) through (i) of this section, all health insurance carriers that offer health insurance coverage in 6
29	29		the individual market in this state shall provide for the guaranteed availability of coverage to an 7
30	30		eligible individual or an individual who has had health insurance coverage, including coverage in 8
31	31		the individual market, or coverage under a group health plan or coverage under 5 U.S.C. § 8901 et 9
32	32		seq. and had that coverage continuously for at least twelve (12) consecutive months and who 10
33	33		applies for coverage in the individual market no later than sixty-three (63) days following 11
34	34		termination of the coverage, desiring to enroll in individual health insurance coverage, and who is 12
35	35		not eligible for coverage under a group health plan, part A or part B or title XVIII of the Social 13
36	36		Security Act, 42 U.S.C. § 1395c et seq. or 42 U.S.C. § 1395j et seq., or any state plan under title 14
37	37		XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (or any successor program) and does not 15
38	38		have other health insurance coverage (provided, that eligibility for the other coverage shall not 16
39	39		disqualify an individual with twelve (12) months of consecutive coverage if that individual applies 17
40	40		for coverage in the individual market for the primary purpose of obtaining coverage for a specific 18
41	41		pre-existing condition, and the other available coverage excludes coverage for that pre-existing 19
42	42
43	43
44		-	LC000285/SUB B - Page 2 of 13
	44	+	LC000285/SUB A - Page 2 of 13
45	45		condition) and any eligible applicant. For the purposes of this section, an "eligible applicant" means 1
46	46		any individual resident of this state. A carrier offering health insurance coverage in the individual 2
47	47		market shall offer to any eligible applicant in the state all health insurance coverage plans of that 3
48	48		carrier that are approved for sale in the individual market and shall accept any eligible applicant 4
49	49		that applies for coverage under those plans. A carrier may not: 5
50	50		(1) Decline to offer the coverage to, or deny enrollment of, the individual; or 6
51	51		(2) Impose any preexisting condition exclusion with respect to the coverage. 7
52	52		(b)(1) All health insurance carriers that offer health insurance coverage in the individual 8
53	53		market in this state shall offer all policy forms of health insurance coverage to all eligible 9
54	54		applicants. Provided, a carrier may offer plans with reduced cost sharing for qualifying eligible 10
55	55		applicants, based on available federal funds including those described by 42 U.S.C. § 18071, or 11
56	56		based on a program established with state funds. Provided, the carrier may elect to limit the 12
57	57		coverage offered so long as it offers at least two (2) different policy forms of health insurance 13
58	58		coverage (policy forms which have different cost-sharing arrangements or different riders shall be 14
59	59		considered to be different policy forms) both of which: 15
60	60		(i) Are designed for, made generally available to, and actively market to, and enroll both 16
61	61		eligible and other individuals by the carrier; and 17
62	62		(ii) Meet the requirements of subparagraph (A) or (B) of this paragraph as elected by the 18
63	63		carrier: 19
64	64		(A) If the carrier offers the policy forms with the largest, and next to the largest, premium 20
65	65		volume of all the policy forms offered by the carrier in this state; or 21
66	66		(B) If the carrier offers a choice of two (2) policy forms with representative coverage, 22
67	67		consisting of a lower-level coverage policy form and a higher-level coverage policy form each of 23
68	68		which includes benefits substantially similar to other individual health insurance coverage offered 24
69	69		by the carrier in this state and each of which is covered under a method that provides for risk 25
70	70		adjustment, risk spreading, or financial subsidization. 26
71	71		(2) For the purposes of this subsection, “lower-level coverage” means a policy form for 27
72	72		which the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) 28
73	73		but not greater than one hundred percent (100%) of the policy form weighted average. 29
74	74		(3) For the purposes of this subsection, “higher-level coverage” means a policy form for 30
75	75		which the actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater 31
76	76		than the actuarial value of lower-level coverage offered by the carrier in this state, and the actuarial 32
77	77		value of the benefits under the coverage is at least one hundred percent (100%) but not greater than 33
78	78		one hundred twenty percent (120%) of the policy form weighted average. 34
79	79
80	80
81		-	LC000285/SUB B - Page 3 of 13
	81	+	LC000285/SUB A - Page 3 of 13
82	82		(4) For the purposes of this subsection, “policy form weighted average” means the average 1
83	83		actuarial value of the benefits provided by all the health insurance coverage issued (as elected by 2
84	84		the carrier) either by that carrier or, if the data are available, by all carriers in this state in the 3
85	85		individual market during the previous year (not including coverage issued under this subsection), 4
86	86		weighted by enrollment for the different coverage. The actuarial value of benefits shall be 5
87	87		calculated based on a standardized population and a set of standardized utilization and cost factors. 6
88	88		(5) The carrier elections under this subsection shall apply uniformly to all eligible 7
89	89		individuals in this state for that carrier. The election shall be effective for policies offered during a 8
90	90		period of not shorter than two (2) years. 9
