Health care reform.

2018
STATE OF WYOMING
18LSO-0075
Numbered
1.5

SENATE FILE

NO.
SF0088

Health care reform.

Sponsored by:
Senator(s) Rothfuss and Representative(s) Connolly

A BILL

for

AN ACT relating to health care; prohibiting specified practices relating to emergency care; requiring a private health benefit plan to cover certain adult children; generally prohibiting discrimination by a private health benefit plan based on health status; creating a multi-payer health claims database; requiring an insurer to provide specified health claims data to group purchasers of private health benefit plans; providing penalties and civil liability for misuse of specified health claims data; requiring the creation of an electronic prescribing system; specifying requirements relating to health care facility billing; creating a prescription drug importation program; creating a Medicaid buy-in program; creating a Medicaid prescription drug program for insurers; requiring the department of health to conduct outreach to specified persons regarding contraceptive services and supplies; clarifying that all political subdivisions may make coverage through the state employees' and officials' group health insurance program available to their officers and employees; clarifying provisions relating to epinephrine auto-injectors in school districts; providing that specified interest rates relating to health care charges and debts are unlawful; requiring the submission of a waiver application relating to the Medicaid buy-in program; requiring specified actions relating to the expansion of Medicaid and the child health insurance program; requiring studies and reports; requiring specified actions relating to telemedicine; making conforming amendments; requiring the promulgation of rules; repealing provisions; and providing for effective dates.

Be It Enacted by the Legislature of the State of Wyoming:

Section
1
.

W.S.

9
‑
3
‑
2
19
,
26
‑
34
‑
136,
26
‑
43
‑
301
through 26
‑
43
‑
305, 26
‑
43
‑
401
through 26
‑
43
‑
4
07,
33
‑
24
‑
159,
35
‑
2
‑
618
,
35
‑
7
‑
2201
,

42
‑
4
‑
122
,
42
‑
4
‑
123
and 42
‑
5
‑
103
are created to read:

9
‑
3
‑
2
19
.

Applicability of specified provisions.

W.S. 26
‑
43
‑
30
1 through 26
‑
43
‑
407 apply to a
health insurance plan issued under this a
ct
.

26
‑
34
‑
136
.

Applicability of specified provisions.

W.S. 26
‑
43
‑
301 through 26
‑
43
‑
407
apply to
a
healt
h insurance plan

issued by a health maintenance
organization under this
act
.

ARTICLE 3
WYOMING
HEALTH INSURANCE REFORM ACT

26
‑
43
‑
301
.

Short title.

This article may be cited as the "
Wyoming
Health Insurance Reform Act."

26
‑
43
‑
302
.

Definitions.

(a)

As used in this article and W.S. 26
‑
43
‑
401 through 26
‑
43
‑
407:

(
i
)

"Health care provider" means
a person or facility which is licensed, certified or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession;

(i
i
)

"
In
‑
network" means an express or implied
contract
between an insurer, or its contractor or subcontractor,
and a health care
provider
in which the provider
has agreed
to make
specified health care
drugs, devices and
services
available
to a person covered by a private health benefit plan

and to receive
payment or reimbursement, other than any applicable
copayment, coinsurance
or other cost
‑
sharing
requirement
,
at a rate
agreed upon
by the insurer and provider;

(i
i
i
)

"Insurer" means an
y
entity defined in W.S. 26
‑
1
‑
102(a)(xv
i)
who provides health insur
ance coverage in this state, including
a health maintenance organization, the
state
employees' and officials'
group
health insurance plan and any provider of a plan made available under W.S. 9
‑
3
‑
201
;

(iv)

"Private health benefit plan" means as defined in W.S. 26
‑
1
‑
102
(a)(xxxiii), and
includes
a
nonfully
funded multiple employer welfare arrangement, the
state
employees' and officials'
group
health insurance plan and any plan ma
de available under W.S. 9
‑
3
‑
201
, but excludes
any
employee welfare benefit plan

that
is not subject to state regulation, as defined in 29 U.S.C. 1002
.

26
‑
43
‑
30
3
.

Prohibition on balance billing, prior authorization and increased cost
‑
sharing
by insurers
for emergency
care
; maximum threshold for emergency care made available by specified health care providers
.

(a)

Except as otherwise provided in this subsection, a
n
insurer

is
solely

liable for payment of all charges
for

medically necessary
emergency
care

which is provided to a person covered by a private health benefit plan
,

whether or not the care was made available by an in
‑
network health care provider
. An insurer may
impose the same
copayment, coinsurance, deductible
or
other
cost
‑
sharing requir
ement which is specified
in a private health benefit plan
for
medically necessary
emergency
care

provided
by
an
in
‑
network
health care provider for care
which is
made available by a provider who is not in
‑
network.
A
person covered by a private health benefit plan
is not
liable for any differential
between an insurer's in
‑
network

health care
provider rates
or
allowed costs
for
medically necessary
emergency care and any
rates

actually charged by the health care provider for emergency care or any payments
or reimbursements actually made
by an
insurer
.
An
insurer shall not increase the
premium, copaym
ent, coinsurance, deductible or
other cost
‑
sharing requirement
of a person covered by a private health benefit plan
or
reduce
or limit
any benefit
based on this
sub
section.

(b)

A health care provider, excluding a person who provides air ambulance evacuation, shall not charge a person, or make a demand for payment or reimbursement to an insurer, for medically necessary emergency care in an amount greater than one hundred twenty
‑
five
percent
(125%) of the amount that would be allowable under the federal Medicare program for the emergency care.

(c)

An insurer shall not
r
equire prior authorization for
medically necessary
emergency care.

(d
)

Coverage for
medically necessary
e
mergency care shall
be made available
to a person covered by a private health benefit plan
whether or not the

health care provider who makes emergency care available
is in
‑
network.

(e)

This section shall not apply t
o
medically necessary
emergency care made available
by a health care provider
outside the United States
.

26
‑
43
‑
304
.

Enrollment of
specified
adult children in health insurance coverage.

