May 2017 Update
Health Benefit Mandates—Effective Oct. 1, 2017, certain insured group health benefit plans must provide specific coverage for diagnosis, screening, and treatment of autism spectrum disorders. This requirement applies to plans delivered, executed, issued, amended, adjusted, or renewed in Alabama on or after Oct. 1, 2017, for employers that have at least 51 employees on at least half of working days during the preceding calendar year.
Effective for health benefit plans delivered, executed, issued, amended, adjusted, or renewed in Alabama on or after Oct. 1, 2017, plans that provide coverage for employers that have at least 51 employees on at least 50 percent of working days during the preceding calendar year must provide coverage for diagnosis, screening, and treatment of autism spectrum disorders for plan participants who are age 18 or younger (doesn't apply to nongrandfathered plans in the individual or small group markets that are required to include essential health benefits under the ACA as of Jan. 1, 2017).
Autism spectrum disorders means any of the pervasive developmental or autism spectrum disorders defined by the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders or the edition in effect at the time of diagnosis.
Treatment for autism spectrum disorders includes the following medically necessary services ordered or prescribed by plan participants' licensed physicians or psychologists:
- Behavioral health treatment,
- Pharmacy care,
- Psychiatric care,
- Psychological care, and
- Therapeutic care
Behavioral health treatment means counselling and applied behavior analysis necessary to:
- Develop, maintain, or restore plan participants' functioning, to the maximum extent practicable; and
- Provided or supervised by board certified behavior analysts or psychologists licensed in Alabama.
Applied behavior analysis means design, evaluation, and implementation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including use of direct observation, measurement, and functional analysis of relationships between behavior and environment.
Plans can limit coverage for applied behavior analysis services to the following maximum benefits:
- $40,000 for plan participants from birth to age 9,
- $30,000 for plan participants between ages 10 and 13, and
- $20,000 for plan participants between ages 14 and 18.
However, plans can't limit maximum benefits for applied behavioral analysis coverage if additional services are medically necessary and plan participants obtain prior approval from plan administrators. Plan payments made on behalf of plan participants for any care, treatment, intervention, services, or items that aren't related to plan participants’ autism spectrum disorder can't be applied towards any maximum benefit amounts for coverage of applied behavior analysis. Coverage for treatments other than for applied behavior analysis can't be applied towards any maximum benefit amounts for applied behavior analysis coverage.
Plans can limit coverage to treatments prescribed by plan participants' treating licensed physicians or licensed psychologists in accordance with treatment plans. Coverage for autism spectrum disorders doesn't limit plan benefits otherwise available to plan participants.
Plans can't apply cost-sharing requirements, such as coinsurance, deductibles, or dollar limits, to autism spectrum disorders coverage that are less favorable than cost-sharing requirements that apply to substantially all medical and surgical benefits covered under plans. Plans also can't limit the number of provider visits for autism spectrum disorder treatments.
Plans can apply other general exclusions and limitations to autism spectrum disorder coverage that apply to other plan benefits, including, but not limited to, coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health-care services, including medical necessity review, case management, and other managed care provisions.
Plans aren't required to provide coverage for services provided to plan participants under individualized education programs, family service plans, or service plans.
Plans can request updated treatment plans once every six months unless plans and treating licensed physicians or licensed psychologists agree that more frequent reviews are necessary for particular plan participants. Agreements to review treatment plans more frequently apply only to a particular plan participant and not to all participants that receive treatment for autism spectrum disorders by physicians or psychologists.
Issuers must pay for costs associated with obtaining or reviewing treatment plans.
Plans can't deny or refuse coverage of, refuse to contract with, or refuse to renew or reissue or otherwise terminate or restrict coverage of plan participants solely because participants are diagnosed with autism spectrum disorder.
Income Tax Withholding—Effective Jan. 1, 2019, employers must use electronic funds transfer for deposits if they owed at least $20,000 in state taxes in any prior taxable year. The threshold for mandatory EFT is set to decrease annually until 2021.
Health Insurance Marketplaces—Effective May 4, 2017, Arkansas enacted legislation stating its intention to prohibit the development of technology for a state-based marketplace for individuals and to review the direction of the Arkansas Health Insurance Marketplace.
Personal Information Protection—Effective July 31, 2017, employers are no longer prohibited from asking, suggesting for or causing employees and applicants to add other employees, supervisors or administrators to contact lists for their social media accounts.
Arrest and Conviction Records—Effective on or about Aug. 4, 2017, Arkansas employers must provide employees and applicants with copies of their background check information upon request.
Health Benefit Mandates—Effective for insured group health plans issued, delivered, amended or modified in Arkansas after Jan. 1, 2018, plans must provide coverage and reimbursement for the treatment of certain medical disorders that require specialized formulas or nutrients, including medical foods.
