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StateOral Chemotherapy Parity Law*States with Step Therapy LawsClinical Trials Coverage LawLaws on Balance Billing (ER only or All care)Infertility CoverageFertility Preservation CoverageWho Runs External Appeals Process
ALABAMARun by HHShttps://externalappeal.cms.gov/ferpportal/
ALASKAxhttp://www.akleg.gov/basis/Bill/Detail/29?RootSB%20142xhttp://www.akleg.gov/PDF/29/Bills/SB0113A.PDFRun by State Agency https://www.commerce.alaska.gov/web/ins/Consumers/Health/ExternalHealthcareReview.aspx
ARIZONAxhttps://www.azleg.gov/legtext/51leg/2r/laws/0255.pdfxhttps://apps.azleg.gov/BillStatus/GetDocumentPdf/59648All carehttps://apps.azleg.gov/BillStatus/GetDocumentPdf/453367Run by State Agency https://insurance.az.gov/consumers/help-problem/filing-health-care-appeal
ARKANSASxhttp://www.arkleg.state.ar.us/assembly/2017/2017R/Bills/HB1592.pdfHas an Override Processhttps://www.arkleg.state.ar.us/Bills/Document?type=pdf&chamber=SB&source=Bills&bill=665&ddBienniumSession=2017%2F2017Rxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agency https://insurance.arkansas.gov/uploads/pages/er_faq2.pdf
CALIFORNIAxhttps://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id201320140AB219Some Legal Protectionshttp://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB374xhttp://www.leginfo.ca.gov/pub/01-02/bill/sen/sb_0001-0050/sb_37_bill_20010810_chaptered.htmlAll carehttps://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB600Run by State Agency http://www.insurance.ca.gov/01-consumers/150-other-prog/001-ahb/appeal-process.cfm
COLORADOxhttps://legiscan.com/CO/text/HB1202/2010Prohibits Step Therapyhttps://leg.colorado.gov/sites/default/files/2017a_203_signed.pdfxhttp://www.leg.state.co.us/clics/clics2009a/csl.nsf/fsbillcont/23DE7C72ECC7D6FF87257537001A369F?Open&file1059_enr.pdfAll carehttp://leg.colorado.gov/sites/default/files/2019a_1174_signed.pdfxhttps://leg.colorado.gov/sites/default/files/documents/2020A/bills/2020a_1158_enr.pdfRun by State Agencyhttps://drive.google.com/file/d/0BwguXutc4vbpMlZYWkxjWll2TGM/view
CONNECTICUTxhttps://law.justia.com/codes/connecticut/2012/title-38a/chapter-700c/section-38a-504Has an Override Processhttps://www.cga.ct.gov/2014/act/pa/2014PA-00118-R00SB-00394-PA.htmxhttps://www.cga.ct.gov/2001/act/Pa/2001PA-00171-R00SB-00325-PA.htmAll carehttps://www.cga.ct.gov/current/pub/chap_700c.htmxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.allianceforfertilitypreservation.org/state-legislation/connecticutRun by State Agencyhttps://portal.ct.gov/CID/Consumer-Affairs/How-To-Guides/How-and-When-to-File-an-External-Review
DELAWARExhttps://delcode.delaware.gov/title18/c033/sc01/index.shtmlHas an Override Processhttps://legiscan.com/DE/text/HB105/2019xhttps://legis.delaware.gov/BillDetail/11875ER onlyhttps://delcode.delaware.gov/title18/c033/sc01/index.shtmlxhttps://delcode.delaware.gov/title18/c035/sc03/index.shtmlxhttp://delcode.delaware.gov/title18/c033/sc01/index.shtmlRun by State Agencyhttps://insurance.delaware.gov/divisions/consumerhp/ihcap/
*DISTRICT OF COLUMBIAxxhttp://www.dccouncil.washington.dc.us/images/00001/20080314142746.pdfRun by State Agencyhttps://dhcf.dc.gov/publication/grievancesappeals-0
FLORIDAxhttp://www.flsenate.gov/Session/Bill/2013/301/BillText/c1/PDFSome Legal Protectionshttps://www.flsenate.gov/Session/Bill/2019/559/BillText/c1/PDFx Agreementhttp://www.bcbsfl.com/DocumentLibrary/Providers/Content/ClinicalTrial.pdfAll carehttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.64194.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