(a)

An
insurer who
issues a
private health benefit plan

which provides coverage fo
r dependents
shall make
coverage available to an
adul
t child of
a policyholder
until the child reaches twenty
‑
six (26)
years of age. Coverage provided to an adult child under this subsection must be identical to the coverage provided to the
policyholder
.

(b)

An insurer shall not be required
to make coverage available for the

spouse or
dependent of an adult child of a
policyholder
.

26
‑
43
‑
305
.

Prohibition against discrimination
by an insurer
based on health status.

(a)

An insurer shall
not fail to
issue a
private health benefit plan

to any person
based on
the health status
of the person or the

spouse or
dependent of the person.
For the purposes of this section, h
ealth status includes:

(
i
)

A
preexisting medical condition of
a
person, including any physical or mental illness;

(ii)

The claims history of a
person, including any prior health care
drugs, devices and
services
made available to

the

person;

(iii
)

Genetic information;

(iv)

Any increased risk for illness, injury or any other medical condition
, status or characteristic
of
a
person.

(b)

An insurer that issues a
private health benefit plan

shall n
ot:

(
i
)

Deny, limit or exclude a benefit based on the health status of
a
person covered by a private health benefit plan
; or

(ii)

Require an
y
person
covered by a private health benefit plan
, as a condition of issuance
or renewal, to pay a premium, deductible, c
opayment,
coinsurance
or other cost
‑
sharing requirement
based on
the person's
health status

which is greater than a
ny
premium, deductible, copay
ment,
coinsurance
or other cost
‑
sharing requirement
charged to an
other

person covered by a private health benefit plan
who does not have a
similar
health status
.

(c)

An insurer that issues a
private health benefit plan
shall not adjust a premium, deductible, copay
ment
coinsurance
or other cost
‑
sharing requirement
for any
person covered by a private health benefit plan

on the basis of genetic informatio
n
.

ARTICLE 4
WYOMING
HEALTH CARE PRICING TRANSPARENCY
ACT

26
‑
43
‑
4
01
.

Short title.

This article may be cited as the "
Wyoming
Health Care Pricing
Transparency Act
.
"

26
‑
43
‑
4
02
.

Definition
s
.

(a)

As used in this article:

(
i
)

"D
epartment" means the department of health
created
pursuant to W.S. 9
‑
2
‑
101(a);

(ii)

"Medical assistance" means
as defined in W.S. 42
‑
4
‑
102(a)(ii)
.

(b)

The definit
ions
in W.S. 26
‑
43
‑
302
(a)

apply to this article.

26
‑
43
‑
4
03
.

Multi
‑
payer
health
claims database
;
standards
;
civil
penalty for failure to submit data
.

(a)

Notwithstanding any contract or provision of law which provides for the confidentiality of the information described in this section, a
n insurer
which
issues a

private health benefit plan

and

persons administering
medical assistance
shall provide

to the department
at no charge
,
not less than on a quarterly basis
, all claims data relating to medical diagnoses, procedures, prescripti
on drugs, eligibility spans,
demog
raphics
and other related
categories
which the department
may
require by rule.

(b)

The department shall
establish or join a multi
‑
payer
health
claims database and deposit the data made available pursuant to subsection (a) of this section in
to
the database
on a quarterly basis
. In determining whether to establish or join a multi
‑
payer
health
claims database, t
he department shall consider all of the following
:

(
i
)

Cost
‑
effectiveness to the state
of Wyoming relating to
establishing or joining a database;

(ii)

Utility of the data which will be made available through establishing or joining a database
, including medical assistance claims data
;

(iii)

Availability of qualified personnel to ensure the data is used effectively
and in a secure manner
;

(iv)

Any other factor determined by the department to be relevant to its decision
under this subsection
.

(c)

The department shall ensure that the data deposited in
the
multi
‑
payer
health
claims database pursuant to subsection (b) of this section is used for:

(
i
)

Public health
research
and
investigations

conducted
by the state of Wyoming and
its
political subdivisions
;

(ii)

Comparison of the quality and
pricing
of health care by health care purchasers, including employers and consumers. The department
shall make a subset or summary of the data required to be provided under subsection (a) of this section available for the purposes of this paragraph.
The department
shall
ensure that
the
data

required to be made available under
this paragraph
is
provided
to the public
through an internet website
;

(iii)

Design and evaluation of alternative
health care
delivery and payment models

conducted
by the state of Wyoming
,
research institutions and institutions of higher education
selected by the department
.

(d)

The data required to be
provided under

subsection (a) of
this sectio
n shall be made available in the most detailed form
which complies with federal law, including the Health Insurance Portability and Accountability Act of 1996,
P.L.
104
‑
191
, as amended
.

(e
)

Data made available pursuant to subsection (a) of this section
shall be used
only
for the purposes set forth in subsection (c) of this section
and as otherwise required
by law
. A violation of this
sub
section shall be punis
hed as specified in W.S. 26
‑
43
‑
4
05.
A person may file a complaint relating to a
suspected
violation
of this subsection
with the department in the
manner prescribed by rule.

(f)

An insurer
which fails to
make available
the data required pursuant to subsection (a) of this section shall be subject to a civil penalty
imposed by the department
in the amount of
ten th
ousand dollars ($10,000.00) per transaction or occurrence
.

(g)

An
employee welfare benefit plan

that
is not subject to state regulation
, as defined in 29 U.S.C. 1002,

may

make the data specified under subsection (a) of this section available to the multi
‑
payer claims database
by entering into a written agreement with the department.

26
‑
43
‑
4
04
.

Health claims data access for group purchasers of
private health benefit plans
;
standards
;
civil
penalty
for failure to make data available
.

