STATE OF NEW YORK ________________________________________________________________________ S. 659 A. 585 2019-2020 Regular Sessions SENATE - ASSEMBLY (Prefiled) January 9, 2019 ___________ IN SENATE -- Introduced by Sens. SALAZAR, METZGER, ADDABBO, BAILEY, BENJAMIN, BIAGGI, BRESLIN, BROOKS, CARLUCCI, COMRIE, GAUGHRAN, GIANAR- IS, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAMINSKY, KAPLAN, KAVANAGH, KENNEDY, KRUEGER, LIU, MARTINEZ, MAY, MAYER, MONTGOMERY, MYRIE, PARK- ER, PERSAUD, RAMOS, RIVERA, SANDERS, SAVINO, SEPULVEDA, SERRANO, SKOUFIS, STAVISKY, STEWART-COUSINS, THOMAS -- read twice and ordered printed, and when printed to be committed to the Committee on Insur- ance IN ASSEMBLY -- Introduced by M. of A. CAHILL, SEAWRIGHT, HEASTIE, L. ROSENTHAL, GLICK, JAFFEE, SIMOTAS, GOTTFRIED, BARRON, BLAKE, BARRETT, MAGNARELLI, BRONSON, LAVINE, CARROLL, GALEF, OTIS, SIMON, HYNDMAN, RAMOS, D'URSO, PEOPLES-STOKES, PICHARDO, ORTIZ, WOERNER, BURKE, CRUZ, FALL, FRONTUS, GRIFFIN, JACOBSON, McMAHON, RAYNOR, ROMEO, REYES, SAYEGH -- Multi-Sponsored by -- M. of A. BRAUNSTEIN, BUCHWALD, COOK, EPSTEIN, LIFTON, LUPARDO, MOSLEY, ROZIC, THIELE, TITUS -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, the social services law, the educa- tion law and the public health law, in relation to requiring health insurance policies to include coverage of all FDA-approved contracep- tive drugs, devices, and products, as well as voluntary sterilization procedures, contraceptive education and counseling, and related follow up services and prohibiting a health insurance policy from imposing any cost-sharing requirements or other restrictions or delays with respect to this coverage The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. This act shall be known and may be cited as the "comprehen- 2 sive contraception coverage act". EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD06618-01-9

S. 659 2 A. 585 1 § 2. Paragraph 16 of subsection (l) of section 3221 of the insurance 2 law, as added by chapter 554 of the laws of 2002, is amended to read as 3 follows: 4 (16) (A) Every group or blanket policy [which provides coverage for 5 prescription drugs shall include coverage for the cost of contraceptive 6 drugs or devices approved by the federal food and drug administration or 7 generic equivalents approved as substitutes by such food and drug admin- 8 istration under the prescription of a health care provider legally 9 authorized to prescribe under title eight of the education law. The 10 coverage required by this section shall be included in policies and 11 certificates only through the addition of a rider. 12 (A)] that is issued, amended, renewed, effective or delivered on or 13 after January first, two thousand twenty, shall provide coverage for all 14 of the following services and contraceptive methods: 15 (1) All FDA-approved contraceptive drugs, devices, and other products. 16 This includes all FDA-approved over-the-counter contraceptive drugs, 17 devices, and products as prescribed or as otherwise authorized under 18 state or federal law. The following applies to this coverage: 19 (a) where the FDA has approved one or more therapeutic and pharmaceu- 20 tical equivalent, as defined by the FDA, versions of a contraceptive 21 drug, device, or product, a group or blanket policy is not required to 22 include all such therapeutic and pharmaceutical equivalent versions in 23 its formulary, so long as at least one is included and covered without 24 cost-sharing and in accordance with this paragraph; 25 (b) if the covered therapeutic and pharmaceutical equivalent versions 26 of a drug, device, or product are not available or are deemed medically 27 inadvisable a group or blanket policy shall provide coverage for an 28 alternate therapeutic and pharmaceutical equivalent version of the 29 contraceptive drug, device, or product without cost-sharing; 30 (c) this coverage shall include emergency contraception without cost- 31 sharing when provided pursuant to an ordinary prescription, non-patient 32 specific regimen order, or order under section sixty-eight hundred thir- 33 ty-one of the education law and when lawfully provided other than 34 through a prescription or order; and 35 (d) this coverage must allow for the dispensing of twelve months worth 36 of a contraceptive at one time; 37 (2) Voluntary sterilization procedures; 38 (3) Patient education and counseling on contraception; and 39 (4) Follow-up services related to the drugs, devices, products, and 40 procedures covered under this paragraph, including, but not limited to, 41 management of side effects, counseling for continued adherence, and 42 device insertion and removal. 