New-Hire Procedures—Effective on or about Aug. 4, 2017, franchisors aren't considered to be employers of franchisees or their employees.
—Effective on or about Aug. 4, 2017, Arkansas fair employment practices law no longer applies to employers' agents.
—Effective on or about Aug. 4, 2017, claims for violations of the retaliation prohibition only can be brought against employers.
Paid Sick Leave—On March 29, 2017, the California Division of Labor Standards Enforcement updated its FAQs on the state's paid sick leave law to clarify how the law interacts with pre-existing paid-time-off plans and attendance policies. https://www.dir.ca.gov/dlse/Paid_Sick_Leave.htm
Arrest and Conviction Records—Effective July 1, 2017, restrictions on pre-employment inquiries are revised under California fair employment practices law. The law also restricts employers' use of criminal history information in employment decisions.
Health Benefit Mandates—Effective on or about Aug. 9, 2017, group health plan insurance issuers that provide coverage for dental services can't directly or indirectly require licensed dentists to provide dental services to plan participants at fees set by plan issuers or subject to plan approval, except under certain conditions. http://leg.colorado.gov/sites/default/files/documents/2017A/bills/2017A_190_signed.pdf
Wage Payment Requirements—Effective April 13, 2017, information collected by the Colorado Department of Labor and Employment on employers' wage violations isn't confidential and can be provided to the public or for use in court proceedings.
District of Columbia
Health Benefit Mandates—Effective April 24, 2017, until July 23, 2017, insured group health plans and health insurance issuers that provide coverage for prescription drugs must provide coverage for certain preventive health services as defined by the federal Affordable Care Act without imposing cost-sharing requirements.
Credit History Discrimination—On April 7, 2017, the Fair Credit in Employment Amendment Act took effect; however, the law's applicability is delayed until its fiscal effect is included in an approved budget and financial plan. The law prohibits employers from discriminating against employees and applicants based on their credit information.
Health Benefit Mandates—Effective April 7, 2017, insured health benefit plans entered or renewed on or after Jan. 1, 2018, that provide coverage for prescription drugs can't apply copayments or coinsurance to specialty drugs in specialty drug tiers that exceed specified amounts for up to a 30 or 90-day supply.
Paid Sick Leave—On April 7, 2017, the Universal Paid Leave Amendment Act took effect; however, the law's applicability is delayed until its fiscal effect is included in an approved budget and financial plan. The law provides employer-funded paid leave to eligible employees for their own or their family member's serious health condition and for reasons related to childbirth or the legal placement of a child with them.
Health Benefit Mandates
— Effective July 1, 2017, Georgia health benefit mandates no longer apply to nonprofit hospital and medical service corporations.
— Effective for insured group health benefit plans that provide prescription drug services' coverage and are issued, delivered, issued for delivery, executed, or renewed in Georgia on or after July 1, 2017, plans must have prescription drug programs that apply medication synchronization under certain conditions.
Prescription drug programs that provide coverage for prescription drug services must permit and apply prorated daily cost-sharing rates to prescriptions dispensed by pharmacies for less than a 30-day supply, if prescribers or pharmacists indicate that prescription fills or refills are in plan participants' best interest or for the purpose of synchronizing plan participants' medications.
Prescription drug programs can't deny coverage for drugs prescribed to treat illnesses that are dispensed in accordance with treatment plans made among plan participants, health-care practitioners and pharmacists to synchronize refilling of multiple prescriptions for plan participants.
Prescription drug programs must determine dispensing fees based exclusively on total number of prescriptions dispensed. Prescription drug programs can't use payment structures that use prorated dispensing fees determined by calculation of the number of days' supply of dispensed medications.
Off-label prescription drugs: Plans that directly or indirectly provide prescription drug coverage can't limit or exclude coverage on the basis that drugs are prescribed for uses that are different from the uses for which such drugs are approved for marketing by the federal Food and Drug Administration. Plans can require that prescription drug coverage is restricted to drugs that are:
- Prescribed by licensed health-care professionals for medically necessary treatment of chronic or debilitating conditions or diseases;
- Included on plans formulary or preferred drug list; and
- Recognized for treatment of conditions or diseases by the American Medical Association Drug Evaluations, American Hospital Formulary Service Drug Information, the United States Pharmacopoeia Dispensing Information, Volume 1, “Drug Information for the Health Care Professional,” or two articles from major peer reviewed medical journals that present data supporting proposed off-label use or uses as generally safe and effective, unless there is clear and convincing contradictory evidence presented in major peer reviewed medical journals.
Coverage for off-label prescription drugs must include medically necessary services associated with drug administration.