(a)

Notwithstanding any contract or provision of law which provides for the confidentiality of the information
described in this section, an insurer which provides coverage to a group purchaser of
a private health benefit plan
shall,
at no charge and
not more than twice
per year, provid
e to the group purchaser upon
written request:

(
i
)

All claims data relating
to

benefits
paid
by the insurer
on behalf of

persons covered by the
private health benefit plan,

pursuant to a contract with the group purchaser
,
over the
preceding
six (6) months
;

(ii)

Sufficient data relati
ng to th
e claims of persons covered by the
private health benefit plan to
allow the group purchaser
of the plan
to calculate the cost

effectiveness of benefits provided by the insurer
over the preceding
six (6) months
. This data shall include:

(A)

Data necessary to calculate the insurer's
actual
rates or allowed costs relating to

health care
drugs, devices and
services
, organized by
drug, device and
service
category
or

category of disease;

(B)

Data relating to demographics, prescriptions, office visits with a health care provider,
inpatient services, outpatient s
ervices, diagnostic procedures and
laboratory tests of
persons covered by the private health benefit plan
;

(C)

Data necessary to make calculations which are required to comply with the risk adjustment, reinsurance and risk corridor requirements of 42 U.S.C. 18061
through
18063
, as applicable
;

(D)

Data used to establish an experience rating for
persons covered by the private health benefit plan
, including coding relating to diagnostics and procedures, the total
amount
charged to any
person, including a health care provider
and the person
covered by the
private health benefit
plan
,
for each drug, device
or service made available to the

person

and all
payments
or

reimbursements made to a health care prov
ider, administrator,
pharmaceutical company, pharmacy benefit manager
or

m
edical device manufacturer
relating to

a
drug, device or service
made available to the
person covered by
the
private health benefit plan
.

(b)

In addition to the data required to be made available under subsection (a)
of this section
, an
insurer shall also provide a
summary
report relating to the
data, including sufficient detail to demonstrate the percentage of increase or decrease
for each category of information
, as applicable, over the preceding five (5) years
or the date on which the insurer first entered into a contract with the group purchaser, whichever is later
.

(c)

An insurer shall provide the data require
d by
subsection (a)
of this section
in:

(
i
)

A
n electronic
fo
rmat which is easily searchable; and

(ii)

T
he most detailed

form which complies with federal law, including the Health Insurance Portability and Accountability Act of 1996,
P.L.
104
‑
191, as amended.

(d
)

A group purchaser shall not disclose the data made available by an insurer under this section to any other person, except a person
under contract with the group purchaser
to assist the purchaser with analysis of the data

and except as otherwise required by law
. A person under contract with a group purchaser
to analyze data
shall not disclose the data made available under this section to any
other
person, except that the person
under contract
may provide a deidentified summary
to a
group purchaser relating to a
data
comparison with other group purchasers.

An insurer shall not require a group purchaser to contract with the insurer to analyze
the
data
made available under this section
and shall not impose any restrictions on analysis of the data which are not
imposed
by this section. A violation of this
sub
section shall be punished as specified in W.S. 26
‑
43
‑
405.
A person may file a complaint relating to a violation
of this subsection
with the department in the
manner prescribed by rule.

(e
)

A group purchaser, and any person under contract with the
group purchaser
, shall have policies and procedures in place which are compliant with federal
law
, including the
Health Insurance Portability and Accountability Act of 1996,
P.L.
104
‑
191, as amended, to ensure the privacy and security of the data made available under this section.

(f
)

An insurer

which fails to
make available
the data required pursuant to subsection (a) of this section shall be subject to a civil penalty imposed by the
department
in the amount of
ten thousand dollars ($10,000.00) per
transaction or occurrence
.

(g
)

An employee welfare benefit plan that is not subject to state regulation, as defined in 29 U.S.C. 1002, may make the data specified under subsection (a) of this section available to group purchasers after entering into a written agreement with the department.

(
h
)

As used in this section, "group purchaser" means:

(
i
)

An employer with not less than fifty (50) employees enrolled in a private health benefit plan issued by an insurer;

(ii)

A group of employers which cumulatively employ not less than fifty (50) employees as part of a
nonfully
funded multipl
e employer welfare arrangement;

(iii)

The state employees' and officials' group health insurance plan; and

(iv)

Any plan made available under W.S. 9
‑
3
‑
201.

26
‑
43
‑
4
05
.

Penalties for misuse of
health claims
data
; applicability
.

(a)

A violation of W.S. 26
‑
43
‑
4
03(e)
or 26
‑
43
‑
4
04(d
) shall be punished as follows:

(
i
)

For a violation committed by a person who did not
h
ave knowledge of the violation
or
failed to exercise reasonable care
under the circumstances
,
the person shall be subject to a civil penalty
imposed
by the
department
of not less than one thousand dollars ($1,000.00) and not more than ten thousand dollars ($10,000.00);

(ii)

Except as otherwise provided by paragraph (iii) of this subsection, for a knowing
violation committed by a person
or a violation based on willful neglect, the violation constitutes a high misdemeanor and shall be
punished by imprisonment for not more than one (1) year, a fine of not more than ten thousan
d dollars ($10,000.00), or both;

(iii)

A knowing violation, or a violation based on willful neglect,
committed by a person

with the intent to use, or allow another person to use, the
health claims
data made available under this article for commercial advantage constitutes a felony and shall be punished by imprisonment for not more than five (5) years, a fine of not more than fifty thousand dollars ($50
,
000.00), or both.

(b)

This section shall not apply to any violation based on
health claims
data which is publicly available at the time of the violation.

26
‑
43
‑
4
06
.

Civil liability for misuse of

health claims
data
; applicability
.

(a)

A
person
injured by
a knowing violation of
W.S. 26
‑
43
‑
4
03
(
e) or
26
‑
43
‑
4
04
(
d
), or a violation of
either
section based on willful neglect, with the intent to use, or allow another person to use,
the

health claims
data
made
available under those sections
for commercial advantage
,
may m
aintain a civil action against
the person who committed the violation
, whether or not the person was convicted of any offense under
W.S. 26
‑
43
‑
4
05
, and recover a
ctual and consequential damages, reasonable
attorney's fees
and court costs
relating to the injury
.