43 (B) A group or blanket policy subject to this paragraph shall not 44 impose a deductible, coinsurance, copayment, or any other cost-sharing 45 requirement on the coverage provided pursuant to this paragraph. 46 (C) Except as otherwise authorized under this paragraph, a group or 47 blanket policy shall not impose any restrictions or delays on the cover- 48 age required under this paragraph. 49 (D) Benefits for an enrollee under this paragraph shall be the same 50 for an enrollee's covered spouse or domestic partner and covered 51 nonspouse dependents. 52 (E) Notwithstanding any other provision of this subsection, a reli- 53 gious employer may request a contract without coverage for federal food 54 and drug administration approved contraceptive methods that are contrary 55 to the religious employer's religious tenets. If so requested, such 56 contract shall be provided without coverage for contraceptive methods.

S. 659 3 A. 585 1 This paragraph shall not be construed to deny an enrollee coverage of, 2 and timely access to, contraceptive methods. 3 (1) For purposes of this subsection, a "religious employer" is an 4 entity for which each of the following is true: 5 (a) The inculcation of religious values is the purpose of the entity. 6 (b) The entity primarily employs persons who share the religious 7 tenets of the entity. 8 (c) The entity serves primarily persons who share the religious tenets 9 of the entity. 10 (d) The entity is a nonprofit organization as described in Section 11 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 12 (2) Every religious employer that invokes the exemption provided under 13 this paragraph shall provide written notice to prospective enrollees 14 prior to enrollment with the plan, listing the contraceptive health care 15 services the employer refuses to cover for religious reasons. 16 [(B) (i)] (F) (1) Where a group policyholder makes an election not to 17 purchase coverage for contraceptive drugs or devices in accordance with 18 subparagraph [(A)] (E) of this paragraph each certificateholder covered 19 under the policy issued to that group policyholder shall have the right 20 to directly purchase the rider required by this paragraph from the 21 insurer which issued the group policy at the prevailing small group 22 community rate for such rider whether or not the employee is part of a 23 small group. 24 [(ii)] (2) Where a group policyholder makes an election not to 25 purchase coverage for contraceptive drugs or devices in accordance with 26 subparagraph [(A)] (E) of this paragraph, the insurer that provides such 27 coverage shall provide written notice to certificateholders upon enroll- 28 ment with the insurer of their right to directly purchase a rider for 29 coverage for the cost of contraceptive drugs or devices. The notice 30 shall also advise the certificateholders of the additional premium for 31 such coverage. 32 [(C)] (G) Nothing in this paragraph shall be construed as authorizing 33 a group or blanket policy which provides coverage for prescription drugs 34 to exclude coverage for prescription drugs prescribed for reasons other 35 than contraceptive purposes. 36 [(D) Such coverage may be subject to reasonable annual deductibles and 37 coinsurance as may be deemed appropriate by the superintendent and as 38 are consistent with those established for other drugs or devices covered 39 under the policy.] 40 § 3. Subsection (cc) of section 4303 of the insurance law, as added by 41 chapter 554 of the laws of 2002, is amended to read as follows: 42 (cc) (1) Every contract [which provides coverage for prescription 43 drugs shall include coverage for the cost of contraceptive drugs or 44 devices approved by the federal food and drug administration or generic 45 equivalents approved as substitutes by such food and drug administration 46 under the prescription of a health care provider legally authorized to 47 prescribe under title eight of the education law. The coverage required 48 by this section shall be included in contracts and certificates only 49 through the addition of a rider. 50 (1)] that is issued, amended, renewed, effective or delivered on or 51 after January first, two thousand twenty, shall provide coverage for all 52 of the following services and contraceptive methods: 53 (A) All FDA-approved contraceptive drugs, devices, and other products. 54 This includes all FDA-approved over-the-counter contraceptive drugs, 55 devices, and products as prescribed or as otherwise authorized under 56 state or federal law. The following applies to this coverage:

S. 659 4 A. 585 1 (i) where the FDA has approved one or more therapeutic and pharmaceu- 2 tical equivalent, as defined by the FDA, versions of a contraceptive 3 drug, device, or product, a contract is not required to include all such 4 therapeutic and pharmaceutical equivalent versions in its formulary, so 5 long as at least one is included and covered without cost-sharing and in 6 accordance with this subsection; 7 (ii) if the covered therapeutic and pharmaceutical equivalent versions 8 of a drug, device, or product are not available or are deemed medically 9 inadvisable a contract shall provide coverage for an alternate therapeu- 10 tic and pharmaceutical equivalent version of the contraceptive drug, 11 device, or product without cost-sharing; 12 (iii) this coverage shall include emergency contraception without 13 cost-sharing when provided pursuant to an ordinary prescription, non-pa- 14 tient specific regimen order, or order under section sixty-eight hundred 15 thirty-one of the education law and when lawfully provided other than 16 through a prescription or order; and 17 (iv) this coverage must allow for the dispensing of twelve months 18 worth of a contraceptive at one time; 19 (B) Voluntary sterilization procedures; 20 (C) Patient education and counseling on contraception; and 21 (D) Follow-up services related to the drugs, devices, products, and 22 procedures covered under this subsection, including, but not limited to, 23 management of side effects, counseling for continued adherence, and 24 device insertion and removal. 25 (2) A contract subject to this subsection shall not impose a deduct- 26 ible, coinsurance, copayment, or any other cost-sharing requirement on 27 the coverage provided pursuant to this subsection. 28 (3) Except as otherwise authorized under this subsection, a contract 29 shall not impose any restrictions or delays on the coverage required 30 under this subsection. 31 (4) Benefits for an enrollee under this subsection shall be the same 32 for an enrollee's covered spouse or domestic partner and covered 33 nonspouse dependents. 34 (5) Notwithstanding any other provision of this subsection, a reli- 35 gious employer may request a contract without coverage for federal food 36 and drug administration approved contraceptive methods that are contrary 37 to the religious employer's religious tenets. If so requested, such 38 contract shall be provided without coverage for contraceptive methods. 39 This paragraph shall not be construed to deny an enrollee coverage of, 40 and timely access to, contraceptive methods. 41 (A) For purposes of this subsection, a "religious employer" is an 42 entity for which each of the following is true: 43 (i) The inculcation of religious values is the purpose of the entity. 44 (ii) The entity primarily employs persons who share the religious 45 tenets of the entity. 46 (iii) The entity serves primarily persons who share the religious 47 tenets of the entity. 48 (iv) The entity is a nonprofit organization as described in Section 49 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986, as amended. 50 (B) Every religious employer that invokes the exemption provided under 51 this paragraph shall provide written notice to prospective enrollees 52 prior to enrollment with the plan, listing the contraceptive health care 53 services the employer refuses to cover for religious reasons. 54 [(2)](6) (A) Where a group contractholder makes an election not to 55 purchase coverage for contraceptive drugs or devices in accordance with 56 paragraph [one] five of this subsection, each enrollee covered under the