Pharmacy choice: Plans, including alternative health benefit plans, can't require plan participants to obtain pharmaceutical services exclusively from mail-order pharmaceutical distributors. Plan participants who choose not to use mail-order pharmaceutical distributors can't be subject to different conditions for receiving pharmaceutical services than those plan participants who choose to use mail-order distributors.
Prescription drug benefit/identification cards: Plans that provide prescription drug coverage must issue insurance identification cards to plan participants that contain the following information:
- BIN number;
- Pharmacy help desk telephone number and names; and
- Processor control number, if applicable.
Insurance identification cards can't display or use plan participants' social security number.
Effective for insured group health benefit plans delivered, issued, executed, renewed, or approved for issuance or renewal in Georgia on or after Jan. 1, 2018, plans that provide major medical benefits coverage must provide coverage for hearing aids under certain circumstances.
Plans that provide major medical benefits coverage must provide coverage for one hearing aid per hearing-impaired ear not to exceed $3,000 per hearing aid for plan participants age 18 or younger (doesn't apply to plans issued to employers that have 10 or fewer employees). Coverage must include at a minimum:
- Replacement for one hearing aid per hearing-impaired ear every 48 months;
- New hearing aids when repairs or adjustments to existing hearing aids can't adequately meet plan participants’ needs within two months from the date determinations are made that hearing aids can't be repaired or adjusted;
- Medically necessary services and supplies, including initial hearing aid evaluations, fittings, dispensing, programming, servicing, repairs, follow-up maintenance, adjustments, ear molds, ear mold impressions, auditory training, and probe microphone measurements to ensure appropriate gain and output, as well as verifying benefits from systems selected according to professional standards;
- Option for plan participants to choose higher priced hearing aids and pay the cost difference between the benefit amount and the cost of hearing aids; and
- Option for plan participants to purchase hearing aids from any licensed audiologists, licensed hearing aid dealers, or dispensers in Georgia.
Hearing aid means any nonexperimental, wearable device or instrument designed to be worn in or on the body and used to aid or compensate for impaired human hearing. Coverage for hearing aids must include any parts, ear molds, and repair and replacement parts, including, but not limited to, nonimplanted bone anchored hearing aids, nonimplanted bone conduction hearing aids, and FM systems. However, hearing aid coverage doesn't include personal sound amplification products.
Plans must provide coverage for medically necessary services and supplies on a continuous basis, as needed, during each 48 month coverage period not to exceed $3,000 per hearing impaired ear or for the duration of hearing aids’ warranty, whichever period is longer.
Plans and issuers can't deny or refuse coverage of, refuse to contract with, or refuse to renew or reissue or otherwise terminate or restrict coverage of plan participants solely because participants are or have been previously diagnosed with hearing loss.
Plans must apply the same annual deductibles, coinsurance, copayments, or utilization review requirements to hearing aids and related services and supplies that apply to similar plan benefits.
Issuers aren't required to provide hearing aid coverage for hearing aids not previously covered as of Jan. 1, 2019, if:
- Actuaries who are members of the American Academy of Actuaries and meet the Academy's professional qualification standards for rendering actuarial opinions related to health insurance rates certify in writing to the Georgia Commissioner of Insurance that, based on analysis to be completed by issuers no more frequently than once per year for the most recent experience period of at least one year's duration, costs associated with hearing aids not covered as of Jan. 1, 2019, exceed 1 percent of all premiums charged and such costs would increase average premiums charged by more than 1 percent for all plans, policies and contracts beginning on the next issue or renewal date, based on issuers’ premium rating methodology and practices; and
- The Georgia Insurance Commissioner approves actuaries’ certification.
Beginning Jan. 1, 2018, if hearing aid benefits' coverage exceeds the definition of essential health benefits required under the ACA, qualified health plans offered through the Georgia Health Insurance Marketplace can, but aren't required to, provide coverage for hearing aid benefits that exceeds required essential health benefits under the ACA.
Paid Sick Leave—Effective July 1, 2017, employers that provide paid sick leave must allow eligible employees to use up to five days of this leave per calendar year to care for immediate family members.
Income Tax Withholding—Effective for 2018, employers previously required to file monthly returns will begin filing quarterly returns instead.
Health Benefit Mandates—Effective April 4, 2017, certain insured group health plan provisions on telemedicine are revised.
Arrest and Conviction Records—Effective July 1, 2017, employees' and former employees' criminal history information can't be used as evidence against employers in civil actions based on the employees' or former employees' conduct under certain circumstances.
Health Benefit Mandates—Effective for insured group health benefit plans delivered, issued for delivery, continued or renewed in Iowa on or after Jan. 1, 2018, plans that provide coverage for prescription drugs and utilize step therapy protocols must permit plan participants and prescribing health-care practitioners to request step therapy exception or override determinations under certain conditions.