(b)

Except as otherwise provided by the Wyoming Governmental Claims Act, W.S. 1
‑
39
‑
101

through 1
‑
39
‑
120
, this section shall not apply to
an
y
action or inaction

of
an employee or officer of a governmental entity, as defined in W.S. 1
‑
39
‑
103(a)(
i
).

(c)

This section shall not apply to any violation based on health claims data which is publicly available at the time of the violation.

26
‑
43
‑
4
07
.

Promulgation of rules.

The department, in consultation with the department of insurance, shall promulgate rules to
implement
this article.

33
‑
24
‑
159
.

Electronic prescribing system; standards; management by the department of health; promulgation of rules.

(a)

There is created the Wyoming electronic prescribing system.
E
ffective January 1, 2023
, all private health benefit plans and health care providers in this state, in
cluding pharmacists, shall use the Wyoming
electronic prescribing system for transmission of all prescriptions and prescription related data, consistent with applicable federal and state law. Notwithstanding any other provision of law, a prescription transmitted by
the Wyoming electronic prescribing system
pursuant to this section shall be treated as a valid prescription.

(b)

A
prescription transmitted by the Wyoming
electronic
prescribing
system pursuant to subsection (a)
of this section
shall be accompanied by the following information:

(
i
)

The validated electronic signature of the prescriber;

(ii)

The prescriber’s contact information;

(iii)

The date of the transmission;

(iv)

The contact information of the pharmacy intended to receive the transmission;

(v)

Other information required by rule of the department or which is required to be contained in a prescription
or electronic prescribing system
pursuant to
federal
or
state
law.

(c)

Any transmission made under subsection (a) of this section shall be encrypted or transmitted by other technological means
which is readily archivable and
designed to protect
the data
and prevent access, alteration, manipulation or use by an unauthorized perso
n
.

(d)

The department

shall be responsible for the design, maintenance and
operation
of the
Wyoming
electronic prescribing system.

If
determined to be feasible, the department may adapt and expand the computerized program maintained by the board of pharmacy pursuant to W.S.
35
‑
7
‑
1060. The board shall cooperate with the depar
tment to carry out this section.

(e)

T
he department shall ensure that the Wyoming electronic prescribing system complies with the requirements of W.S. 35
‑
7
‑
1060.

(f
)

The department may apply for and accept any gifts, grants or donations to assist in developing and maintaining the Wyoming electronic prescribing system.

(g)

The department shall, in consultation with the board of pharmacy and the office of the attorney general, promulgate rules to implement this section, including establishing the technical and operational requirements of the
Wyoming
electronic
prescribing
system.

(h
)

As used in this section:

(
i
)

"D
epartment" means the department of health c
reated pursuant to W.S. 9
‑
2
‑
101;

(ii)

"Private health benefit plan" means as defined in W.S.
26
‑
43
‑
302
(a)(iv).

35
‑
2
‑
618
.

Health care facility billing.

(a)

Upon request, and not later than
seven (7
) business days after a patient's
discharge

from a health care facility, the facility shall provide to the patient, or the
patient's
representative or legal guardian
, an itemized statement of charges and any procedural or diagnostic codes which relate to the
se
charges.
The bill shall contain a due date for the
itemized
charges, unit price data on rates charged by the facility and projected
payments or
reimbursements

which may
be made by an insurer for the charges. The statement
shall
also identify any facility charge or miscellaneous charges and explain the
ir purpose.

(b)

A health care facility shall ensure that all charges for
drugs, devices and services made available
by
any
health care
provider

during
an
episode of care at the facility are contained in a single bill which is provided to the patient
, consistent with subsection (a) of this
section
.
As used in
this subsection,
"episode of care" means
one (1)
visit or admission to a health care facility.

(c)

A health care facility shall make available to
a patient
a standard list of charges for
drugs, devices and services
at the facility
and any facility charge or miscellaneous charges
which may be imposed
. The facility shall

annually
update this list and
notify all
patients in writing of the requirement
s
of this subsection.

(d)

The department shall promulgate rules to
implement
this section.

ARTICLE 22
PRESCRIPTION DRUG IMPORTATION PROGRAM

35
‑
7
‑
2201
.

Prescription drug importation program.

(a)

There is created the prescription drug importation program.
To the extent authorized by federal law and notwithstanding any other provision of state law, the department of health shall:

(
i
)

Identify
three (3)
prescription drugs
,
excluding

any schedule II
controlled substances
as defined in W.S. 35
‑
7
‑
1002(a)(iv),
with the highest potential for consumer savings through importation from
outside the United States
;

and

(ii)

Conduct a limited prescription drug importation program

relating to the prescription drugs identified in paragraph (
i
) of this subsection
to benefit

not more than five (5) counties within this state

which face
high prescription drug costs,
as determined by the department.

(b)

The department of health shall:

(
i
)

E
nsure that only drugs meeting United States food and drug admin
istration safety and
effectiveness standards are i
mported under subsection (a)
of this section
;

(ii)

Consult with

representatives of the pharmaceutical industry, patient advocates and any other
re
levant persons or organizations before implementing this section;

(iii)

Apply for
any
necessary federal permit, waiver, certification or other authorization
necessary
to carry out this section
,
which may include
approval under 21 U.S.C.
384(l);

(iv)

If necessary, establish a process to ensure t
he purity, chemical

composition
and potency of imported prescription drugs;

(v)

Ensure that imported prescription drugs will not be
distributed, dispensed
or sold outside of Wyoming;
and

(vi)

Comply with any applicable federal laws, including laws relating to patents and prescription drug security and tracing requirements.

(c)

To cover any administrative expenses, t
he department of health may charge a fee to a distribut
or or a consumer who receives an imported
prescription drug under
this section, unless doing so would not be cost

effective for the consumer
, based on the cost of the prescription drug in the United States
.

The department shall deposit fees collected under this section in the account created pursuant to subsection (d) of this section.

(d)

There is created the prescription drug importation account.