91	91		(c)(1) A carrier may deny health insurance coverage in the individual market to an eligible 10
92	92		individual applicant if the carrier has demonstrated to the director commissioner that: 11
93	93		(i) It does not have the financial reserves necessary to underwrite additional coverage; and 12
94	94		(ii) It is applying this subsection uniformly to all individuals in the individual market in 13
95	95		this state consistent with applicable state law and without regard to any health status-related factor 14
96	96		of the individuals and without regard to whether the individuals are eligible individuals. 15
97	97		(2) A carrier upon denying individual health insurance coverage in this state in accordance 16
98	98		with this subsection may not offer that coverage in the individual market in this state for a period 17
99	99		of one hundred eighty (180) days after the date the coverage is denied or until the carrier has 18
100	100		demonstrated to the director commissioner that the carrier has sufficient financial reserves to 19
101	101		underwrite additional coverage, whichever is later. 20
102	102		(d) Nothing in this section shall be construed to require that a carrier offering health 21
103	103		insurance coverage only in connection with group health plans or through one or more bona fide 22
104	104		associations, or both, offer health insurance coverage in the individual market. 23
105	105		(e) A carrier offering health insurance coverage in connection with group health plans 24
106	106		under this title shall not be deemed to be a health insurance carrier offering individual health 25
107	107		insurance coverage solely because the carrier offers a conversion policy. 26
108	108		(f) Except for any high risk pool rating rules to be established by the Office of the Health 27
109	109		Insurance Commissioner (OHIC) as described in this section, nothing in this section shall be 28
110	110		construed to create additional restrictions on the amount of premium rates that a carrier may charge 29
111	111		an individual for health insurance coverage provided in the individual market; or to prevent a health 30
112	112		insurance carrier offering health insurance coverage in the individual market from establishing 31
113	113		premium rates or modifying applicable copayments or deductibles in return for adherence to 32
114	114		programs of health promotion and disease prevention. 33
115	115		(g) OHIC may pursue federal funding in support of the development of a high risk pool for 34
116	116
117	117
118		-	LC000285/SUB B - Page 4 of 13
	118	+	LC000285/SUB A - Page 4 of 13
119	119		the individual market, as defined in § 27-18.5-2, contingent upon a thorough assessment of any 1
120	120		financial obligation of the state related to the receipt of said federal funding being presented to, and 2
121	121		approved by, the general assembly by passage of concurrent general assembly resolution. The 3
122	122		components of the high risk pool program, including, but not limited to, rating rules, eligibility 4
123	123		requirements and administrative processes, shall be designed in accordance with § 2745 of the 5
124	124		Public Health Service Act (42 U.S.C. § 300gg-45) also known as the State High Risk Pool Funding 6
125	125		Extension Act of 2006 and defined in regulations promulgated by the office of the health insurance 7
126	126		commissioner on or before October 1, 2007. 8
127	127		(h)(1) In the case of a health insurance carrier that offers health insurance coverage in the 9
128	128		individual market through a network plan, the carrier may limit the individuals who may be enrolled 10
129	129		under that coverage to those who live, reside, or work within the service areas for the network plan; 11
130	130		and within the service areas of the plan, deny coverage to individuals if the carrier has demonstrated 12
131	131		to the director that: 13
132	132		(i) It will not have the capacity to deliver services adequately to additional individual 14
133	133		enrollees because of its obligations to existing group contract holders and enrollees and individual 15
134	134		enrollees; and 16
135	135		(ii) It is applying this subsection uniformly to individuals without regard to any health 17
136	136		status-related factor of the individuals and without regard to whether the individuals are eligible 18
137	137		individuals. 19
138	138		(2) Upon denying health insurance coverage in any service area in accordance with the 20
139	139		terms of this subsection, a carrier may not offer coverage in the individual market within the service 21
140	140		area for a period of one hundred eighty (180) days after the coverage is denied. 22
141	141		(i) A carrier must allow an eligible applicant to enroll in coverage during: 23
142	142		(A) An open enrollment period to be established by the commissioner and held annually 24
143	143		for a period of between thirty (30) and sixty (60) days; 25
144	144		(B) Special enrollment periods as established in accordance with the version of 45 C.F.R. 26
145	145		§ 147.104 in effect on January 1, 2023; and 27
146	146		(C) Any other open enrollment periods or special enrollment periods established by federal 28
147	147		or state law, rule or regulation. 29
148	148		27-18.5-4. Continuation of coverage — Renewability. 30
149	149		(a) A health insurance carrier that provides individual health insurance coverage to an 31
150	150		individual in this state shall renew or continue in force that coverage at the option of the individual. 32
151	151		(b) A health insurance carrier may nonrenew non-renew or discontinue health insurance 33
152	152		coverage of an individual in the individual market based only on one or more of the following: 34