Step therapy protocol means protocols or programs that establish the specific order in which medically appropriate prescription drugs are prescribed and covered by plans, issuers or utilization review organizations to treat specified medical conditions, including self-administered drugs and drugs administered by health-care professionals. Step therapy override exceptions means that step therapy protocols should be overridden in favor of coverage of prescription drugs selected by health-care professionals. Step therapy override exception determinations means decisions whether step therapy protocols should apply in a particular situation or whether step therapy protocols should be overridden in favor of coverage of prescription drugs selected by prescribing health-care practitioners within applicable time frames. Override exception determinations must be based on reviews of plan participants’ or their prescribers’ request for an override, along with supporting rationale and documentation.
Step therapy protocol exception procedures must be easily accessible on issuers’, plans’ or utilization review organizations’ websites.
Issuers, plans or utilization review organizations:
- Can require plan participants to use existing medical exceptions processes to request step therapy override exception determinations,
- Must consider available recognized evidence-based and peer-reviewed clinical practice guidelines when establishing step therapy protocols, and
- Must provide plan participants with any clinical review criteria that applies to specific prescription drugs upon request.
Step therapy override exception procedures must provide that override requests are granted if:
- Prescription drugs are contraindicated, due to documented adverse events with prior usage or documented medical conditions, including comorbid conditions, likely to cause adverse reactions to plan participants, decrease plan participants’ ability to achieve or maintain reasonable functional ability in performing daily activities or cause plan participants' physical or mental harm;
- Prescription drugs are expected to be ineffective based on plan participants' known clinical characteristics, such as participants’ adherence to or compliance with their individual care plan, and any of the following: prescription drug regimens’ known characteristics as found in peer-reviewed literature or in manufacturers’ prescribing information, health-care professionals’ medical judgment based on clinical practice guidelines or peer-reviewed journals, or plan participants’ documented experience with prescription drug regimens;
- Plan participants previously received a trial of therapeutically equivalent doses of the prescription drug under the step therapy protocol for a time period to allow for positive outcomes and such prescription drugs were discontinued by plan participants’ health-care professionals due to lack of effectiveness; or
Plan participants are currently experiencing positive therapeutic outcomes using prescription drugs prescribed by participants’ health-care providers under current or previous health benefit plans.
Plan participants are discouraged from using pharmacy drug samples for the sole purpose of meeting step therapy override exception procedures.
Issuers, plans or utilization review organizations that grant step therapy override exceptions must authorize coverage for prescription drugs prescribed by plan participants’ treating health-care providers if such drugs are covered under plans.
Issuers, plans or utilization review organizations must approve or deny requests for step therapy override exceptions in the same manner as requests for prior authorizations of prescription drug benefits.
If step therapy override exception requests result in denials, issuers, plans or utilization review organizations must provide plan participants or their authorized representatives and their treating health-care providers with reasons for denials and information regarding procedures to request external reviews of denials.
Issuers, plans or utilization review organizations can require plan participants to use generic equivalents with the same demonstrated bioavailability or interchangeable biological products before authorizing coverage for requested prescription drugs. Step therapy protocol exceptions can't prevent health-care providers from prescribing prescription drugs that are determined to be medically appropriate.
Health Benefit Mandates—Effective July 1, 2017, insured health-care plans, policies or contracts delivered, issued for delivery, continued or renewed in Iowa on or after Jan. 1, 2018, to employers that have 50 or more full-time equivalent employees on at least 50 or more working days in the preceding calendar year and provide coverage for health, medical and surgical benefits must provide coverage for applied behavior analysis for plan participants under age 19 for treatment of autism spectrum disorders.
Income Tax Withholding—On April 26, Maine enacted a law that conforms the state to the Internal Revenue Code in effect on Dec. 31, 2016.
Income Tax Withholding—Beginning with tax year 2017 forms filed in 2018, all employers must file state copies of Form W-2 electronically.
Health Benefit Mandates
—Effective Oct. 1, 2017, insured health benefit plans that provide coverage for services that are within the scope of practice of licensed clinical professional art therapists must provide coverage for services performed by licensed clinical professional art therapists.
—Effective for insured health benefit policies, contracts and plans issued, delivered or renewed on or after Jan. 1, 2018, plans can't apply coinsurance, copayments or deductibles to diabetes test strips, except under certain conditions. http://mgaleg.maryland.gov/2017RS/bills/hb/hb0730t.pdf
Child Support—Effective July 1, 2017, Maryland's Department of Human Resources is renamed Department of Human Services and its Child Support Enforcement Administration is renamed Child Support Administration.
Health Benefit Mandates—Effective for insured group health plans offered, sold, issued or renewed to Minnesota residents on or after Jan. 1, 2018, plans that provide coverage for prescription eye drops also must provide coverage for prescription eye drop refills if certain conditions are met.