Funds remitted to the account pursuant to subsection (c) of this section shall be used by the department of health to implement this section. The account may be divided into subaccounts for purposes of administrative management. Funds in the account are continuously appropriated and shall not lapse at the end of any fiscal period. Interest accruing to this account shall be retained in the account and shall be expended for the purposes provided in this section.

(e)

The department
of health
may enter into contracts to implement this section, including contracts with distributors and contracts with insurers to make coverage under a private health benefit plan available for imported prescription drugs under this section. As used in this
subsection, "insurer" and "private health benefit plan" m
ean as defined in W.S. 26
‑
43
‑
302
(a).

(f)

The provisions of W.S. 33
‑
24
‑
153, and any regulations adopted under that section, shall not apply to the department of health, or any person under contract with the department, while acting as an importer or distributor of
imported
prescription drugs under this section.

(g
)

The board of pharmacy, department of revenue and department of agriculture shall cooperate with the department of health to implement this section.

(h
)

The
department
of health
may promulgate rules to implement this section.

42
‑
4
‑
122
.

Me
dical assistance
buy
‑
in program;
standards;

promulgation of rules.

(a)

To the extent authorized by federal law, the department
of health
shall make coverage through medical assistance available for purchase to any person who is not otherwise eligible for medical assistance:

(
i
)

Through an application made to the department in a manner established by rule;

(ii
)

If the secretary of the United States department of health and human services grants any necessary waiver, through the federal health benefits exchange established by
the United States department of health and human services pursuant to the Patient Protection and Affordable Care Act,
P.L.
1
11
‑
148
, as amended
.

(b)

The
monthly
premium
charged to a person who purchases coverage through medical assistance shall be set by the department
of health
at an amount which ensures the program established pursuant to this section can fund all necessary expenses and is actuarially sound.
The department may age
rate the premium
according to cost.
The department
shall
maintain an appropriate reserve and may impos
e a limited co
pay
ment, co
insurance or other cost
‑
sharing
requirement
to fund a
reserve.

(c)

A person who purchases coverage
under
this section shall receive the same benefits as those received by persons who are
determined to be
eligible for medical assistance
pursuant to W.S. 42
‑
4
‑
106
, the state plan for medical assistance and
federal law
.

(d)

The purchase of coverage under
this section
shall only take place during an annual open enrollment period
fixed
by the department of health
pursuant to

rule.

(e
)

The department
of health
shall allow employers to make
a contribution
toward the premium established under subsection (b) of this section on behalf of an em
ployee, if the employee chooses, in writing,
to forgo enrollment in any
private health benefit plan

offered
to the employee
by the employer
.
If the secretary of the United States department of health and human services grants any necessary waiver
and unless 26 U.S.C. 4980H or the imposition contained within that section is repealed,
the department shall
notify
an employer
subject to 26 U.S.C. 4980H
who makes a
substantial
contribut
ion under this
sub
section that the
requirements of
that section
have been waived with respect to that employer
.

(f
)

Except as authorized by f
ederal law and
any waiver granted by the United States department of health and human services
and then only as appropriated by the legislature and available for expenditure
, the department
of health
shall not use any federal funds to
implement
this section.

(g
)

If
the standards of subsection (f) of this section are met
, any
federal
savings
obtained
by the state of Wyoming from a federal
waiver
shall be used to

implement
this section
.

(
h
)

Notwithstanding any other provision of law,
a person who purchases coverage through medical assistance under this section
shall not be subject to the following provisions
:

(
i
)

W.S. 42
‑
2
‑
401 through 42
‑
2
‑
405 and any other eligibility criteria relating to medical assistance which is not contained in this section or
is not
required by federal law; and

(ii)

W.S. 42
‑
4
‑
106(b) and 42
‑
4
‑
201 through 42
‑
4
‑
208.

(
j
)

A person shall not be eligible to purchase coverage through this section if the person is eligible for medical assistance under W.S. 42
‑
2
‑
401 through 42
‑
2
‑
4
05 or if the person is currently enrolled in a private health benefit plan for the period in which the person is seeking to purchase coverage under this section.

(
k
)

The department
of health
sha
ll p
romulgate rules to
implement
this section
, including establishing the characteristics of a substantial
contribution under subsection (e
) of this section
.

(m)

As used in this subsection, "private health benefit plan" means as defined in W.S. 26
‑
43
‑
302(a)(iv)
.

42
‑
4
‑
123
.

Medica
l assistance
prescription drug program
for insurers
;
standards;
promulgation of rules
.

(a)

The department of health shall make prescription drug services

under medical assistance
, which may include
the purchase of prescription drugs or
services otherwise provided by a pharmacy benefit manager,
available
for a fee
to
any
insurer which
issues a

private health benefit plan.
As used in this subsection, "insurer" and "private health benefit plan"
mean as defined
in W.S. 26
‑
43
‑
302
(a)
.

(b)

The fee
for services made available pursuant to subsection (a) of this section shall be set by the department of health at an amount not more than that which ensures the program established pursuant to this section can fund all necessary expenses, is actuarially sound and maintains an appropriate reserve.

(c)

No federal funds shall be used to
implement
this section.

(d
)

The department of health shall promulgate rules to
implement
this section.

(e
)

As
used in this section, "pharmacy benefit manager" means an entity that contracts with a pharmacy on behalf of an insurer or third party administrator to administer or manage prescription drug benefits.

42
‑
5
‑
103
.

Outreach
to specified p
ersons regarding contraceptive services and supplies
.

(a)

The department of health shall periodically conduct outreach to persons between thirteen (13)
and eighteen (18) years of age
who receive coverage through medical assistance
pursuant to
W.S. 42
‑
4
‑
101 through 42
‑
4
‑
121, or through
the child health insurance program pursuant to W.S. 35
‑
25
‑
101 through 35
‑
25
‑
108,
and the pa
rents or legal guardians of these
persons,
regarding the availability of contraceptive
services and supplies under tho
se programs.

(b)

The department of health shall promote the use of long acting reversible contraceptives to community health organizations and to persons who receive coverage through medical assistance and the child health insurance program, including
as a component of

the
outreach
conducted
under subsection (a) of this section.