153	153
154	154
155		-	LC000285/SUB B - Page 5 of 13
	155	+	LC000285/SUB A - Page 5 of 13
156	156		(1) The individual has failed to pay premiums or contributions in accordance with the terms 1
157	157		of the health insurance coverage, including terms relating to or the carrier has not received timely 2
158	158		premium payments; 3
159	159		(2) The individual has performed an act or practice that constitutes fraud or made an 4
160	160		intentional misrepresentation of material fact under the terms of the coverage; 5
161	161		(3) The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of 6
162	162		this section; 7
163	163		(4) In the case of a carrier that offers health insurance coverage in the market through a 8
164	164		network plan, the individual no longer resides, lives, or works in the service area (or in an area for 9
165	165		which the carrier is authorized to do business) but only if the coverage is terminated uniformly 10
166	166		without regard to any health status-related factor of covered individuals; or 11
167	167		(5) In the case of health insurance coverage that is made available in the individual market 12
168	168		only through one or more bona fide associations, the membership of the individual in the 13
169	169		association (on the basis of which the coverage is provided) ceases but only if the coverage is 14
170	170		terminated uniformly and without regard to any health status-related factor of covered individuals. 15
171	171		(c) In any case in which a carrier decides to discontinue offering a particular type of health 16
172	172		insurance coverage offered in the individual market, coverage of that type may be discontinued 17
173	173		only if: 18
174	174		(1) The carrier provides notice, to each covered individual provided coverage of this type 19
175	175		in the market, of the discontinuation at least ninety (90) days prior to the date of discontinuation of 20
176	176		the coverage; 21
177	177		(2) The carrier offers to each individual in the individual market provided coverage of this 22
178	178		type, the opportunity to purchase any other individual health insurance coverage currently being 23
179	179		offered by the carrier for individuals in the market; and 24
180	180		(3) In exercising this option to discontinue coverage of this type and in offering the option 25
181	181		of coverage under subdivision (2) of this subsection, the carrier acts uniformly without regard to 26
182	182		any health status-related factor of enrolled individuals or individuals who may become eligible for 27
183	183		the coverage. 28
184	184		(d) In any case in which a carrier elects to discontinue offering all health insurance 29
185	185		coverage in the individual market in this state, health insurance coverage may be discontinued only 30
186	186		if: 31
187	187		(1) The carrier provides notice to the director commissioner and to each individual of the 32
188	188		discontinuation at least one hundred eighty (180) days prior to the date of the expiration of the 33
189	189		coverage; and 34
190	190
191	191
192		-	LC000285/SUB B - Page 6 of 13
	192	+	LC000285/SUB A - Page 6 of 13
193	193		(2) All health insurance issued or delivered in this state in the market is discontinued and 1
194	194		coverage under this health insurance coverage in the market is not renewed. 2
195	195		(e) In the case of a discontinuation under subsection (d) of this section, the carrier may not 3
196	196		provide for the issuance of any health insurance coverage in the individual market in this state 4
197	197		during the five (5) year period beginning on the date the carrier filed its notice with the department 5
198	198		to withdraw from the individual health insurance market in this state. This five (5) year period may 6
199	199		be reduced to a minimum of three (3) years at the discretion of the health insurance commissioner, 7
200	200		based on his/her analysis of market conditions and other related factors. 8
201	201		(f) The provisions of subsections (d) and (e) of this section do not apply if, at the time of 9
202	202		coverage renewal, a health insurance carrier modifies the health insurance coverage for a policy 10
203	203		form offered to individuals in the individual market so long as the modification is consistent with 11
204	204		this chapter and other applicable law and effective on a uniform basis among all individuals with 12
205	205		that policy form. 13
206	206		(g) In applying this section in the case of health insurance coverage made available by a 14
207	207		carrier in the individual market to individuals only through one or more associations, a reference 15
208	208		to an “individual” includes a reference to the association (of which the individual is a member). 16
209	209		27-18.5-5. Enforcement — Limitation on actions. 17
210	210		The director commissioner has the power to enforce the provisions of this chapter in 18
211	211		accordance with § 42-14-16 and all other applicable laws. 19
212	212		27-18.5-6. Rules and regulations. 20
213	213		The director commissioner may promulgate rules and regulations necessary to effectuate 21
214	214		the purposes of this chapter. 22
215	215		27-18.5-10. Prohibition on preexisting condition exclusions. 23
216	216		(a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for 24
217	217		delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant 25
218	218		to this title and/or chapter: shall not limit or exclude coverage for any individual by imposing a 26
219	219		preexisting condition exclusion on that individual. 27
220	220		(1) Shall not limit or exclude coverage for an individual under the age of nineteen (19) by 28
221	221		imposing a preexisting condition exclusion on that individual. 29