Effective for health plans offered, sold, issued or renewed to Minnesota residents on or after Jan. 1, 2018, plans that provide coverage for prescription eye drops can't deny coverage for prescription eye drop refills if:
- Plan participants request refills for a 30-day supply between 21 and 30 days after plan participants receive an original prescription or the date participants receive the last prescription refill, whichever is later;
- Plan participants request refills for a 90-day supply between 75 and 90 days after the date plan participants receive an original prescription or the date participants receive the last prescription refill, whichever is later; and
- Prescribing health-care providers indicate on the original prescription that additional eye drops are needed and refills don't exceed the number of additional quantities needed.
Prescribing heArrest and Conviction Records—Effective July 1, 2017, employers aren't liable for negligent hiring or retention regarding acts committed by employees with criminal records if certain conditions are met.
Employers aren't liable for any negligent hiring or negligent employment claims regarding acts committed by employees with criminal records, if the acts are committed outside of the scope of employment and:
- The employer reviewed the employee's arrest record prior to hiring, and the record didn't show a disposition of the case or indicated that the case was acquitted or dismissed;
- The conviction was for a misdemeanor or an offense unrelated to the job; or
- The employee is under probation supervision and the employment has been approved by the supervising officer.
Health Benefit Mandates
—Effective Jan. 1, 2019, insured group health benefit plan provisions relating to choice of health-care providers are expanded to include licensed marriage and family therapists.
— Effective April 25, 2017, health insurance issuers and insured group health benefit plans must pay certain air ambulance service charges associated with transporting plan participants who have emergency medical conditions.
Issuers and plans must pay the difference charged to plan participants, if any, that exceeds allowable amounts for air ambulance covered services and supplies and applicable copayments, coinsurance and deductibles. Issuers and plans must make payments if plan participants receive services from non-Montana hospital-controlled out-of-network air ambulance service providers. Payment isn't required if plan participants have air ambulance membership subscriptions for services provided by the air ambulance.
Emergency medical conditions means medical conditions characterized by acute symptoms of sufficient severity, including severe pain, such that persons knowledgeable about health and medicine could reasonably expect the absence of immediate medical attention to result in serious:
- Jeopardy to plan participants' health or with respect to pregnant women, jeopardy to the health of pregnant women or their unborn children;
- Impairment to plan participants' bodily functions; or
- Dysfunction of plan participants' bodily organs or parts.
—Effective for insured group health plans issued, modified or renewed on or after Jan. 1, 2018, plan provisions are revised regarding coverage for necessary care and treatment of mental illnesses and substance use disorders.
Plans must provide coverage for necessary care and treatment of plan participants who have mental illnesses, severe mental illnesses or substance use disorders at a level of benefits that is no less favorable than the level of benefits provided for physical illnesses generally, including emergency care, inpatient and outpatient benefits and prescription drugs. Coverage for necessary care and treatment of mental illnesses, severe mental illnesses and substance use disorders must comply with treatment parity requirements in accordance with the federal Mental Health Parity and Addiction Equity Act of 2008 and related regulations as of Jan. 1, 2017 (doesn't apply to HMOs).
Mental illness means clinically significant behavioral or psychological syndromes or patterns that occur in plan participants and are associated with:
- Present distress or painful symptoms;
- Disability or impairment in one or more areas of functioning; or
- Significantly increased risks of suffering death, pain, disability or an important loss of freedom.
Mental illness must be considered as a manifestation of behavioral, biological or psychological dysfunction in plan participants.
Mental illness doesn't include:
- Developmental disorders;
- Eating disorders, except bulimia and anorexia nervosa;
- Impulse control disorders, except for intermittent explosive disorders and trichotillomania;
- Psychoactive substance use disorders; or
- Speech disorders.
Severe mental illnesses means the following disorders as defined by the American Psychiatric Association:
- Bipolar disorders
- Major depression,
- Obsessive-compulsive disorders,
- Panic disorders,
- Schizophrenia and
- Schizoaffective disorders
Substance use disorders means uncontrollable or excessive use of addictive substances including, but not limited to, alcohol, amphetamines, barbiturates, cannabis, cocaine, hallucinogens, heroin, morphine, opium or tranquilizers and resulting physiological or psychological dependency that develops with continued use of addictive substances. Substance use disorders require medical care or other appropriate treatments as determined by licensed addiction counselors or medical practitioners.
Inpatient benefits are benefits payable for charges made by hospitals, freestanding inpatient facilities or qualified health-care providers for necessary care and treatment of mental illness, severe mental illnesses or substance use disorders provided to plan participants who are confined as inpatients. Inpatient benefits include coverage for medically monitored and managed intensive inpatient services and clinically managed high-intensity residential services. Care and treatment of substance use disorders in freestanding inpatient facilities must be provided at substance use disorder treatment centers.