S. 659 5 A. 585 1 contract issued to that group contractholder shall have the right to 2 directly purchase the rider required by this subsection from the insurer 3 or health maintenance organization which issued the group contract at 4 the prevailing small group community rate for such rider whether or not 5 the employee is part of a small group. 6 (B) Where a group contractholder makes an election not to purchase 7 coverage for contraceptive drugs or devices in accordance with paragraph 8 [one] five of this subsection, the insurer or health maintenance organ- 9 ization that provides such coverage shall provide written notice to 10 enrollees upon enrollment with the insurer or health maintenance organ- 11 ization of their right to directly purchase a rider for coverage for the 12 cost of contraceptive drugs or devices. The notice shall also advise the 13 enrollees of the additional premium for such coverage. 14 [(3)](7) Nothing in this subsection shall be construed as authorizing 15 a contract which provides coverage for prescription drugs to exclude 16 coverage for prescription drugs prescribed for reasons other than 17 contraceptive purposes. 18 [(4) Such coverage may be subject to reasonable annual deductibles and 19 coinsurance as may be deemed appropriate by the superintendent and as 20 are consistent with those established for other drugs or devices covered 21 under the policy.] 22 § 4. Subparagraph (E) of paragraph 17 of subsection (i) of section 23 3216 of the insurance law is amended by adding a new clause (v) to read 24 as follows: 25 (v) all FDA-approved contraceptive drugs, devices, and other products, 26 including all over-the-counter contraceptive drugs, devices, and 27 products as prescribed or as otherwise authorized under state or federal 28 law; voluntary sterilization procedures; patient education and coun- 29 seling on contraception; and follow-up services related to the drugs, 30 devices, products, and procedures covered under this clause, including, 31 but not limited to, management of side effects, counseling for continued 32 adherence, and device insertion and removal. Except as otherwise author- 33 ized under this clause, a contract shall not impose any restrictions or 34 delays on the coverage required under this clause. However, where the 35 FDA has approved one or more therapeutic and pharmaceutical equivalent, 36 as defined by the FDA, versions of a contraceptive drug, device, or 37 product, a contract is not required to include all such therapeutic and 38 pharmaceutical equivalent versions in its formulary, so long as at least 39 one is included and covered without cost-sharing and in accordance with 40 this clause. If the covered therapeutic and pharmaceutical equivalent 41 versions of a drug, device, or product are not available or are deemed 42 medically inadvisable a contract shall provide coverage for an alternate 43 therapeutic and pharmaceutical equivalent version of the contraceptive 44 drug, device, or product without cost-sharing. This coverage shall 45 include emergency contraception without cost-sharing when provided 46 pursuant to an ordinary prescription, non-patient specific regimen 47 order, or order under section sixty-eight hundred thirty-one of the 48 education law and when lawfully provided other than through a 49 prescription or order; and this coverage must allow for the dispensing 50 of twelve months worth of a contraceptive at one time. 51 § 5. Paragraph (d) of subdivision 3 of section 365-a of the social 52 services law, as amended by chapter 909 of the laws of 1974 and as 53 relettered by chapter 82 of the laws of 1995, is amended to read as 54 follows: 55 (d) family planning services and twelve months of supplies for eligi- 56 ble persons of childbearing age, including children under twenty-one

S. 659 6 A. 585 1 years of age who can be considered sexually active, who desire such 2 services and supplies, in accordance with the requirements of federal 3 law and regulations and the regulations of the department. No person 4 shall be compelled or coerced to accept such services or supplies. 