2006 -- S 2706 SUBSTITUTE A AS AMENDED

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LC02402/SUB A/2

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2006

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A N A C T

RELATING TO HEALTH AND SAFETY

     Introduced By: Senators Perry, Goodwin, Roberts, C Levesque, and Walaska

     Date Introduced: February 14, 2006

     Referred To: Senate Finance

It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness

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Insurance Policies" is hereby amended by adding thereto the following section:

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     27-18-65. Tobacco cessation programs. – (1) Every individual or group health

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insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

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January 1, 2007, which provides medical coverage that includes coverage for physician services

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in a physician's office, and every policy which provides major medical or similar comprehensive-

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type coverage, shall include coverage for smoking cessation treatment, provided that if such

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medical coverage does not include prescription drug coverage, such contract, plan or policy shall

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not be required to include coverage for prescription nicotine replacement therapy.

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     (2) As used in this section, smoking cessation treatment includes the use of an over-the-

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counter (OTC) or prescription US Food and Drug Administration (FDA) approved nicotine

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replacement therapy, when recommended and prescribed by a prescriber who holds prescriptive

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privileges in the state in which they are licensed, and used in combination with an annual

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outpatient benefit of eight (8) one-half (1/2) hour smoking cessation counseling sessions provided

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by a qualified practitioner for each covered individual. Smoking cessation treatment may be

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further defined through regulation promulgated by the health insurance commissioner.

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     (3) Health insurance contracts, plans, or policies to which this section applies, may

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impose copayments and/or deductibles for the benefits mandated by this section consistent with

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the contracts', plans' or policies' copayments and/or deductibles for physician services and

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medications. Nothing contained in this section shall impact the reimbursement, medical necessity

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or utilization review, managed care, or case management practices of these health insurance

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contracts, plans or policies.

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     (4) This section shall not apply to insurance coverage providing benefits for:

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     (a) hospital confinement indemnity;

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     (b) disability income;

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     (c) accident only;

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     (d) long-term care;

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     (e) Medicare supplement;

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     (f) limited benefit health;

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     (g) specified disease indemnity;

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     (h) sickness or bodily injury or death by accident or both; and

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     (i) other limited benefit policies.

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     SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-19-56. Tobacco cessation programs. -- (1) Every individual or group health

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insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

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January 1, 2007, which provides medical coverage that includes coverage for physician services

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in a physician's office, and every policy which provides major medical or similar comprehensive-

2-20

type coverage, shall include coverage for smoking cessation treatment, provided that if such

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medical coverage does not include prescription drug coverage, such contract, plan or policy shall

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not be required to include coverage for prescription nicotine replacement therapy.

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     (2) As used in this section, smoking cessation treatment includes the use of an over-the-

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counter (OTC) or prescription US Food and Drug Administration (FDA) approved nicotine

2-25

replacement therapy, when recommended and prescribed by a prescriber who holds prescriptive

2-26

privileges in the state in which they are licensed, and used in combination with an annual

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outpatient benefit of eight (8) one-half (1/2) hour smoking cessation counseling sessions provided

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by a qualified practitioner for each covered individual. Smoking cessation treatment may be

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further defined through regulation promulgated by the health insurance commissioner.

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     (3) Health insurance contracts, plans, or policies to which this section applies, may

2-31

impose copayments and/or deductibles for the benefits mandated by this section consistent with

2-32

the contracts', plans' or policies' copayments and/or deductibles for physician services and

2-33

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

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or utilization review, managed care, or case management practices of these health insurance

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contracts, plans or policies.

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     (4) This section shall not apply to insurance coverage providing benefits for:

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     (a) hospital confinement indemnity;

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     (b) disability income;

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     (c) accident only;

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     (d) long-term care;

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     (e) Medicare supplement;

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     (f) limited benefit health;

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     (g) specified disease indemnity;

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     (h) sickness or bodily injury or death by accident or both; and

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     (i) other limited benefit policies.