Outpatient benefits are benefits payable for reasonable charges made by hospitals, qualified health-care providers or mental health or substance use disorders treatment centers for necessary care and treatment of mental illness, severe mental illnesses or substance use disorders provided to plan participants on an outpatient basis or for reasonable service charges assessed by qualified individuals in acute or subacute partial hospitalization or intensive outpatient treatment settings.
Coverage for children age 18 or younger who are diagnosed with Asperger's, autistic or pervasive developmental disorders not otherwise specified must comply with Montana's autism spectrum disorders requirements.
Treatment parity: Effective Jan. 1, 2018, for group health insurance and group health plans offered, renewed or issued to Montana residents, plans that provide coverage for mental health benefits must provide coverage under the same terms and conditions that apply to physical health benefits as provided by federal law as of Jan. 1, 2017.
—Effective Jan. 1, 2018, insured group health benefit plans must provide coverage for health-care services delivered through telemedicine by health-care professionals licensed in Montana to practice dentistry and dental hygiene, if such services otherwise are covered by plans.
Income Tax Withholding—On May 10, 2017, Nebraska enacted a law that conforms the state to the Internal Revenue Code as it existed on the law's effective date.
Health Benefit Mandates—Effective on or about Aug. 31, 2017, insured group health plans delivered, issued for delivery or renewed in Nebraska can't exclude health-care services from coverage solely because they are provided through telehealth.
Wage Payment Requirements—Effective July 11, 2017, employers can pay employee wages weekly or biweekly.
Health Benefit Mandates—Effective for insured group health plans issued or renewed on or after July 31, 2017, plan provisions are revised regarding coverage for medically necessary diagnosis and treatment of infertility.
Plans that have more than 50 plan participants and provide coverage for pregnancy-related benefits must provide coverage for medically necessary diagnosis and treatment of infertility. Such benefits must include, but aren't limited to:
- Artificial insemination,
- Diagnosis and diagnostic tests,
- Embryo transfer,
- Four completed egg retrievals over the course of the plan participants’ life,
- Gamete intrafallopian transfer,
- Intracytoplasmic sperm injection,
- In vitro fertilization,
- Surgery, and
- Zygote intrafallopian transfer.
Plans can limit coverage of gamete intrafallopian transfer, in vitro fertilization and zygote intrafallopian transfer to plan participants who have used all reasonable, less expensive and medically appropriate treatments and are still unable to become pregnant or carry a pregnancy; haven't reached the limit of four completed egg retrievals; and are 45 years old or younger.
Benefits for diagnosis and treatment of infertility must be provided to the same extent as benefits provided for other pregnancy-related procedures covered under plans, except that infertility services must be provided at facilities that conform to standards adopted by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.
Plans must apply the same benefit limits, copayments and deductibles to coverage for diagnosis and treatment of infertility that apply to other medical or surgical benefits covered by plans.
Effective until July 31, 2017, infertility means diseases or conditions affecting plan participants that result in abnormal function of the reproductive system such that plan participants aren't able to:
- Impregnate another person,
- Conceive after two years of unprotected sexual intercourse if female partners are under age 35,
- Conceive after one year of unprotected sexual intercourse if female partners are age 35 or older or one of the partners is medically sterile, or
- Carry a pregnancy to live birth.
Effective for policies or contracts issued or renewed on or after July 31, 2017, infertility means diseases or conditions affecting plan participants that result in abnormal function of the reproductive system, or infertility based on ASRM practice guidelines as determined by physicians who are board certified or board eligible in reproductive endocrinology and infertility or obstetrics and gynecology.
Infertility also means that plan participants meet one of the following conditions:
- Male plan participants can't impregnate females,
- Female plan participants who are under age 35 and have male partners can't conceive after 12 months of unprotected sexual intercourse,
- Female plan participants who are 35 years of age or older and have male partners can't conceive after six months of unprotected sexual intercourse,
- Female plan participants who are under age 35 and don't have male partners can't conceive after 12 failed attempts of medically supervised intrauterine insemination,
- Female plan participants who are over 35 years of age and don't have male partners can't conceive after six failed attempts of medically supervised intrauterine insemination,
- Plan participants' partners can't conceive because of involuntary medical sterility,
- Plan participants can't carry a pregnancy to live birth, or
- Plan participants previously have been determined to be infertile.
Coverage for medically necessary diagnosis and treatment of infertility doesn't include infertility resulting from voluntary sterilization procedures.
Religious employer exemption: Employers that are tax-exempt religious organizations, such as churches or groups or entities that are controlled, operated or supervised by churches, can exclude coverage for artificial insemination, embryo transfer, intracytoplasmic sperm injection, in vitro fertilization and zygote intrafallopian transfer if such coverage is contrary to the religious employer's bona fide religious beliefs.