5 § 6. Subdivision 6 of section 6527 of the education law, as added by 6 chapter 573 of the laws of 1999, paragraph (c) as amended by chapter 464 7 of the laws of 2015, paragraph (d) as added by chapter 429 of the laws 8 of 2005, paragraph (e) as added by chapter 352 of the laws of 2014, 9 paragraph (f) as added by section 6 of part V of chapter 57 of the laws 10 of 2015 and paragraph (g) as added by chapter 502 of the laws of 2016, 11 is amended to read as follows: 12 6. A licensed physician may prescribe and order a non-patient specific 13 regimen [to a registered professional nurse], pursuant to regulations 14 promulgated by the commissioner, and consistent with the public health 15 law, [for] to: 16 (a) a registered professional nurse for: 17 (i) administering immunizations[.]; 18 [(b)] (ii) the emergency treatment of anaphylaxis[.]; 19 [(c)] (iii) administering purified protein derivative (PPD) tests or 20 other tests to detect or screen for tuberculosis infections[.]; 21 [(d)] (iv) administering tests to determine the presence of the human 22 immunodeficiency virus[.]; 23 [(e)] (v) administering tests to determine the presence of the hepati- 24 tis C virus[.]; 25 [(f)] (vi) emergency contraception, to be administered to or dispensed 26 to be self-administered by the patient, under section sixty-eight 27 hundred thirty-two of this title; 28 (vii) the urgent or emergency treatment of opioid related overdose or 29 suspected opioid related overdose[.]; or 30 [(g)] (viii) screening of persons at increased risk of syphilis, 31 gonorrhea and chlamydia. 32 (b) a licensed pharmacist, for dispensing emergency contraception, to 33 be self-administered by the patient, under section sixty-eight hundred 34 thirty-two of this title. 35 § 7. Subdivision 3 of section 6807 of the education law, as added by 36 chapter 573 of the laws of 1999, is amended and a new subdivision 4 is 37 added to read as follows: 38 3. A pharmacist may dispense drugs and devices to a registered profes- 39 sional nurse, and a registered professional nurse may possess and admin- 40 ister, drugs and devices, pursuant to a non-patient specific regimen 41 prescribed or ordered by a licensed physician, licensed midwife or 42 certified nurse practitioner, pursuant to regulations promulgated by the 43 commissioner and the public health law. 44 4. A pharmacist may dispense a non-patient specific regimen of emer- 45 gency contraception, to be self-administered by the patient, prescribed 46 or ordered by a licensed physician, certified nurse practitioner, or 47 licensed midwife, under section sixty-eight hundred thirty-two of this 48 article. 49 § 8. The education law is amended by adding a new section 6832 to read 50 as follows: 51 § 6832. Emergency contraception; non-patient specific prescription or 52 order. 1. As used in this section, the following terms shall have the 53 following meanings, unless the context requires otherwise: 54 (a) "Emergency contraception" means one or more prescription or 55 nonprescription drugs, used separately or in combination, in a dosage 56 and manner for preventing pregnancy when used after intercourse, found

S. 659 7 A. 585 1 safe and effective for that use by the United States food and drug 2 administration, and dispensed or administered for that purpose. 3 (b) "Prescriber" means a licensed physician, certified nurse practi- 4 tioner or licensed midwife. 5 2. This section applies to the administering or dispensing of emergen- 6 cy contraception by a registered professional nurse or the dispensing of 7 emergency contraception by a licensed pharmacist pursuant to a 8 prescription or order for a non-patient specific regimen made by a pres- 9 criber under section sixty-five hundred twenty-seven, sixty-nine hundred 10 nine or sixty-nine hundred fifty-one of this title. This section does 11 not apply to administering or dispensing emergency contraception when 12 lawfully done without such a prescription or order. 13 3. The administering or dispensing of emergency contraception by a 14 registered professional nurse or the dispensing of emergency contracep- 15 tion by a licensed pharmacist shall be done in accordance with profes- 16 sional standards of practice and in accordance with written procedures 17 and protocols agreed to by the registered professional nurse or licensed 18 pharmacist and the prescriber or a hospital (licensed under article 19 twenty-eight of the public health law) that provides gynecological or 20 family planning services. 21 4. When emergency contraception is administered or dispensed, the 22 registered professional nurse or licensed pharmacist shall provide to 23 the patient written material that includes: (i) the clinical consider- 24 ations and recommendations for use of the drug; (ii) the appropriate 25 method for using the drug; (iii) information on the importance of 26 follow-up health care; (iv) information on the health risks and other 27 dangers of unprotected intercourse; and (v) referral information relat- 28 ing to health care and services relating to sexual abuse and domestic 29 violence. Such written material shall be developed or approved by the 30 commissioner in consultation with the department of health and the Amer- 31 ican college of obstetricians and gynecologists. 