222	222		(2) For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude 30
223	223		coverage for any individual by imposing a preexisting condition exclusion on that individual. 31
224	224		(b) As used in this section:, (1) “Preexisting “preexisting condition exclusion” means a 32
225	225		limitation or exclusion of benefits, including a denial of coverage, based on the fact that the 33
226	226		condition (whether physical or mental) was present before the effective date of coverage, or if the 34
227	227
228	228
229		-	LC000285/SUB B - Page 7 of 13
	229	+	LC000285/SUB A - Page 7 of 13
230	230		coverage is denied, the date of denial, under a health benefit plan whether or not any medical advice, 1
231	231		diagnosis, care or treatment was recommended or received before the effective date of coverage. 2
232	232		(2) “Preexisting condition exclusion” means any limitation or exclusion of benefits, 3
233	233		including a denial of coverage, applicable to an individual as a result of information relating to an 4
234	234		individual’s health status before the individual’s effective date of coverage, or if the coverage is 5
235	235		denied, the date of denial, under the health benefit plan, such as a condition (whether physical or 6
236	236		mental) identified as a result of a pre-enrollment questionnaire or physical examination given to 7
237	237		the individual, or review of medical records relating to the pre-enrollment period. 8
238	238		(c) This section shall not apply to grandfathered health plans providing individual health 9
239	239		insurance coverage. 10
240	240		(d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital 11
241	241		confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare 12
242	242		supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily 13
243	243		injury or death by accident or both; and (9) Other limited benefit policies. 14
244	244		SECTION 2. Chapter 27-18.5 of the General Laws entitled "Individual Health Insurance 15
245	245		Coverage" is hereby amended by adding thereto the following section: 16
246	246		27-18.5-11. Essential health benefits -- Individual. 17
247	247		(a) The following words and phrases as used in this section have the following meanings 18
248	248		consistent with federal law and regulations adopted thereunder, as long as they remain in effect. If 19
249	249		such authorities are determined by the commissioner to no longer be in effect, the laws and 20
250	250		regulations in effect as of the date immediately prior to their legislative repeal or their being 21
251	251		declared invalid or nullified by final federal judicial or executive branch action, as identified by the 22
252	252		commissioner shall govern, unless a different meaning is required by the context: 23
253	253		(1) "Essential health benefits" means the following general categories, and the services 24
254	254		covered within those categories as defined pursuant to the processes described in 42 U.S.C. § 18022 25
255	255		and implementing regulations and guidance: 26
256	256		(i) Ambulatory patient services; 27
257	257		(ii) Emergency services; 28
258	258		(iii) Hospitalization; 29
259	259		(iv) Maternity and newborn care; 30
260	260		(v) Mental health and substance use disorder services, including behavioral health 31
261	261		treatment; 32
262	262		(vi) Prescription drugs; 33
263	263		(vii) Rehabilitative and habilitative services and devices; 34
264	264
265	265
266		-	LC000285/SUB B - Page 8 of 13
	266	+	LC000285/SUB A - Page 8 of 13
267	267		(viii) Laboratory services; 1
268	268		(ix) Preventive services, wellness services, and chronic disease management; and 2
269	269		(x) Pediatric services, including oral and vision care. 3
270	270		(2) "Preventive services" means those services described in 42 U.S.C. § 300gg-13 and 4
271	271		implementing regulations and guidance. 5
272	272		(b) If any provision of the federal Patient Protection and Affordable Care Act and 6
273	273		implementing regulations relating to coverage for essential health benefits and/or for preventive 7
274	274		services without cost sharing are determined by the commissioner to have been repealed or to have 8
275	275		been declared invalid or nullified by the final judgment of a federal court applicable to the state or 9
276	276		by executive or administrative action, which shall be deemed to include an action of the federal 10
277	277		executive or judicial branch that nullifies the effectiveness of the obligation to provide coverage 11
278	278		without cost sharing for a meaningful range of preventive services substantially similar to those 12
279	279		preventive services required under 42 U.S.C. § 300gg-13 as of January 1, 2023, then the following 13
280	280		shall apply: 14
281	281		(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, 15
282	282		issued for delivery, or issued to cover a resident of this state, by a health insurance company 16
283	283		licensed pursuant to this title and/or chapter shall provide coverage of at least the essential health 17
284	284		benefits categories set forth in this section, and shall further provide coverage of preventive services 18
285	285		from in-network providers without applying any copayments, deductibles, coinsurance, or other 19
286		-	cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including 20
287		-	existing exemptions, in effect as of the date immediately prior to their repeal, revocation, or 21
288		-	nullification, as set forth above. 22
289		-	(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations 23
290		-	with respect to grade "A" or "B" preventive services, or other expert advisory panel designated in 24
291		-	42 U.S.C. § 300gg-13 similarly provides new or revised recommendations, the office of the health 25