GEORGIAxhttp://www.legis.ga.gov/Legislation/20132014/144444.pdfHas an Override Processhttp://www.legis.ga.gov/Legislation/20192020/187554.pdfx Agreementhttp://www.legis.ga.gov/legis/2003_04/gacode/33-24-59.1.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
HAWAIIxhttps://law.justia.com/codes/hawaii/2013/title-24/chapter-432/Prohibits Step Therapy for Patients with Stage 2 Cancerhttps://www.capitol.hawaii.gov/session2020/bills/SB493_HD1_.HTMxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlLegislation Pendinghttp://www.allianceforfertilitypreservation.org/state-legislation/hawaiiRun by State Agencyhttps://cca.hawaii.gov/ins/external-review-of-health-plan-disputes/
IDAHORun by State Agencyhttps://doi.idaho.gov/Consumer/FAQ/ExternalReviewFAQ
ILLINOISxhttp://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID1249&ChapterID22Has an Override Processhttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=099-0761xhttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name093-1000All carehttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=096-1523xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.ilga.gov/legislation/publicacts/100/PDF/100-1102.pdfRun by State Agencyhttp://insurance.illinois.gov/ExternalReview/ExternalReviewMain.html
INDIANAxHas an Override Processhttp://iga.in.gov/legislative/2016/bills/senate/41xhttp://www.in.gov/legislative/bills/2009/HE/HE1382.1.htmlAll care (effective July 1, 2020)http://iga.in.gov/legislative/2020/bills/house/1004Run by State Agencyhttps://www.in.gov/idoi/3008.htm
IOWAxhttps://www.legis.iowa.gov/legislation/BillBook?ga83&baSF%20478Has an Override Processhttps://www.legis.iowa.gov/docs/code/514F.7.pdfxhttps://www.legis.iowa.gov/legislation/BillBook?ga83&baHF2075ER onlyhttps://www.legis.iowa.gov/docs/code/514C.16.pdfRun by State Agencyhttps://iid.iowa.gov/external-review
KANSASxhttps://www.ksrevisor.org/statutes/chapters/ch40/040_002_0184.htmlSome Legal Protectionshttp://www.kslegislature.org/li_2016/b2015_16/measures/documents/sb402_enrolled.pdfxhttps://www.ksinsurance.org/documents/department/regulations-adopted/article-4/40-4-43.pdfRun by State Agencyhttps://www.ksinsurance.org/documents/department/publications/independent-medical-review.pdf
KENTUCKYxHas an Override Processhttps://apps.legislature.ky.gov/record/12RS/sb114.htmlxLegislation Pendinghttp://www.allianceforfertilitypreservation.org/state-legislation/kentuckyRun by State Agencyhttp://insurance.ky.gov/ppc/Documents/abdappeal071217.pdf
LOUISIANAxhttps://law.justia.com/codes/louisiana/2017/code-revisedstatutes/title-22/Has an Override Processhttps://law.justia.com/codes/louisiana/2018/code-revisedstatutes/title-22/rs-22-1053/xhttps://law.justia.com/codes/louisiana/2006/6/82801.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://www.ldi.la.gov/docs/default-source/documents/publicaffairs/consumerpublications/understanding-your-healthcare-rights.pdf?sfvrsn=45277652_22
MAINExhttp://www.mainelegislature.org/legis/bills/bills_126th/chapters/PUBLIC449.aspHas an Override Processhttp://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP0751&item=3&snum=129xhttp://www.mainelegislature.org/legis/statutes/24-A/title24-Ach56-A.pdfAll carehttp://legislature.maine.gov/legis/bills/bills_129th/billtexts/HP150101.aspRun by State Agencyhttps://www.maine.gov/pfr/insurance/consumer/individuals_families/health/complaints_appeals_externalreviews/external_reviews.html