32 § 9. Subdivision 4 of section 6909 of the education law, as added by 33 chapter 573 of the laws of 1999, paragraph (a) as amended by chapter 221 34 of the laws of 2002, paragraph (c) as amended by chapter 464 of the laws 35 of 2015, paragraph (d) as added by chapter 429 of the laws of 2005, 36 paragraph (e) as added by chapter 352 of the laws of 2014, paragraph (f) 37 as added by section 5 of part V of chapter 57 of the laws of 2015 and 38 paragraph (g) as added by chapter 502 of the laws of 2016, is amended to 39 read as follows: 40 4. A certified nurse practitioner may prescribe and order a non-pa- 41 tient specific regimen [to a registered professional nurse], pursuant to 42 regulations promulgated by the commissioner, consistent with subdivision 43 three of section [six thousand nine] sixty-nine hundred two of this 44 article, and consistent with the public health law, for: 45 (a) a registered professional nurse for: 46 (i) administering immunizations[.]; 47 [(b)] (ii) the emergency treatment of anaphylaxis[.]; 48 [(c)] (iii) administering purified protein derivative (PPD) tests or 49 other tests to detect or screen for tuberculosis infections[.]; 50 [(d)] (iv) administering tests to determine the presence of the human 51 immunodeficiency virus[.]; 52 [(e)] (v) administering tests to determine the presence of the hepati- 53 tis C virus[.]; 54 [(f)] (vi) emergency contraception, to be administered to or dispensed 55 to be self-administered by the patient, under section sixty-eight 56 hundred thirty-two of this title;

S. 659 8 A. 585 1 (vii) the urgent or emergency treatment of opioid related overdose or 2 suspected opioid related overdose[.]; or 3 [(g)] (viii) screening of persons at increased risk for syphilis, 4 gonorrhea and chlamydia. 5 (b) a licensed pharmacist, for dispensing emergency contraception, to 6 be self-administered by the patient, under section sixty-eight hundred 7 thirty-two of this title. 8 § 10. Subdivision 5 of section 6909 of the education law, as added by 9 chapter 573 of the laws of 1999, is amended to read as follows: 10 5. A registered professional nurse may execute a non-patient specific 11 regimen prescribed or ordered by a licensed physician, licensed midwife 12 or certified nurse practitioner, pursuant to regulations promulgated by 13 the commissioner. 14 § 11. Section 6951 of the education law is amended by adding a new 15 subdivision 4 to read as follows: 16 4. A licensed midwife may prescribe and order a non-patient specific 17 regimen pursuant to regulations promulgated by the commissioner, 18 consistent with this section and the public health law, to: 19 (a) a registered professional nurse for emergency contraception, to be 20 administered to or dispensed to be self-administered by the patient, 21 under section sixty-eight hundred thirty-two of this title; or 22 (b) a licensed pharmacist, for dispensing emergency contraception, to 23 be self-administered by the patient, under section sixty-eight hundred 24 thirty-two of this title. 25 § 12. Subdivision 1 of section 207 of the public health law is amended 26 by adding a new paragraph (p) to read as follows: 27 (p) Emergency contraception, including information about its safety, 28 efficacy, appropriate use and availability. 29 § 13. Severability clause. If any provision of this act or the appli- 30 cation thereof is held invalid, such invalidity shall not affect other 31 provisions or applications of this act which can be given effect without 32 the invalid provision or application, and to this end the provisions of 33 this act are declared to be severable. 34 § 14. This act shall take effect January 1, 2020; provided that 35 section six of this act shall take effect January 1, 2021; provided, 36 however, that effective immediately, the addition, amendment and/or 37 repeal of any rule or regulation necessary for the implementation of 38 this act on its effective date are authorized and directed to be made 39 and completed by the commissioner of education and the board of regents 40 on or before such effective date.