Personal Information Protection—Effective June 16, 2017, employers must maintain reasonable security procedures and practices for protecting personal information and provide notification about security breaches of such information.
Income Tax Withholding—Effective April 1 through June 30, 2017, the interest rate for tax underpayments remains at 4 percent.
New-Hire Procedures—Effective May 4, 2017, franchisors aren't considered to be employers of franchisees or their employees for any purpose.
Equal Employment Opportunity
—Effective March 30, 2017, employees and applicants have the right to seek, obtain and hold employment without discrimination based on “sex” instead of “biological sex.”
—Effective March 30, 2017, the statute of limitations for lawsuits alleging wrongful discharge, in violation of North Carolina fair employment practices law, is three years for claims arising on or after that date.
Drug and Alcohol Use—Effective April 17, 2017, North Dakota repealed and replaced the medical marijuana use provisions that were suspended on Jan. 26, 2017. The provisions initially were enacted on Nov. 8, 2016, through a ballot initiative.
Health Benefit Mandates
—Effective for plans or policies delivered, issued, executed or renewed on or after Aug. 1, 2017, plans that provide coverage for health benefits must provide coverage for health services delivered through telehealth.
—Effective Jan. 1, 2018, insured health benefit plans must establish reimbursement rates for out-of-network air ambulance provider services that are equal to the average of plans’ in-network rates for air ambulance providers in North Dakota. http://www.legis.nd.gov/assembly/65-2017/documents/17-0231-01000.pdf
Income Tax Withholding—Effective Aug. 1, 2017, out-of-state businesses and employees responding to a disaster in North Dakota aren't required to pay income taxes to the state.
Income Tax Withholding—Effective March 30, 2017, Ohio conforms to the Internal Revenue Code in effect on March 30, 2017.
Health Benefit Mandates
— Effective for insured health benefit plans delivered, issued or renewed after Nov. 1, 2017, plans that provide coverage for prescription drugs must provide coverage for synchronization of prescription drug refills at least once per year for each plan participant if certain conditions are met.
—Effective for insured group health plans issued or renewed on or after Nov. 1, 2017, plans that provide coverage for medical and surgical expenses and prescription eye drops can't deny coverage for prescription eye drop refills under certain conditions.
Equal Employment Opportunity—Effective May 25, 2017, the Puerto Rico Department of Labor and Human Resources implements new regulations on religious accommodation requirements.
Income Tax Withholding—On April 5, 2017, South Carolina enacted a law that conforms the state to the Internal Revenue Code in effect on Dec. 31, 2016.
Separation Procedures—Effective May 11, 2017, employees generally must leave their employer's premises within 10 hours after separating from employment.
Wage Payment Requirements—Effective May 11, 2017, employers must pay employee wages at least once per month.
Arrest and Conviction Records—Effective July 1, 2017, ex-offenders can submit a petition for a certificate of employability regardless of whether they are seeking restoration of their citizenship rights.
Health Benefit Mandate—Effective for insured group health benefit plans and policies issued, renewed or entered into on or after Jan. 1, 2018, plans that provide coverage for prescription eye drops must provide coverage for prescription eye drop refills if plan participants meet certain conditions.
Equal Employment Opportunity—Effective March 22, 2017, employers can give hiring preference to honorably discharged veterans, spouses of veterans with service-connected disabilities and widows or widowers of certain veterans or service members.
Health Insurance Marketplace—Effective July 1, 2018, Utah expects to wind down operations of Avenue H, the state's health insurance marketplace for small employers, and transition to a federally facilitated health insurance marketplace.
Health Benefit Mandates—Effective for insured health benefit plans entered into or renewed on or after Jan. 1, 2018, plans that provide coverage for dental services and stand-alone dental plans can't require dentists directly or indirectly to provide dental services to plan participants at fees set by plan issuers or subject to plan approval unless dental services are covered services under such plans. https://le.utah.gov/~2017/bills/sbillint/SB0044S01.pdf
Pregnancy Discrimination—Effective Jan. 1, 2018, employers must provide reasonable accommodations for employees' pregnancy-related conditions, unless these accommodations would impose undue hardship on employers.
Pregnancy-related conditions are limitations on employees' ability to perform their job functions, where these limitations are caused by pregnancy, childbirth, or related medical conditions. For reasonable accommodation purposes, employees with pregnancy-related conditions have the same rights and are subject to the same standards as qualified employees with disabilities, regardless of whether these conditions are protected disabilities.
Personal Information Protection—Effective July 1, 2017, employers must notify the Virginia attorney general's office about certain security breaches involving employees' income tax information.
Health Benefit Mandates—Effective for insured group health benefit plans issued or renewed on or after Jan. 1, 2018, plans that provide coverage for contraceptive drugs must provide reimbursement for a 12-month supply or refill of contraceptive drugs dispensed at one time to plan participants.