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     SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

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Corporations" is hereby amended by adding thereto the following section:

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     27-20-51. Tobacco cessation programs. -- (1) Every individual or group health

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insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

3-16

January 1, 2007, which provides medical coverage that includes coverage for physician services

3-17

in a physician's office, and every policy which provides major medical or similar comprehensive-

3-18

type coverage, shall include coverage for smoking cessation treatment, provided that if such

3-19

medical coverage does not include prescription drug coverage, such contract, plan or policy shall

3-20

not be required to include coverage for prescription nicotine replacement therapy.

3-21

     (2) As used in this section, smoking cessation treatment includes the use of an over-the-

3-22

counter (OTC) or prescription US Food and Drug Administration (FDA) approved nicotine

3-23

replacement therapy, when recommended and prescribed by a prescriber who holds prescriptive

3-24

privileges in the state in which they are licensed, and used in combination with an annual

3-25

outpatient benefit of eight (8) one-half (1/2) hour smoking cessation counseling sessions provided

3-26

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

3-27

further defined through regulation promulgated by the health insurance commissioner.

3-28

     (3) Health insurance contracts, plans, or policies to which this section applies, may

3-29

impose copayments and/or deductibles for the benefits mandated by this section consistent with

3-30

the contracts', plans' or policies' copayments and/or deductibles for physician services and

3-31

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

3-32

or utilization review, managed care, or case management practices of these health insurance

3-33

contracts, plans or policies.

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     (4) This section shall not apply to insurance coverage providing benefits for:

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     (a) hospital confinement indemnity;

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     (b) disability income;

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     (c) accident only;

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     (d) long-term care;

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     (e) Medicare supplement;

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     (f) limited benefit health;

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     (g) specified disease indemnity;

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     (h) sickness or bodily injury or death by accident or both; and

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     (i) other limited benefit policies.

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     SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance

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Organizations" is hereby amended by adding thereto the following section:

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     27-41-69. Tobacco cessation programs. -- (1) Every individual or group health

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insurance contract, plan or policy delivered, issued for delivery or renewed in this state on or after

4-14

January 1, 2007, which provides medical coverage that includes coverage for physician services

4-15

in a physician's office, and every policy which provides major medical or similar comprehensive-

4-16

type coverage, shall include coverage for smoking cessation treatment, provided that if such

4-17

medical coverage does not include prescription drug coverage, such contract, plan or policy shall

4-18

not be required to include coverage for prescription nicotine replacement therapy.

4-19

     (2) As used in this section, smoking cessation treatment includes the use of an over-the-

4-20

counter (OTC) or prescription US Food and Drug Administration (FDA) approved nicotine

4-21

replacement therapy, when recommended and prescribed by a prescriber who holds prescriptive

4-22

privileges in the state in which they are licensed, and used in combination with an annual

4-23

outpatient benefit of eight (8) one-half (1/2) hour smoking cessation counseling sessions provided

4-24

by a qualified practitioner for each covered individual. Smoking cessation treatment may be

4-25

further defined through regulation promulgated by the health insurance commissioner.

4-26

     (3) Health insurance contracts, plans, or policies to which this section applies, may

4-27

impose copayments and/or deductibles for the benefits mandated by this section consistent with

4-28

the contracts', plans' or policies' copayments and/or deductibles for physician services and

4-29

medications. Nothing contained in this section shall impact the reimbursement, medical necessity

4-30

or utilization review, managed care, or case management practices of these health insurance

4-31

contracts, plans or policies.

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     (4) This section shall not apply to insurance coverage providing benefits for:

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     (a) hospital confinement indemnity;

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     (b) disability income;

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     (c) accident only;

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     (d) long-term care;

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     (e) Medicare supplement;

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     (f) limited benefit health;

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     (g) specified disease indemnity;

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     (h) sickness or bodily injury or death by accident or both; and

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     (i) other limited benefit policies.

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     SECTION 5. This act shall take effect upon passage.

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LC02402/SUB A/2

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY

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     This act would provide that every insurance policy which provides medical coverage for

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physician services in a physician's office, and every policy which provides major medical or

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similar comprehensive-type coverage, would include coverage for smoking cessation treatment.

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     This act would take effect upon passage.

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LC02402/SUB A/

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