Section 2
.

W.S.

9
‑
3
‑
203(a)(iv)
,
(xvi)
,

by creating a new paragraph
(xvii) and by
amending and
renumbering (xvii)
as
(xviii),
9
‑
3
‑
210
(e)
,
9
‑
3
‑
217,
21
‑
4
‑
316
(e)(v),
26
‑
18
‑
106
by creating a new subsection (d),
26
‑
18
‑
306, 26
‑
19
‑
306(c
)(iii),
26
‑
22
‑
202(a)(xv),
26
‑
34
‑
102(a)(xxix),
35
‑
2
‑
605(a)(xiv),
40
‑
12
‑
105 by
creating
a new subsection (b),
42
‑
4
‑
102(a)(iii),
42
‑
4
‑
106
(b)
and
42
‑
4
‑
110
are amended to read:

9
‑
3
‑
203
.

Definitions.

(a)

As used in this act:

(iv)

"Employee" means any employee of a participating school district or participating board of cooperative educational services whose salary is paid by funds of the district or board,
or
any official or employee
of a political subdivision
of the state of Wyoming
or any official or employee

of the state of Wyoming whose salary is paid by state funds, including employees and faculty members of the University of Wyoming and various community colleges in the state, except persons employed on intermittent, irregular, or less than halftime basis and any at
‑
will contract employee who does not meet the requirements established under W.S. 9
‑
2
‑
1022(a)(xi)(F)(III)
or (IV).

"Employee" shall not include employees of the agricultural extension service of the University of Wyoming who hold federal civil service appointments, are required to participate in federal civil service retirement and who elect to participate in the federal employees' health benefit program as authorized in W.S. 9
‑
3
‑
210(d);

(xvi)

"Voluntary participating employer" includes a participating board of cooperative educational services
,

and
a

participating school district
or
a
ny other
political subdivision

of the state of Wyoming
;

(xvii)

"Political subdivision" means

a county, municipality, special district or other local government entity of the state of Wyoming;

(xvii)
(xviii)

"This act" means W.S. 9
‑
3
‑
202 through
9
‑
3
‑
218

9
‑
3
‑
219
.

9
‑
3
‑
210
.

Amount of state's contribution; estimates submitted to state budget officer; specified employees participation in federal
program; participating employer and resident
contributions.

(e)

A participating school district
or
other participating
political subdivision

shall pay to the department the monthly premium established by the department for coverage of each eligible employee or official of that district
or subdivision

electing to become covered by any portion of the group insurance plan. Monthly premiums shall be at minimum no less than rates assessed for coverage of other enrollees qualified under W.S. 9
‑
3
‑
203(a)(iv), and shall be based upon information reported by the participating district
or political subdivision

to the department, to be in a form and manner prescribed by the department.

9
‑
3
‑
217
.

Advisory panel; composition; compensation.

(a)

The director of the department shall establish an advisory panel consisting of active plan participants employed by the state, participating school districts
and political subdivisions
, the University of Wyoming and Wyoming community colleges and of retired employees who are plan participants. The panel shall consist of no more than ten (10) members if there are less than five (5)
participating school districts
or political subdivisions

or no more than twelve (12) members if there are at least five (5) participating school districts

or political subdivisions
and, insofar as possible, shall proportionally represent the specified employee groups participating in the group health insurance plan. The advisory panel shall be consulted regarding plan benefits and costs. The director of the department shall, upon receiving notification from at least five (5) school districts
or political subdivisions

electing group insurance plan participation under W.S. 9
‑
3
‑
201(e), appoint two (2) additional advisory panel members to increase the advisory panel to twelve (12) members as provided in this section.

(b)

State, participating school district
,

political subdivision and
university and community college
employee
officers and employees who serve as
members of the panel shall suffer no loss of wages for the time devoted to attending meetings of the panel called by the department. All members shall be provided per diem and travel expenses incurred for attending such meetings at the rates provided under W.S. 9
‑
3
‑
102 and 9
‑
3
‑
103.

21
‑
4
‑
316
.

Administration of stock epinephrine auto
‑
injectors.

(e)

As used in this section:

(v)

"Stock epinephrine"
or "epinephrine auto
‑
injector"
means injectable medications used for the treatment of severe, life
‑
threatening allergies that schools or districts buy and keep on
‑
site for emergency use
, and
may
include any type or brand of injector
, including a generic equivalent, which has been
a
pproved
by the United States food and drug administration for epinephrine delivery
.

26
‑
18
‑
106
.

Time limit on certain defenses; applicability.

(d)

Subsections (b) and (c) of this section shall not apply to a private health benefit plan
governed by
W.S. 26
‑
43
‑
305
.

26
‑
18
‑
306
.

Conflict with other code provisions.

(a)

If the provisions of this article conflict with
W.S. 26
‑
43
‑
301 through 26
‑
43
‑
305
or any other provision implementing those statutes, this article shall not control.

(b)

If the provisions of this article conflict with any other provision of this code, the provisions of this article shall control.

26
‑
19
‑
306
.

Availability of coverage.

(c)

All health benefit plans covering small employers shall comply with the following provisions:

(iii)

Late enrollees may be excluded from coverage for
the greater of
eighteen (18) months
;

or an eighteen (18) month preexisting condition exclusion, provided that if both a period of exclusion from coverage and a preexisting condition exclusion are applicable to a late enrollee, the combined period shall not exceed eighteen (18) months
;

26
‑
22
‑
202
.

Issuance of a converted policy; conditions.

(a)

Issuance of a converted policy is subject to the following conditions:

(xv)

Maternity benefits may be included at the insured's option
;
and may be subject to the preexisting conditions limitations as discussed under paragraph (v) of this subsection
;

26
‑
34
‑
102
.

Definitions.

(a)

As used in this chapter:

(xxix)

"This act" means W.S. 26
‑
34
‑
101 through
26
‑
34
‑
134
26
‑
34
‑
136
.