Plans that provide coverage for contraceptive drugs must provide reimbursement for a 12-month supply or refill of contraceptive drugs dispensed at one time to plan participants, unless plan participants request smaller quantities or prescribing health-care providers instruct dispensaries that plan participants must receive smaller quantities.
Contraceptive drugs means all drugs approved by the FDA to prevent pregnancy, including, but not limited to, hormonal drugs administered intravaginally, orally, or transdermally.
Plans must allow health-care providers to dispense contraceptives drugs to plan participants at providers’ on-site offices, if available. Plans’ required dispensing practices must adhere to clinical guidelines for appropriate prescribing and dispensing to ensure plan participants’ health while maximizing access to effective contraceptive drugs.
Plans can, but aren't required to, limit refills dispensed in the last quarter of the plan year if a 12-month supply of contraceptive drugs has already been dispensed during the plan year.
Health Benefit Mandates—Effective Jan. 1, 2018, insured group health benefit plan provisions pertaining to coverage for health-care services delivered through telemedicine are revised.
Plans must reimburse health-care providers for health-care services provided through telemedicine or store-and-forward technology if:
- Plans provide coverage for the same health-care services provided in person;
- Health-care services are medically necessary;
- Health-care services are considered to be essential health benefits under the federal Patient Protection and Affordable Care Act; and
- Effective Jan. 1, 2018, health-care services are determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health-care practices and standards, and technology used to provide health-care services meets standards required by state and federal laws governing privacy and security of health information.
Telemedicine means delivery of health-care services through interactive audio and video technology that permits real-time communication between plan participants located at originating sites and health-care providers located at distant sites for purposes of consultation, diagnosis, or treatment. Store-and-forward technology means using asynchronous transmission of medical information from originating sites to communicate with health-care providers located at distant sites for purposes of plan participants' medical diagnosis and management. Telemedicine and store-and-forward technology don't include use of audio-only telephone calls, fax transmissions, or e-mail.
Originating sites means that plan participants are physically located at one place and health-care providers are located at a different place. Originating sites include:
- Community mental health centers;
- Federally qualified health centers;
- Homes or effective Jan. 1, 2018, any location as determined by plan participants receiving telemedicine services;
- Physicians' or other health-care providers' offices;
- Renal dialysis centers, except independent renal dialysis centers;
- Rural health clinics; and
- Skilled nursing facilities.
Distant sites means physicians' or licensed providers' location at the time telemedicine services are provided.
If health-care services are provided through store-and-forward technology, plan participants must have an office visit with referring health-care providers and the associated office visit can take place through telemedicine.
Plans can't distinguish between originating sites in rural or urban locations for coverage of health-care services delivered through telemedicine.
Plans can apply the same cost-sharing requirements, including coinsurance, copayments, and deductibles, prior authorization and utilization review to health-care services provided through telemedicine and store-and-forward technology that apply to the same health-care services provided in person.
Effective Jan. 1, 2018, originating sites, except for plan participants' homes, can charge facility fees for infrastructure and preparation of plan participants. Distant sites can't charge facility fees for telemedicine services.
Arrest and Conviction Records—Effective July 7, 2017, employers can't be sued in civil actions solely based on their employment of anyone who has been convicted of a nonviolent, nonsexual offense or whose conviction for a nonviolent felony offense has been reduced to a misdemeanor.
This is pursuant to the Second Chance in Employment Act. The fact that an employee was previously convicted of a nonsexual, nonviolent felony or that his or her prior felony conviction was reduced before the employment began can't be used as evidence in an action against the employer alleging negligent hiring. Such information can be used as evidence in an action against the employer alleging inadequate supervision of the employee, but only if the employer:
- Knew of the conviction or was grossly negligent in not knowing about the conviction or reduced offense; and
- The conviction or reduced offense was directly related to the job and to the alleged injury upon which the cause of action is based.
Drug and Alcohol Use—Effective April 19, 2017, West Virginia allows for the medical use of marijuana to treat serious medical conditions, although identification cards authorizing such use aren't available until July 1, 2019. Employers can't retaliate against employees and applicants because they are authorized to use medical marijuana, but can refuse to accommodate such use at the workplace.
Health Insurance Marketplace—Effective on or about July 4, 2017, the law establishing the West Virginia Health Benefit Exchange is repealed
Health Benefit Mandates—Effective on or about June 19, 2017, insured health benefit plans issued for delivery, delivered, renewed or contracted in West Virginia on or after
Jan. 1, 2018, that provide coverage for prescription drugs and utilize step therapy protocols must permit plan participants and prescribing health-care practitioners to request step therapy exception or override determinations under certain conditions.
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