MARYLANDxSome Legal Protectionshttps://law.justia.com/codes/maryland/2017/insurance/title-15/subtitle-1/section-15-142/xhttp://mgaleg.maryland.gov/webmga/frmMain.aspx?ys1998rs%2fbillfile%2fhb0045.htmAll carehttp://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg§ion=19-710&enactments=falsexhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttps://govt.westlaw.com/mdc/Document/NA2EF98008F6511E8B8BB8A4FADCC9053?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)&bhcp=1Run by State Agencyhttps://insurance.maryland.gov/Consumer/Pages/AppealsAndGrievances.aspx
MASSACHUSETTSxhttps://malegislature.gov/Bills/187/S2363Has an Override Processhttps://malegislature.gov/Bills/191/HD1506.Htmlxhttps://malegislature.gov/Laws/SessionLaws/Acts/2002/Chapter257All carehttps://www.mass.gov/files/documents/2018/03/14/2015-ctr-out-of-network.pdfxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlLegislation Pendinghttps://malegislature.gov/Bills/191/SD1321Run by State Agencyhttps://www.mass.gov/request-an-external-review-of-a-health-insurance-decision
MICHIGANx AgreementRun by State Agencyhttps://difs.state.mi.us/Complaints/ExternalReview.aspx
MINNESOTAxhttps://legiscan.com/MN/text/HF2009/id/1196312Has an Override Processhttps://www.revisor.mn.gov/statutes/cite/62Q.184Non-ERhttps://www.revisor.mn.gov/statutes/cite/62Q.556xhttps://www.revisor.mn.gov/statutes/cite/256b.0625Run by State Agencyhttp://mn.gov/commerce-stat/pdfs/external-review-appeal.pdf
MISSISSIPPIxhttp://billstatus.ls.state.ms.us/documents/2015/html/HB/0900-0999/HB0952SG.htmHas an Override Processhttp://billstatus.ls.state.ms.us/documents/2011/pdf/SB/2700-2799/SB2737SG.pdfAll carehttps://legiscan.com/MS/text/HB374/id/734015/Mississippi-2013-HB374-Enrolled.htmlRun by State Agencyhttps://www.mid.ms.gov/healthcare/external-review.aspx
MISSOURIxhttps://legiscan.com/MO/text/SB668/id/983931Has an Override Processhttps://house.mo.gov/billtracking/bills161/billpdf/intro/HB2029I.PDFxhttp://www.senate.mo.gov/06info/pdf-bill/tat/SB567.pdfER onlyhttps://revisor.mo.gov/main/OneSection.aspx?section=376.690Legislation Pendinghttps://malegislature.gov/Bills/191/SD1321Run by State Agencyhttps://insurance.mo.gov/consumers/health/externalreviewprocess.php
MONTANAxhttps://legiscan.com/MT/text/SB55/2013ER onlyhttps://leg.mt.gov/bills/mca/title_0330/chapter_0020/part_0230/section_0020/0330-0020-0230-0020.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://csimt.gov/your-insurance/health/
NEBRASKAxx AgreementRun by State Agencyhttps://doi.nebraska.gov/sites/doi.nebraska.gov/files/doc/out13261.pdf
NEVADA xhttps://legiscan.com/NV/text/SB266/2013xhttps://www.leg.state.nv.us/73rd/bills/SB/SB29.pdfER onlyhttps://legiscan.com/NV/text/AB469/id/2017524/Nevada-2019-AB469-Enrolled.pdfRun by State Agencyhttp://dhhs.nv.gov/Programs/CHA/ExtRev/External_Review/
NEW HAMPSHIRExhttps://legiscan.com/NH/text/HB508/2015xhttp://www.gencourt.state.nh.us/legislation/2000/sb0409.htmlAll carehttps://www.gencourt.state.nh.us/rsa/html/XXX/329/329-31-b.htmxhttp://gencourt.state.nh.us/bill_status/billText.aspx?sy=2019&id=870&txtFormat=pdf&v=currentRun by State Agencyhttps://www.nh.gov/insurance/consumers/appeals.htm
NEW JERSEYxftp://www.njleg.state.nj.us/20102011/AL11/188_.PDFxhttps://academic.oup.com/jnci/article/92/4/300/2624693All carehttps://www.state.nj.us/dobi/division_consumers/insurance/outofnetwork.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://www.cqstatetrack.com/texis/redir?id=5a94f400a10Run by State Agencyhttps://www.state.nj.us/dobi/division_consumers/insurance/appealcomplaintguide.pdf