35
‑
2
‑
605
.

Definitions.

(a)

As used in this act, unless the context otherwise requires:

(xiv)

"This act" means W.S. 35
‑
2
‑
605 through
35
‑
2
‑
617
35
‑
2
‑
618
.

40
‑
12
‑
105
.

Unlawful practices.

(b)

It is unlawful for a health care
provider
or debt collecto
r to impose an interest rate
greater than the prime rate of interest plus three percent (3%) on any health care related charge
or debt
. As used in this subsection:

(
i
)

"Debt collec
tor" means a
person employed or engaged by a collection agency to perform
the collection of debts owed,
due or asserted to be owed or due to another, including any owner or shareholder of the collection agency business who engages in the collection of debts;

(ii)

"Prime rate of interest" means
the interest rate listed in the first edition of the Wall Street Journal published in a calendar year, unless the prime rate is not listed in that edition of the Wall Street Journal, in which case any reasonable determination of the prime rate on the first day of the year may be used;

(iii)

"
H
ealth care
provider
" means
a person
or facility
who is licensed, certified or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession
, and includes a person who provides air ambulance evacuation
.

42
‑
4
‑
102
.

Definitions.

(a)

As used in this chapter:

(iii)

"Qualified" means any categorically eligible individual satisfying eligibility criteria imposed by this chapter, the state plan for medical assistance
and services
and by rule and regulation of the department

and shall include a
person who purchases coverage through medical assistance
pursuant to W.S. 42
‑
4
‑
122(a),
to the extent
necessary to implement

that section
;

42
‑
4
‑
106
.

Application for assistance; determination of eligibility; assignment of benefits; resources and income allowances defined for institutionalized spouse.

(b)

Except as otherwise provided in W.S. 42
‑
4
‑
122
(
h
)
(ii)
, u
pon signing an application for medical assistance under this chapter, an applicant assigns to the department any right to medical support or payment for medical expenses from any other person on his behalf or on behalf of any relative for whom application is made. The assignment is effective upon a determination of eligibility. Application for medical assistance shall contain an explanation of the assignment provided under this subsection.

42
‑
4
‑
110
.

Charges for inpatient hospital services.

Except as otherwise provided in W.S. 42
‑
4
‑
122(b), a
cost deduction, cost sharing or other similar charge shall not be imposed upon any recipient of medical assistance for inpatient hospital services provided on his behalf pursuant to this chapter.

Section 3
.

W.S. 35
‑
7
‑
1060
(a) through
(d
)
is amended to read:

35
‑
7
‑
1060
.

Wyoming electronic prescribing system
‑
controlled substances
.

(a)

In addition to other duties and responsibilities as provided by this act, the board shall maintain a computerized program to
The Wyoming electronic prescribing system created pursuant to
W.S.
33
‑
24
‑
159 shall

track prescriptions for controlled substances for the purposes of assisting patients, practitioners and pharmacists to avoid inappropriate use of controlled substances and of assisting with the identification of illegal activity related to the dispen
sing of controlled substances.

The tracking program and any data created thereby shall be administered by the board, and the board may charge reasonable fees to help defray the costs of operating the program. Any fee shall be included with and in addition to other registration fees established by the board as authorized in W.S. 35
‑
7
‑
1023.

(b)

All prescriptions for schedule II, III and IV controlled substances dispensed by any retail pharmacy licensed by the board shall be filed with the

board electronically or by other means required by the board

Wyoming electronic prescribing system

no later than the
close of business on the business day immediately following the day the controlled substance was dispensed.
The board may require the filing of other prescriptions and may specify the manner in which the prescriptions are filed.

(c)

The
tracking program

Wyoming electronic prescribing system

shall not be used to infringe on the legal
use of a controlled substance.
Information obtained

through the controlled substance prescription tracking program
pursuant to this section

is confidential and may not be released and is not admissible in any judicial or administrative proceeding, except as follows:

(
i
)

The
board
department

may release information to practitioners and practitioner appointed delegates and to pharmacists and pharmacist appointed delegates when the release of the information may be of assistance in preventing or avoiding inappropriate use of controlled substances;

(ii)

The
board
department

shall report any information that it reasonably suspects may relate to fraudulent or illegal activity to the appropriate law
enforcement agency and the relevant occupational licensing board;

(iii)

The
board
department

may release information to the patient to whom the information pertains or his agent or, if the patient is a minor, to his parents or guardian;

(iv)

The
board
department

may release information to a third party if the patient has signed a consent specifically for the release of his controlled substance prescription information to the specific third party;

(v)

The
board
department

may release information that does not identify individual patients, practitioners, pharmacists or pharmacies, for educational, research or public information purposes; and

(vi)

Subject to the rules of evidence, information obtained
from the program
under this subsection

is admissible in a criminal proceeding or an administrative proceeding involving professional licensing.

(d)

Unless there is shown malice, gross negligence, recklessness or willful and wanton conduct in disclosing information collected under this
act

section regarding controlled substance information
, the
board

department
, any other state agency and any other person or entity in proper possession of information as provided by this section shall not be subject to any civil or criminal liability or action for legal or equitable relief.

Section 4
.

W.S. 26
‑
19
‑
107(a)(xi), (f), (g) and (m), 26
‑
19
‑
201(a)(ii), 26
‑
19
‑
302(a)(xix), 26
‑
19
‑
304(d)(iv), 26
‑
19
‑
306(c)(
i
)
,
(ii) and (j), 26
‑
22
‑
202(a)(iii)(C), 35
‑
7
‑
1060(e) and 2013 Wyoming Session Laws, Chapter 116, Section 5 are repealed.

Section
5
.