292		-	insurance commissioner shall have the authority to issue guidance clarifying the services that shall 26
293		-	qualify as preventive services under this section, consistent with said recommendations and in 27
294		-	accordance with the processes as had been described by the version of 42 U.S.C. § 300gg-13(b) 28
295		-	and related regulations and guidance in effect as of the date immediately prior to their repeal, 29
296		-	revocation, or nullification, as set forth above. 30
297		-	(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, 31
298		-	issued for delivery, or issued to cover a resident of this state, by a health insurance company 32
299		-	licensed pursuant to this title and/or chapter, was not subject to the requirements described in 33
300		-	subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, 34
301		-
302		-
303		-	LC000285/SUB B - Page 9 of 13
304		-	contract, or plan shall remain so exempt and the provisions of this section shall not apply. 1
305		-	SECTION 3. Chapter 27-18.6 of the General Laws entitled "Large Group Health Insurance 2
306		-	Coverage" is hereby amended by adding thereto the following section: 3
307		-	27-18.6-3.2. Preventative services. 4
308		-	(a) As used in this section, "preventive services" means those services described in 42 5
309		-	U.S.C. § 300gg-13 and implementing regulations and guidance. 6
310		-	(b) If any provision of the federal Patient Protection and Affordable Care Act and 7
311		-	implementing regulations relating to preventive services without cost sharing are determined by 8
312		-	the commissioner to have been repealed or to have been declared invalid or nullified by the final 9
313		-	judgment of a federal court applicable to the state or by executive or administrative action, which 10
314		-	shall be deemed to include an action of the executive or judicial branch that nullifies the 11
315		-	effectiveness of the obligation to provide coverage without cost sharing for a meaningful range of 12
316		-	preventive services substantially similar to those in effect as of January 1, 2023, then the following 13
317		-	shall apply: 14
318		-	(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, 15
319		-	issued for delivery, or issued to cover a resident of this state, by a health insurance company 16
320		-	licensed pursuant to this title and/or chapter, shall provide coverage of preventive services from in-17
321		-	network providers without applying any copayments, deductibles, coinsurance, or other cost 18
322		-	sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including 19
323		-	existing exemptions, in effect as of the date immediately prior to their repeal, revocation, or 20
324		-	nullification, as set forth above. 21
	286	+	cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance in effect 20
	287	+	as of the date immediately prior to their repeal, revocation, or nullification, as set forth above. 21
325	288		(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations 22
326		-	with respect to grade "A" or "B" preventive services or other expert advisory panel ~~described~~ in 42 23
327		-	U.S.C. § 300gg-13, similarly provides new or revised recommendations the office of the health 24
	289	+	with respect to grade "A" or "B" preventive services, or other expert advisory panel designated in 23
	290	+	42 U.S.C. § 300gg-13 similarly provides new or revised recommendations, the office of the health 24
328	291		insurance commissioner shall have the authority to issue guidance clarifying the services that shall 25
329		-	qualify as preventive services under this section, consistent with said recommendations, and in 26
330		-	accordance with the ~~process~~ as had been described by the version of 42 U.S.C. § 300gg-13(b) ~~and~~ 27
331		-	related regulations and guidance in effect as of the date immediately prior to their repeal, 28
	292	+	qualify as preventive services under this section, consistent with said recommendations and in 26
	293	+	accordance with the processes as had been described by the version of 42 U.S.C. § 300gg-13(b) 27
	294	+	and related regulations and guidance in effect as of the date immediately prior to their repeal, 28
332	295		revocation, or nullification, as set forth above. 29
333	296		(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, 30
334	297		issued for delivery, or issued to cover a resident of this state, by a health insurance company 31
335	298		licensed pursuant to this title and/or chapter, was not subject to the requirements described in 32
336	299		subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, 33
337	300		contract, or plan shall remain so exempt and the provisions of this section shall not apply. 34
338	301
339	302
340		-	LC000285/SUB B - Page 10 of 13
341		-	SECTION 4. ~~Section~~ 27-~~50-11~~ of the General Laws ~~in Chapter 27-50~~ entitled "~~Small~~ 1
342		-	~~Employer Health Insurance Availability Act~~" is hereby amended ~~to read as follows~~: 2
343		-	27-~~50-11~~. ~~Administrative procedures~~. 3
344		-	~~The director shall issue commissioner may promulgate rules and regulations necessary to~~ 4
345		-	~~effectuate the purposes of this chapter in accordance with chapter 35 of this title for the~~ 5
346		-	~~implementation and administration~~ of the ~~Small Employer Health Insurance Availability~~ Act. 6
347		-	~~SECTION 5.~~ ~~Chapter 27-50~~ ~~of the General Laws entitled "Small~~ ~~Employer Health~~ 7
348		-	~~Insurance Availability Act"~~ ~~is hereby amended~~ by ~~adding thereto~~ the ~~following section:~~ 8
349		-	~~27-50-19. Essential health benefits.~~ 9
350		-	~~(a)~~ The ~~following words and phrases as used in this section have~~ the ~~following meanings~~ 10
