Bill > SF65

Introduced Session

This bill requires the department of health and human services (HHS) to establish a health equity program (program) to improve menstrual and post-menstrual health by providing for reimbursement of the costs associated with the provision of covered services and treatments related to menstrual and post-menstrual health conditions not otherwise covered by a third-party payor. The department shall promote the program statewide and limit program administrative costs to no more than 4 percent of the funds appropriated for the program on an annual basis. The bill requires HHS to adopt administrative rules to administer the program and specify the types of services and treatments covered under the program, and requires that the covered services and treatments shall include health care services, treatments, supplies, and drugs needed to treat a menstrual or post-menstrual illness, injury, condition, disease, or its symptoms that comply with standard medical practice, or are approved by the United States food and drug administration or are recommended or preferred by the patient’s provider and supported by appropriate medical records. The department shall establish a process for the registration of participating providers eligible to receive reimbursement through the program. A participating provider shall be reimbursed for a covered service or treatment through the program fund within 10 days of submission of a billing statement, and if applicable, the billing statement shall confirm that the patient is uninsured or that the service or treatment is not covered by the patient’s insurer. The amount billed by the participating provider shall not exceed the actual cost incurred by the provider in delivering the covered service or treatment. Reimbursement shall be paid directly to the participating provider and such payment shall be considered payment in full. The program shall be the payor of last resort. If sufficient program funds are not available to cover all of the billings submitted, HHS shall place a participating provider on a reimbursement waiting list in the order the participating provider’s billing statement was received. The provisions of the bill are not to be construed as granting an entitlement to reimbursement for any covered service or treatment provided by a participating provider. The bill creates a health equity program fund under the control of HHS. The fund includes amounts appropriated by the general assembly and other moneys available from federal or private sources. Moneys in the fund at the end of each fiscal year shall not revert but remain in the fund. Moneys in the fund are appropriated to HHS for the purposes of the program. There is appropriated from the general fund of the state to the program fund a sum which reflects the total equivalent of all state revenue expended for genitourinary agents for state employees under the group insurance plan for public employees pursuant to Code chapter 509A, for the fiscal period between July 1, 2002, and June 30, 2022. The department shall submit an annual report to the governor and the general assembly regarding the status of the program and fund including the balance remaining in the fund, the number of participating providers, the total amount billed per participating provider, the covered services and treatments for which reimbursement was provided in the previous year, and any recommendations for changes to the program or fund. The bill defines “genitourinary agents” and “period products”.

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Janet Petersen (D)*, 

Subcommittee: Edler, Costello, and Petersen. S.J. 143. (on 01/17/2023)

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Official Document