(a)

The department of health shall apply to the secretary of the United States department of health and human services for any waiver necessary under 42 U.S.C. 1315 or 18052, as applicable, to implement W.S. 42
‑
4
‑
122, including to allow:

(
i
)

Coverage under medical assistance to be made available for purchase on the
federal health benefits exchange established by the United States department of health and human services pursuant to the Patient Protection and Affordable Care Act,
P.L.
111
‑
148, as amended, by a person who is not otherwise eligible for medical assistance;

(ii)

A person who is determined eligible pursuant to 45 C.F.R. 155.305 for advance premium tax credits and cost
‑
sharing reductions, if available, to use those credits and reductions to purchase coverage through medical assistance on the federal health benefits exchange in the manner set forth in W.S. 42
‑
4
‑
122, provided that, any cost
‑
sharing reductions made available under this paragraph shall be provided to the state of Wyoming to make coverage available under W.S. 42
‑
4
‑
122;

(iii)

An
employer to make a contribution toward the premium established under W.S. 42
‑
4
‑
122(b) on behalf of an employee and for a substantial contribution to satisfy the requirements of 26 U.S.C. 4980H, provided that no
waiver relating to the satisfaction of 26 U.S.C. 4980H shall be sought if that section or the imposition contained within that section is repealed;

(iv)

If applicable, the state of Wyoming to use any federal savings made available from the implementation of this waiver as pass

through funds to administer W.S. 42
‑
4
‑
122.

Section
6
.

(a)

The governor, the director of the department of health and the insurance commissioner shall collaborate with the secretary of the United States department of health and human services and the centers for Medicare and Medicaid services to explore options for the expansion of:

(
i
)

Medical assistance eligibility to one hundred thirty
‑
three percent (133%) of the federal poverty level, plus any applicable income disregard, as authorized by 42 U.S.C. 1396a(a)(10)(A)(
i
)(VIII); and

(ii)

Child health insurance program eligibility to three hundred percent (300%) of the federal poverty level, plus any applicable income disregard, as authorized by 42 U.S.C. 1397ee
.

(b)

If the collaboration required by subsection (a) of this section reveals viable and fiscally advantageous options for the expansion of medical assistance or child health insurance program eligibility in Wyoming, the department of health, with the approval of the governor, is authorized to pursue necessary and prudent state plan amendments and federal waivers for any expansion to take place.

(c)

Prior to making an application to expand eligibility under any program pursuant to subsection (b) of this section, the director of the department of health shall provide written notice to the speaker of the house of representatives and the president of the senate. The director also shall provide a report to the joint labor, health and social services interim committee and the joint appropriations committee detailing the reasons for any proposed expansion, the means by which any proposed
expansion may be approved, any necessary funding and the reasons that any expansion is viable and fiscally advantageous for Wyoming. The notice and report required under this subsection shall be submitted in sufficient time to allow the legislature to have adequate notice to call a special session for the consideration of any expansion and prior to the effective date of any federal obligations which may be binding on the state.

(d)

This section is repealed effective January 1, 2020, or on the date an amendment or repeal of 42 U.S.C. 1396a(a)(10)(A)(
i
)(VIII) is enacted into law, whichever is earlier.

Section
7
.

(a)

The department of health shall study the following topics and issue reports to the joint labor, health and social services interim committee by the dates specified:

(
i
)

Not later than October 1, 2018, the current quality and availability of telemedicine in Wyoming and strategies for improving this service;

(ii)

Not later than October 1, 2018, opportunities for pharmacists to provide limited primary care services, which may include vaccinations, treatments relating to the common cold and minor forms of influenza and testing for common maladies;

(iii)

Not later than July 1, 2019,
the department's decision to establish or join a multi
‑
payer claims database, as required by W.S. 26
‑
43
‑
403; and

(iv)

Not later than July 1 of each year from 2019 through 2028, an update on the implementation of W.S. 42
‑
4
‑
122 and 42
‑
4
‑
123.

(b)

Not later than November 1, 2018, and pursuant to the requirements of W.S. 35
‑
7
‑
2201 as created by this act, the department of health shall study the manner in which to gain approval for the state of Wyoming to import prescription drugs from outside the United States for use
by Wyoming consumers and issue a report to the joint labor, health and social services interim committee. As a component of this study and report, the department shall:

(
i
)

Determine how the state of Wyoming can become certified by the United States
department
of health and human services to operate a prescription drug importation program, including under 21 U.S.C. 384(l);

(ii)

Determine how to ensure that only drugs meeting United States food and drug administration safety, effectiveness and other related standards are imported as part of this program;

(iii)

Identify prescription drugs, excluding
schedule II
controlled substances as defined in W.S. 35
‑
7
‑
1002(a)(iv), with potential for consumer savings through importation from outside the United States
;

(iv)

Estimate potential consumer savings based on importation;

(v)

Determine potential contractors who are capable of distributing imported drugs, if necessary;

(vi)

Determine how to limit the distribution of imported drugs to Wyoming residents;

(vii)

Consult with the department of agriculture, department of revenue, board of pharmacy, representatives of the pharmaceutical industry, patient advocates and any other relevant persons or organizations; and

(viii)

Consult with the attorney general regarding the potential for pharmaceutical manufacturers to manipulate the pharmaceutical

market in
Wyoming
or adversely affect consumer access to pharmaceuticals if prescription drugs were imported into Wyoming.

(c)

The reports required by subsections (a) and (b) of this section shall also include, if necessary, any recommendations for legislative action.

Section 8
.

The department of health shall, if feasible, take any necessary steps to improve the quality and availability of telemedicine in Wyoming, including working with community health organizations to increase awareness and adjusting health care provider reimbursement rates under medical assistance. The department shall inform the joint labor, health and social services interim committee in writing of any actions taken pursuant to this section.

Section 9
.

(a)

Section
s 1 and
2

of this act are effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution only for t
he purposes of promulgating
rules necessary to
implement
tho
se sections, provided these rules shall not take effect until January 1, 2019.

(b)

Section 3 of this act is effective January 1, 2023.

(
c
)

Sections 5, 6, 7
, 8
and 9
of this act are effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.

(d
)

Except as otherwise provided by subsections (a)
,
(b)
and (c)
of this section
,

t
h
is act is effective January 1, 2019.

(END)

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