351		-	~~consistent with federal law and regulations adopted thereunder,~~ ~~as long as they remain in effect. If~~ 11
352		-	~~such authorities are determined by the commissioner~~ to ~~no longer be~~ in effect, the ~~laws and~~ 12
353		-	~~regulations in effect as of the date immediately prior to their legislative repeal or their being~~ 13
354		-	~~declared invalid~~ or ~~nullified by federal judicial or executive branch action~~, ~~as identified by the~~ 14
355		-	~~commissioner shall govern~~, ~~unless~~ a ~~different meaning is required~~ by ~~the context:~~ 15
356		-	~~(1) "Essential~~ ~~health benefits"~~ ~~means the following general categories~~, ~~and the~~ services 16
357		-	~~covered within those categories as defined pursuant to the processes described in 42 U.S.C. § 18022~~ 17
358		-	and ~~implementing~~ regulations and guidance: 18
359		-	~~(i) Ambulatory patient services;~~ 19
360		-	(ii) ~~Emergency~~ services; 20
361		-	~~(iii) Hospitalization;~~ 21
362		-	~~(iv) Maternity and newborn care;~~ 22
363		-	~~(v) Mental health and substance use disorder~~ services~~, including behavioral health~~ 23
364		-	~~treatment;~~ 24
365		-	(vi) ~~Prescription drugs;~~ 25
366		-	~~(vii) Rehabilitative~~ and ~~habilitative services and devices;~~ 26
367		-	~~(viii) Laboratory services;~~ 27
368		-	(ix) ~~Preventive services~~, ~~wellness services~~, ~~and chronic disease management;~~ ~~and~~ 28
369		-	~~(x) Pediatric services~~, ~~including oral and vision care.~~ 29
370		-	~~(2) "Preventative~~ ~~services" means those services~~ described in ~~42 U.S.C. § 300gg-13 and~~ 30
371		-	~~implementing regulations and guidance.~~ 31
372		-	~~(b) If any provision~~ of ~~the federal Patient Protection and Affordable Care Act and~~ 32
373		-	~~implementing regulations relating to coverage for essential health benefits and/or for preventive~~ 33
374		-	~~services without cost sharing are determined by the commissioner~~ to ~~have been repealed or to have~~ 34
	303	+	LC000285/SUB A - Page 9 of 13
	304	+	SECTION 3. Chapter 27-18.6 of the General Laws entitled "Large Group Health Insurance 1
	305	+	Coverage" is hereby amended by adding thereto the following section: 2
	306	+	27-18.6-3.2. Preventative services. 3
	307	+	(a) As used in this section, "preventive services" means those services described in 42 4
	308	+	U.S.C. § 300gg-13 and implementing regulations and guidance. 5
	309	+	(b) If any provision of the federal Patient Protection and Affordable Care Act and 6
	310	+	implementing regulations relating to preventive services without cost sharing are determined by 7
	311	+	the commissioner to have been repealed or to have been declared invalid or nullified by the final 8
	312	+	judgment of a federal court applicable to the state or by executive or administrative action, which 9
	313	+	shall be deemed to include an action of the executive or judicial branch that nullifies the 10
	314	+	effectiveness of the obligation to provide coverage without cost sharing for a meaningful range of 11
	315	+	preventive services substantially similar to those in effect as of January 1, 2023, then the following 12
	316	+	shall apply: 13
	317	+	(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, 14
	318	+	issued for delivery, or issued to cover a resident of this state, by a health insurance company 15
	319	+	licensed pursuant to this title and/or chapter, shall provide coverage of preventive services from in-16
	320	+	network providers without applying any copayments, deductibles, coinsurance, or other cost 17
	321	+	sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance in effect as of 18
	322	+	the date immediately prior to their repeal, revocation, or nullification, as set forth above. 19
	323	+	(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations 20
	324	+	with respect to grade "A" or "B" preventive services or other expert advisory panel described in 42 21
	325	+	U.S.C. § 300gg-13, similarly provides new or revised recommendations the office of the health 22
	326	+	insurance commissioner shall have the authority to issue guidance clarifying the services that shall 23
	327	+	qualify as preventive services under this section, consistent with said recommendations, and in 24
	328	+	accordance with the process as had been described by the version of 42 U.S.C. § 300gg-13(b) and 25
	329	+	related regulations and guidance in effect as of the date immediately prior to their repeal, 26
	330	+	revocation, or nullification, as set forth above. 27
	331	+	(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, 28
	332	+	issued for delivery, or issued to cover a resident of this state, by a health insurance company 29
	333	+	licensed pursuant to this title and/or chapter, was not subject to the requirements described in 30
	334	+	subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, 31
	335	+	contract, or plan shall remain so exempt and the provisions of this section shall not apply. 32
	336	+	SECTION 4. Section 27-50-11 of the General Laws in Chapter 27-50 entitled "Small 33
	337	+	Employer Health Insurance Availability Act" is hereby amended to read as follows: 34
375	338
376	339
377		-	LC000285/SUB B - Page 11 of 13
378		-	~~been declared invalid or nullified by the final judgment of a federal judicial branch applicable to~~ 1
379		-	the ~~state or by executive or administrative action, which~~ shall ~~be deemed~~ to ~~include an action of the~~ 2
380		-	~~federal executive or judicial branch that nullifies~~ the ~~effectiveness~~ of the ~~obligation to provide~~ 3
381		-	~~coverage without cost sharing for a meaningful range~~ of ~~preventive services substantially similar~~ 4
382		-	~~to those preventive services required under 42 U.S.C~~. ~~§ 300gg-13 as~~ of ~~January 1,~~ ~~2023, then the~~ 5
