,i #aai? ,,congress #a/ ,session ,h4 ,r4 #eabg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,septemb] #d1 #bjbe,ms4 ,wat]s 7= h]self1 ,mr4 ,g>cia ( ,cali=nia1 ,mr4 ,nadl]1 ,ms4 ,norton1 ,mr4 ,?ompson ( ,mississippi1 ,mr4 ,kri%namoor?i1 ,ms4 ,g>cia ( ,texas1 ,ms4 ,velzquez1 ,ms4 ,sewell1 ,mr4 ,c>son1 ,mr4 ,jackson ( ,ill9ois1 ,ms4 ,titus1 ,mr4 ,johnson ( ,georgia1 ,mrs4 ,mc,iver1 ,mrs4 ,beatty1 ,mr4 ,cleav]1 ,mr4 ,coh51 ,ms4 ,wilson ( ,florida1 ,ms4 ,simon1 ,mr4 ,?an$>1 ,mr4 ,mull91 ,mrs4 ,ramirez1 ,ms4 ,b>ragn1 ,mrs4 ,watson ,coleman1 ,ms4 ,tlaib1 ,ms4 ,cl>ke ( ,new ,york1 & ,ms4 ,williams ( ,georgia7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 & ,ov]sight & ,gov]nm5t ,re=m1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 titles ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act1 & title #e1 ,unit$ ,/ates ,code1 to require no-co/ cov]age ( c]ta9 ,,hiv prev5tion s]vices4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,pr,e,p & ,,pep are ,prev5tion ,act4 #b4 ,no-co/ cov]age ( ,,hiv prev5tion s]vices 7a7 ,private insurance 7#a7 ,9 g5]al ,section #bgac7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ac7;a77 is am5d$-- 7,a7 9 p>agraph 7#b71 by /rik+ 2 & & ins]t+ a semicolon2 7,b7 9 p>agraph 7#c71 by /rik+ ! p]iod & ins]t+ a semicolon2 7,c7 9 p>agraph 7#d71 by /rik+ ! p]iod & ins]t+ a semicolon2 7,d7 9 p>agraph 7#e71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,e7 by add+ at ! end ! foll[+3 7#f7 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv 7o!r ?an a drug subject to preau?orization requirem5ts consi/5t ) section #bgbi;,a71 includ+ any su* drug approv$ = use z pre-exposure prophylaxis 7commonly ref]r$ to z ,pr,e,p7 or z po/-exposure prophylaxis 7commonly ref]r$ to z ,,pep71 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 c\nsel+ ) respect to ,,hiv prev5tion 7includ+ ,,hiv risk assessm5t1 ,,hiv risk r$uction1 & m$ication adh]5ce71 & cl9ical foll[ up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7#b7 ,prohibition on preau?orization requirem5ts ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgbi;,a4 ,prohibition on preau?orization requirem5ts ) respect to c]ta9 s]vices ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age %all n impose any preau?orization requirem5ts ) respect to cov]age ( ! s]vices describ$ 9 section #bgac7;a77#f71 except t a plan or issu] may impose preau?orization requirem5ts ) respect to cov]age ( a p>ticul> drug approv$ "u section #eje7;c7 ( ! ,f$]al ,food1 ,drug1 & ,cosmetic ,act or section #cea7;a7 ( ?is ,act if su* plan or issu] provides cov]age )\t any preau?orization requirem5ts = a drug t is !rapeutically equival5t4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply beg9n+ ) respect to ! fir/ plan ye> beg9n+ aft] ! date ( enactm5t ( ?is section4 7b7 ,m$ic>e 7#a7 ,cov]age ( ,,hiv prev5tion s]vices "u ,"p ,b 7,a7 ,cov]age 7i7 ,9 g5]al ,section #ahfa7s77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7s77#b77 is am5d$-- 7,i7 9 subp>agraph 7,,jj71 by ins]t+ & at ! end2 & 7,,ii7 by add+ at ! end ! foll[+ new subp>agraph3 7,,kk7 ,,hiv prev5tion s]vices 7z def9$ 9 subsection 7nnn772 4 7ii7 ,def9ition ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7nnn7 ,,hiv prev5tion s]vices ,! t]m ,,hiv prev5tion s]vices means-- 7#a7 drugs or biologicals approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 includ+ any su* drug or biological approv$ = use z pre-exposure prophylaxis 7commonly ref]r$ to z ,pr,e,p7 or z po/-exposure prophylaxis 7commonly ref]r$ to z ,,pep72 7#b7 adm9i/rative fees = su* drugs & biologicals2 7#c7 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs & biologicals2 7#d7 c\nsel+ ) respect to ,,hiv prev5tion1 includ+ ,,hiv risk assessm5t1 ,,hiv risk r$uction1 & m$ication adh]5ce2 & 7#e7 cl9ical foll[ up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7,b7 ,elim9ation ( co9surance ,section #ahcc7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77#a77 is am5d$-- 7i7 by /rik+ & 7,,hh7 & ins]t+ 7,,hh72 & 7ii7 by ins]t+ be=e ! semicolon at ! end ! foll[+3 1 & 7,,ii7 ) respect to ,,hiv prev5tion s]vices 7z def9$ 9 section #ahfa7nnn771 ! am\nt paid %all be #ajj p]c5t ( 7i7 except z provid$ 9 clause 7ii71 ! less] ( ! actual *>ge = ! s]vice or ! am\nt det]m9$ "u ! fee s*$ule t applies to su* s]vices "u ?is "p1 & 7ii7 9 ! case ( su* s]vices t are cov]$ ,,opd s]vices 7z def9$ 9 subsection 7t77#a77;,b771 ! am\nt det]m9$ "u subsection 7t74 7,c7 ,exemption f ,"p ,b d$uctible ,! fir/ s5t5ce ( section #ahcc7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7b77 is am5d$-- 7i7 by /rik+ 1 & 7#ac7 & ins]t+ 7#ac72 & 7ii7 by /rik+ #ahfa7n744 & ins]t+ #ahfa7n71 & 7#ad7 su* d$uctible %all n apply ) respect to ,,hiv prev5tion s]vices 7z def9$ 9 section #ahfa7nnn77#a7744 7,d7 ,effective date ,! am5dm5ts made by ?is p>agraph %all apply to items & s]vices furni%$ on or aft] ,janu>y #a ( ! fir/ cal5d> ye> beg9n+ aft] ! date ( enactm5t ( ?is section4 7#b7 ,elim9ation ( co/-%>+ = drugs = ! prev5tion ( ,,hiv "u "p ,d 7,a7 ,9 g5]al ,section #ahfj;,d-#b ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7;b77 is am5d$-- 7i7 9 subsection 7b7-- 7,i7 9 p>agraph 7#a77;,a71 by /rik+ & 7#i7 & ins]t+ 1 7#i71 & 7#aj72 7,,ii7 9 p>agraph 7#b7-- 7aa7 9 subp>agraph 7,a71 by /rik+ & 7#i7 & ins]t+ 1 7#i71 & 7#aj72 7bb7 9 subp>agraph 7,c77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ & 7#i7 & ins]t+ 7#i71 & 7#aj72 & 7cc7 9 subp>agraph 7,d77i71 9 ! matt] prec$+ subclause 7,i71 by /rik+ & 7#i7 & ins]t+ 7#i71 & 7#aj72 7,,iii7 9 p>agraph 7#c77;,a71 9 ! matt] prec$+ clause 7i71 by /rik+ & 7#i7 & ins]t+ 7#i71 & 7#aj72 7,,iv7 9 p>agraph 7#d77;,a77i71 by /rik+ & 7#i7 & ins]t+ 1 7#i71 & 7#aj72 & 7,v7 by add+ at ! end ! foll[+ new p>agraph3 7#aj7 ,elim9ation ( co/-%>+ = drugs = ! prev5tion ( ,,hiv ,) respect to a cov]$ "p ,d drug t is = ! prev5tion ( ,,hiv-- 7,a7 ! d$uctible "u p>agraph 7#a7 %all n apply2 & 7,b7 !re %all be no co9surance or o!r co/-%>+ "u ?is "p ) respect to su* drug4 2 & 7ii7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,treatm5t ( co/-%>+ = drugs = ! prev5tion ( ,,hiv ,! cov]age is provid$ 9 accordance ) subsection 7b77#aj74 4 7,b7 ,con=m+ am5dm5ts to co/-%>+ = l[-income individuals ,section #ahfj;,d-#ad7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is am5d$-- 7i7 9 p>agraph 7#a77;,d71 9 ea* ( clauses 7ii7 & 7iii71 by /rik+ p>agraph 7#f7 & ins]t+ p>agraphs 7#f7 & 7#g72 7ii7 9 p>agraph 7#b7-- 7,i7 9 subp>agraph 7,b71 by /rik+ & 7#i7 & ins]t+ 1 7#i71 & 7#aj72 7,,ii7 9 subp>agraph 7,d71 by /rik+ p>agraph 7#f7 & ins]t+ p>agraphs 7#f7 & 7#g72 & 7,,iii7 9 subp>agraph 7,e71 by /rik+ p>agraph 7#f7 & ins]t+ p>agraphs 7#f7 & 7#g72 & 7iii7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,no application ( co/-%>+ or d$uctible = drugs = ! prev5tion ( ,,hiv ,) respect to a cov]$ "p ,d drug t is = ! prev5tion ( ,,hiv-- 7,a7 ! d$uctible "u section #ahfj;,d-#b7;b77#a7 %all n apply2 & 7,b7 !re %all be no co/-%>+ "u ?is section ) respect to su* drug4 4 7,c7 ,effective date ,! am5dm5ts made by ?is p>agraph %all apply beg9n+ ) respect to ! fir/ plan ye> beg9n+ aft] ! date ( enactm5t ( ?is section4 7c7 ,m$icaid & ,,*ip 7#a7 ,m$icaid 7,a7 ,9 g5]al ,section #aije ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is am5d$-- 7i7 9 subsection 7a77#d7-- 7,i7 by /rik+ 2 & 7,d7 & ins]t+ 2 7,d72 7,,ii7 by /rik+ 2 & 7,e7 & ins]t+ 2 7,e72 7,,iii7 by /rik+ 2 & 7,f7 & ins]t+ 2 7,f72 & 7,,iv7 by /rik+ ! semicolon at ! end & ins]t+ 2 & 7,g7 ,,hiv prev5tion s]vices22 & 7ii7 by add+ at ! end ! foll[+ new subsection3 7ll7 ,,hiv prev5tion s]vices ,= purposes ( subsection 7a77#d77;,g71 ! t]m ,,hiv prev5tion s]vices means prescription drugs approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 includ+ any su* drug approv$ = use z pre-exposure prophylaxis 7commonly ref]r$ to z ,pr,e,p7 or z po/-exposure prophylaxis 7commonly ref]r$ to z ,,pep71 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 c\nsel+ ) respect to ,,hiv prev5tion 7includ+ ,,hiv risk assessm5t1 ,,hiv risk r$uction1 & m$ication adh]5ce71 & cl9ical foll[ up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7,b7 ,no co/-%>+ ,title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 is am5d$-- 7i7 9 section #aiaf1 by ins]t+ ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g71 aft] section #aije7;a77#d77;,c71 ea* place x appe>s2 & 7ii7 9 section #aiaf;,a7b77#c77;,b71 by add+ at ! end ! foll[+ new clause3 7xv7 ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g74 4 7,c7 ,inclusion 9 b5*m>k cov]age ,section #aicg7;b77#g7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;b77#g77 is am5d$-- 7i7 9 ! p>agraph head]1 by ins]t+ & ,,hiv prev5tion s]vices aft] supplies2 & 7ii7 by /rik+ includes = any individual describ$ 9 section #aije7;a77#d77;,c71 m$ical assi/ance = family plann+ s]vices & supplies 9 accordance ) su* section & ins]t+ includes m$ical assi/ance = ,,hiv prev5tion s]vices describ$ 9 section #aije7;a77#d77;,g71 & includes1 = any individual describ$ 9 section #aije7;a77#d77;,c71 m$ical assi/ance = family plann+ s]vices & supplies 9 accordance ) su* section4 7#b7 ,,*ip 7,a7 ,9 g5]al ,section #bajc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc71 z am5d$ by section #aadje7;b77#a7 ( ,public ,law #aag-afi1 is am5d$-- 7i7 9 subsection 7a71 by /rik+ & 7#h7 & ins]t+ 7#h71 & 7#ac72 & 7ii7 9 subsection 7c71 by add+ at ! end ! foll[+ new p>agraph3 7#ac7 ,,hiv prev5tion s]vices ,reg>dless ( ! type ( cov]age elect$ by a ,/ate "u subsection 7a71 ! *ild heal? assi/ance provid$ = a t>get$ l[-income *ild1 &1 9 ! case ( a ,/ate t elects to provide pregnancy-relat$ assi/ance pursuant to section #baab1 ! pregnancy-relat$ assi/ance provid$ = a t>get$ l[-income pregnant woman 7z su* t]ms are def9$ = purposes ( su* section71 %all include cov]age ( ,,hiv prev5tion s]vices 7z def9$ 9 section #aije7ll774 4 7,b7 ,no co/-%>+ ,section #bajc7;e77#b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b77 is am5d$ by ins]t+ ,,hiv prev5tion s]vices describ$ 9 subsection 7c77#ac71 be=e or = pregnancy-relat$ assi/ance4 7#c7 ,effective date 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 ! am5dm5ts made by ?is subsection %all take effect on ,janu>y #a ( ! fir/ cal5d> ye> beg9n+ aft] ! date ( enactm5t ( ?is section4 7,b7 ,delay p]mitt$ if ,/ate legislation requir$ ,9 ! case ( a ,/ate plan approv$ "u title ,,xix or ,,xxi ( ! ,social ,security ,act :i* ! ,secret>y ( ,heal? & ,human ,s]vices det]m9es requires ,/ate legislation 7o!r ?an legislation appropriat+ funds7 9 ord] = ! plan to meet ! additional requirem5ts impos$ by ?is section1 ! ,/ate plan %all n be reg>d$ z fail+ to comply ) ! requirem5ts ( su* title solely on ! basis ( ! failure ( ! plan to meet su* additional requirem5ts be=e ! #a/ day ( ! #a/ cal5d> qu>t] beg9n+ aft] ! close ( ! #a/ regul> session ( ! ,/ate legislature t ends aft] ! #a-ye> p]iod beg9n+ ) ! date ( ! enactm5t ( ?is section4 ,= purposes ( ! prec$+ s5t5ce1 9 ! case ( a ,/ate t has a #b-ye> legislative session1 ea* ye> ( ! session is deem$ to be a sep>ate regul> session ( ! ,/ate legislature4 7d7 ,f$]al ,employees ,heal? ,b5efits program 7#a7 ,9 g5]al ,section #hijd ( title #e1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+3 7c7 ,any heal? b5efits plan (f]$ "u ?is *apt] %all include b5efits =1 & may n impose any co/-%>+ requirem5ts =1 any prescription drug approv$ by ! ,food & ,drug ,adm9i/ration = ! prev5tion ( ,,hiv1 includ+ any su* drug approv$ = use z pre-exposure prophylaxis 7commonly ref]r$ to z ,pr,e,p7 or z po/-exposure prophylaxis 7commonly ref]r$ to z ,,pep71 adm9i/rative fees = su* drugs1 laboratory & o!r diagno/ic proc$ures associat$ ) ! use ( su* drugs1 c\nsel+ ) respect to ,,hiv prev5tion 7includ+ ,,hiv risk assessm5t1 ,,hiv risk r$uction1 & m$ication adh]5ce71 & cl9ical foll[ up & monitor+1 includ+ any relat$ s]vices recomm5d$ 9 curr5t ,unit$ ,/ates ,public ,heal? ,s]vice cl9ical practice guidel9es1 )\t limitation4 4 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply beg9n+ ) respect to ! fir/ plan ye> beg9n+ aft] ! date ( enactm5t ( ?is section4