NEW MEXICOxhttps://law.justia.com/codes/new-mexico/2006/nmrc/jd_ch59aart22-14353.htmlHas an Override Processhttps://www.nmlegis.gov/Sessions/18%20Regular/final/SB0011.pdfxhttps://www.nmlegis.gov/sessions/01%20Regular/bills/senate/SB0240.htmlAll carehttps://www.nmlegis.gov/Sessions/19 Regular/final/SB0337.pdfRun by State Agencyhttps://www.osi.state.nm.us/index.php/consumer-guide-to-external-review/
NEW YORKxhttps://law.justia.com/codes/new-york/2010/isc/article-32/3221/Has an Override Processhttps://assembly.state.ny.us/leg/?default_fld=&bn=A02834&term=2015&Summary=Y&Actions=Y&Votes=Y&Memo=Y&Text=YAll carehttps://www.nysenate.gov/legislation/laws/FIS/A6xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttps://assembly.state.ny.us/leg/?default_fld=&leg_video=&bn=A02817&term=2019&Summary=Y&Memo=Y&Text=YRun by State Agencyhttps://www.dfs.ny.gov/complaints/file_external_appeal
NORTH CAROLINAxhttps://www.ncleg.net/Sessions/2001/Bills/Senate/HTML/S199v5.htmlER onlyhttps://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_58/Article_3.htmlRun by State Agencyhttps://www.ncdoi.gov/consumers/health-insurance/health-claim-denied/request-external-review
NORTH DAKOTAxhttps://www.legis.nd.gov/assembly/63-2013/interim/15-0117-04000.pdfProhibits Step Therapy for Patients with Metastatic Cancerhttps://www.legis.nd.gov/cencode/t19c02-1.pdf#nameddest=19-02p1-16p3Run by State Agencyhttps://www.nd.gov/ndins/health
OHIOxhttp://archives.legislature.state.oh.us/bills.cfm?ID130_SB_99Has an Override Processhttps://www.steptherapy.com/wp-content/uploads/2019/02/sb265_05_EN-3.pdfxhttp://archives.legislature.state.oh.us/bills.cfm?ID127_SB_186xhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://insurance.ohio.gov/wps/portal/gov/odi/about-us/divisions/consumer-services/health/understanding-health-coverage-external-review-appeal
OKLAHOMAxHas an Override Processhttp://webserver1.lsb.state.ok.us/cf_pdf/2019-20%20ENR/SB/SB509%20ENR.PDFRun by State Agencyhttps://www.ok.gov/oid/Consumers/External_Review_Process/
OREGONxSome Legal Protectionshttps://www.oregonlaws.org/ors/414.637xhttps://www.oregonlaws.org/ors/743A.192All carehttps://www.oregonlegislature.gov/bills_laws/ors/ors743b.htmlRun by State Agencyhttps://dfr.oregon.gov/insure/health/understand/coverage/Pages/if-your-claim-was-denied.aspx
PENNSYLVANIAxOverride Legislation Filedhttps://legiscan.com/PA/text/HB1194/2019ER onlyhttp://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/028/chapter9/subchapHtoc.html&d=reduceRun by HHShttps://externalappeal.cms.gov/ferpportal/
*PUERTO RICOxRun by State Agencyhttp://ocs.gobierno.pr/ocspr/index.php/seguros-de-salud/370
RHODE ISLANDxHas an Override Processhttps://trackbill.com/bill/rhode-island-house-bill-5806-an-act-relating-to-insurance-accident-and-sickness-insurance-policies-step-therapy-protocol-creates-a-thirteen-13-member-commission-to-review-and-recommend-guidelines-for-step-therapy-protocols-and-who-would-report-back-to-the-house-by-march-7-2020-and-would-expire-on-may-7-2020/1717189/xhttps://law.justia.com/codes/rhode-island/2013/title-27/chapter-27-18/section-27-18-74All carehttp://webserver.rilin.state.ri.us/BillText/BillText18/SenateText18/S2077Aaa.pdfxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlxhttp://webserver.rilin.state.ri.us/BillText/BillText17/SenateText17/S0821A.pdfRun by State Agencyhttp://www.eohhs.ri.gov/Consumer/ConsumerInformation/Appeals.aspx
SOUTH CAROLINAx AgreementRun by State Agencyhttps://doi.sc.gov/DocumentCenter/View/2554/Patients-Guide-to-External-Review?bidId=