383		-	following ~~shall apply~~: 6
384		-	~~(1) A~~ health ~~insurance policy,~~ ~~subscriber contract,~~ ~~or health plan offered, issued, renewed,~~ 7
385		-	~~issued for delivery,~~ ~~or issued to cover a resident of~~ this ~~state, by a health insurance company~~ 8
386		-	~~licensed pursuant to this title~~ and~~/or chapter shall provide coverage of at least the essential health~~ 9
387		-	~~benefits categories set forth~~ in ~~this section,~~ and ~~shall further provide coverage of preventive services~~ 10
388		-	~~from~~ in~~-network providers without applying any copayments,~~ ~~deductibles, coinsurance,~~ or ~~other~~ 11
389		-	~~cost sharing~~, as ~~described in 42 U.S.C. § 300gg-13 and related regulations and guidance, including~~ 12
390		-	~~existing exemptions~~, ~~in effect as of~~ the ~~date immediately prior to their repeal, revocation, or~~ 13
391		-	~~nullification~~, ~~as set forth above.~~ 14
392		-	~~(2)~~ To the ~~extent that the~~ U.S. ~~Preventive Services Taskforce revises its recommendations~~ 15
393		-	~~with respect to grade "A" or "B" preventive services, or other expert advisory panel designated in~~ 16
394		-	~~42 U.S.C. § 300gg-13 similarly provides new or revised recommendations, the office of health~~ 17
395		-	~~insurance commissioner shall have the authority to issue guidance clarifying the~~ services ~~that shall~~ 18
396		-	~~qualify as preventive services under this section, consistent with said recommendations and in~~ 19
397		-	~~accordance with the processes as had been described by the version of 42 U.S.C. § 300gg-13(b)~~ 20
398		-	~~and related regulations~~ and ~~guidance in effect as of the date immediately prior to their repeal,~~ 21
399		-	~~revocation, or nullification, as set forth above.~~ 22
400		-	(c) ~~If a health insurance policy, subscriber contract, or health plan offered, issued, renewed,~~ 23
401		-	~~issued for delivery,~~ ~~or issued to cover a resident of this state, by a health insurance company~~ 24
402		-	~~licensed pursuant to this title and/or chapter, was not subject to the requirements described in~~ 25
403		-	~~subsection~~ (b) ~~of this section prior to their repeal~~, ~~revocation~~, ~~or nullification,~~ ~~then such policy,~~ 26
404		-	~~contract~~, ~~or plan shall remain so exempt~~ and ~~the provisions of this section shall not apply~~. 27
405		-	~~SECTION 6~~. ~~Chapter 42-14.5 of the General Laws entitled "The Rhode Island Health Care~~ 28
406		-	~~Reform Act of 2004 — Health Insurance Oversight" is hereby amended by adding thereto the~~ 29
407		-	~~following section:~~ 30
408		-	~~42-14.5-3.1. Reporting changes in federal law.~~ 31
409		-	~~If any provision of~~ the ~~federal Patient Protection and Affordable Care Act and/~~or ~~its~~ 32
410		-	~~implementing regulations relating~~ to ~~coverage for essential health benefits or preventive services~~ 33
411		-	~~are determined~~ by ~~the commissioner~~ to ~~have been repealed or to have been declared invalid or~~ 34
	340	+	LC000285/SUB A - Page 10 of 13
	341	+	27-50-11. Administrative procedures. 1
	342	+	The director shall issue commissioner may promulgate rules and regulations necessary to 2
	343	+	effectuate the purposes of this chapter in accordance with chapter 35 of this title for the 3
	344	+	implementation and administration of the Small Employer Health Insurance Availability Act. 4
	345	+	SECTION 5. Chapter 27-50 of the General Laws entitled "Small Employer Health 5
	346	+	Insurance Availability Act" is hereby amended by adding thereto the following section: 6
	347	+	27-50-19. Essential health benefits. 7
	348	+	(a) The following words and phrases as used in this section have the following meanings 8
	349	+	consistent with federal law and regulations adopted thereunder, as long as they remain in effect. If 9
	350	+	such authorities are determined by the commissioner to no longer be in effect, the laws and 10
	351	+	regulations in effect as of the date immediately prior to their legislative repeal or their being 11
	352	+	declared invalid or nullified by federal judicial or executive branch action, as identified by the 12
	353	+	commissioner shall govern, unless a different meaning is required by the context: 13
	354	+	(1) "Essential health benefits" means the following general categories, and the services 14
	355	+	covered within those categories as defined pursuant to the processes described in 42 U.S.C. § 18022 15
	356	+	and implementing regulations and guidance: 16
	357	+	(i) Ambulatory patient services; 17
	358	+	(ii) Emergency services; 18
	359	+	(iii) Hospitalization; 19
	360	+	(iv) Maternity and newborn care; 20
	361	+	(v) Mental health and substance use disorder services, including behavioral health 21
	362	+	treatment; 22
	363	+	(vi) Prescription drugs; 23
	364	+	(vii) Rehabilitative and habilitative services and devices; 24
	365	+	(viii) Laboratory services; 25
	366	+	(ix) Preventive services, wellness services, and chronic disease management; and 26
	367	+	(x) Pediatric services, including oral and vision care. 27
	368	+	(2) "Preventative services" means those services described in 42 U.S.C. § 300gg-13 and 28
	369	+	implementing regulations and guidance. 29
	370	+	(b) If any provision of the federal Patient Protection and Affordable Care Act and 30
	371	+	implementing regulations relating to coverage for essential health benefits and/or for preventive 31
	372	+	services without cost sharing are determined by the commissioner to have been repealed or to have 32
	373	+	been declared invalid or nullified by the final judgment of a federal judicial branch applicable to 33
	374	+	the state or by executive or administrative action, which shall be deemed to include an action of the 34
412	375