SOUTH DAKOTAxhttps://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?TypeStatuteChapter&Statute58-17Has an Override Processhttps://mylrc.sdlegislature.gov/api/Documents/66388.pdfRun by State Agencyhttps://dlr.sd.gov/insurance/external_review_health_major_medical.aspx
TENNESSEEOverride Legislation Filedhttp://www.capitol.tn.gov/Bills/111/Fiscal/FM1853.pdfxhttp://www.capitol.tn.gov/Bills/104/Bill/HB0837.pdfRun by State Agencyhttps://www.tn.gov/commerce/tenncare-oversight/mco-dispute-resolution/independent-review-process.html
TEXASxhttps://law.justia.com/codes/texas/2017/insurance-code/title-8/subtitle-e/chapter-1369/Has an Override Processhttps://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB00680I.htmxhttps://capitol.texas.gov/tlodocs/81R/billtext/html/SB00039F.htmAll carehttps://www.tdi.texas.gov/medical-billing/providers.htmlxhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
UTAHxhttps://le.utah.gov/~2013/bills/sbillint/sb0189.pdfProhibits Step Therapy for Patients with Metastatic Cancerhttps://le.utah.gov/~2019/bills/static/SB0241.htmlxhttps://le.utah.gov/~2014/bills/static/HB0347.htmlRun by State Agencyhttps://insurance.utah.gov/consumer/health/independent-review
VERMONTxhttps://law.justia.com/codes/vermont/2012/title08/chapter107/section4089b/Some Legal Protectionshttps://legislature.vermont.gov/statutes/section/08/107/04089ixhttp://www.leg.state.vt.us/docs/legdoc.cfm?URL/docs/2006/acts/ACT003.HTMER onlyhttps://legislature.vermont.gov/statutes/fullchapter/33/065Run by State Agencyhttps://dfr.vermont.gov/consumers/file-complaint/insurance/healthcare-external-appeal
VIRGINIAxhttps://lis.virginia.gov/cgi-bin/legp604.exe?121+ful+CHAP0641+pdfHas an Override Processhttps://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+CHAP0337&191+ful+CHAP0337xhttp://leg1.state.va.us/cgi-bin/legp504.exe?991+ful+CHAP0643All care (effective Jan. 1, 2021)https://legiscan.com/VA/text/SB172/id/2169472Run by State Agencyhttps://www.scc.virginia.gov/boi/omb/ext_review.aspx
WASHINGTONxHas an Override Processhttp://lawfilesext.leg.wa.gov/biennium/2019-20/Pdf/Bills/House%20Passed%20Legislature/1879-S.PL.pdfxhttps://apps.leg.wa.gov/wac/default.aspx?dispotrue&cite284-43All carehttps://www.insurance.wa.gov/surprise-billing-and-balance-billing-protection-actRun by State Agencyhttps://www.insurance.wa.gov/appealing-health-insurance-denial
WEST VIRGINIAxhttp://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdochb2493%20intr.htm&yr2015&sesstypeRS&i2493Has an Override Processhttps://legiscan.com/WV/bill/HB2300/2017xhttp://www.wvlegislature.gov/Bill_Text_HTML/2003_SESSIONS/rs/BILLS/hb2675%20enr.htmER onlyhttp://www.wvlegislature.gov/WVCODE/code.cfm?chap=33&art=25Axhttp://www.resolve.org/family-building-options/insurance_coverage/state-coverage.htmlRun by State Agencyhttps://www.wvinsurance.gov/portals/0/pdf/External Review Request Form 2-4-2016.pdf
WISCONSINxhttps://docs.legis.wisconsin.gov/2013/related/acts/186Has an Override Processhttps://docs.legis.wisconsin.gov/2019/related/acts/12.pdfxhttp://docs.legis.wisconsin.gov/2005/related/proposals/ab617.pdfRun by HHShttps://externalappeal.cms.gov/ferpportal/
WYOMINGxhttps://law.justia.com/codes/wyoming/2016/title-26/chapter-20/article-6/section-26-20-601xhttps://www.wyoleg.gov/2008/Enroll/SF0024.pdfRun by State Agencyhttp://doi.wyo.gov/consumers/consumer-request-for-assistance/medical-claim-denial-external-review-process
GUAMRun by HHShttps://externalappeal.cms.gov/ferpportal/
* Federal law introduced March 14