413	376
414		-	LC000285/SUB B - Page 12 of 13
415		-	nullified by the final judgment of a federal court applicable to the state or by executive or 1
416		-	administrative action, which shall be deemed to include an action of the executive or judicial branch 2
417		-	that nullifies the effectiveness of the provision, such that the commissioner intends to take action 3
418		-	pursuant to the authority conferred on him or her pursuant to the authority granted by §§ 27-18.5-4
419		-	11, 27-18.6-3.2, or 27-50-18, the commissioner shall report to the general assembly as soon as 5
420		-	possible to describe the impact of the change and to make recommendations regarding consumer 6
421		-	protections, consumer choices, and stabilization and affordability of the Rhode Island insurance 7
422		-	market. 8
423		-	SECTION 7. This act shall take effect upon passage. 9
	377	+	LC000285/SUB A - Page 11 of 13
	378	+	federal executive or judicial branch that nullifies the effectiveness of the obligation to provide 1
	379	+	coverage without cost sharing for a meaningful range of preventive services substantially similar 2
	380	+	to those preventive services required under 42 U.S.C. § 300gg-13 as of January 1, 2023, then the 3
	381	+	following shall apply: 4
	382	+	(1) A health insurance policy, subscriber contract, or health plan offered, issued, renewed, 5
	383	+	issued for delivery, or issued to cover a resident of this state, by a health insurance company 6
	384	+	licensed pursuant to this title and/or chapter shall provide coverage of at least the essential health 7
	385	+	benefits categories set forth in this section, and shall further provide coverage of preventive services 8
	386	+	from in-network providers without applying any copayments, deductibles, coinsurance, or other 9
	387	+	cost sharing, as described in 42 U.S.C. § 300gg-13 and related regulations and guidance in effect 10
	388	+	as of the date immediately prior to their repeal, revocation, or nullification, as set forth above. 11
	389	+	(2) To the extent that the U.S. Preventive Services Taskforce revises its recommendations 12
	390	+	with respect to grade "A" or "B" preventive services, or other expert advisory panel designated in 13
	391	+	42 U.S.C. § 300gg-13 similarly provides new or revised recommendations, the office of health 14
	392	+	insurance commissioner shall have the authority to issue guidance clarifying the services that shall 15
	393	+	qualify as preventive services under this section, consistent with said recommendations and in 16
	394	+	accordance with the processes as had been described by the version of 42 U.S.C. § 300gg-13(b) 17
	395	+	and related regulations and guidance in effect as of the date immediately prior to their repeal, 18
	396	+	revocation, or nullification, as set forth above. 19
	397	+	(c) If a health insurance policy, subscriber contract, or health plan offered, issued, renewed, 20
	398	+	issued for delivery, or issued to cover a resident of this state, by a health insurance company 21
	399	+	licensed pursuant to this title and/or chapter, was not subject to the requirements described in 22
	400	+	subsection (b) of this section prior to their repeal, revocation, or nullification, then such policy, 23
	401	+	contract, or plan shall remain so exempt and the provisions of this section shall not apply. 24
	402	+	SECTION 6. Chapter 42-14.5 of the General Laws entitled "The Rhode Island Health Care 25
	403	+	Reform Act of 2004 — Health Insurance Oversight" is hereby amended by adding thereto the 26
	404	+	following section: 27
	405	+	42-14.5-3.1. Reporting changes in federal law. 28
	406	+	If any provision of the federal Patient Protection and Affordable Care Act and/or its 29
	407	+	implementing regulations relating to coverage for essential health benefits or preventive services 30
	408	+	are determined by the commissioner to have been repealed or to have been declared invalid or 31
	409	+	nullified by the final judgment of a federal court applicable to the state or by executive or 32
	410	+	administrative action, which shall be deemed to include an action of the executive or judicial branch 33
	411	+	that nullifies the effectiveness of the provision, such that the commissioner intends to take action 34
	412	+
	413	+
	414	+	LC000285/SUB A - Page 12 of 13
	415	+	pursuant to the authority conferred on him or her pursuant to the authority granted by §§ 27-18.5-1
	416	+	11, 27-18.6-3.2, or 27-50-18, the commissioner shall report to the general assembly as soon as 2
	417	+	possible to describe the impact of the change and to make recommendations regarding consumer 3
	418	+	protections, consumer choices, and stabilization and affordability of the Rhode Island insurance 4
	419	+	market. 5
	420	+	SECTION 7. This act shall take effect upon passage. 6
424	421		========
425		-	LC000285/SUB B
	422	+	LC000285/SUB A
426	423		========
427	424
428	425
429		-	LC000285/SUB B - Page 13 of 13
	426	+	LC000285/SUB A - Page 13 of 13
430	427		EXPLANATION
431	428		BY THE LEGISLATIVE COUNCIL
432	429		OF
433	430		A N A C T
434	431		RELATING TO INSURANCE -- INDIVIDUAL HEALTH INSURANCE COVERAGE
435	432		***
436	433		This act would provide guaranteed availability of coverage to any eligible individual 1
437	434		resident of this state. Coverage could not be limited or excluded by imposing a preexisting 2
438	435		condition exclusion. It would also require individual health insurers, large group health insurers 3
439	436		and small employer health insurers to provide coverage for ten (10) categories of essential health 4
440	437		benefits listed in the act. 5
441	438		This act would take effect upon passage. 6
442	439		========
443		-	LC000285/SUB B
	440	+	LC000285/SUB A
444	441		========
445	442