Bill Text: NY A01500 | 2023-2024 | General Assembly | Introduced
Bill Title: Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas.
Spectrum: Strong Partisan Bill (Democrat 10-1)
Status: (Introduced) 2024-01-03 - referred to insurance [A01500 Detail]
Download: New_York-2023-A01500-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 1500 2023-2024 Regular Sessions IN ASSEMBLY January 17, 2023 ___________ Introduced by M. of A. JEAN-PIERRE, GUNTHER, WILLIAMS, JOYNER, TAYLOR, COOK, DICKENS, McDONOUGH, PEOPLES-STOKES, JACKSON, ZEBROWSKI -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of certain infant and baby formulas The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 21 of subsection (i) of section 3216 of the 2 insurance law, as amended by section 6 of subpart B of part J of chapter 3 57 of the laws of 2019, is amended to read as follows: 4 (21) Every policy that provides coverage for prescription drugs shall 5 include coverage for the cost of enteral, infant and baby formulas for 6 home use, whether administered orally or via tube feeding, for which a 7 physician or other licensed health care provider legally authorized to 8 prescribe under title eight of the education law has issued a written 9 order. Such written order shall state that the enteral, infant and baby 10 formula is clearly medically necessary and has been proven effective as 11 a disease-specific treatment regimen. Specific diseases and disorders 12 for which enteral, infant and baby formulas have been proven effective 13 shall include, but are not limited to, inherited diseases of amino acid 14 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 15 disorders of gastrointestinal motility such as chronic intestinal pseu- 16 do-obstruction; and multiple, severe food allergies including, but not 17 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies 18 to multiple food proteins; severe food protein induced enterocolitis 19 syndrome; eosinophilic disorders; and impaired absorption of nutrients 20 caused by disorders affecting the absorptive surface, function, length, 21 and motility of the gastrointestinal tract. Enteral, infant and baby 22 formulas that are medically necessary and taken under written order from 23 a physician for the treatment of specific diseases shall be distin- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD02931-01-3A. 1500 2 1 guished from nutritional supplements taken electively. Coverage for 2 certain inherited diseases of amino acid and organic acid metabolism as 3 well as severe protein allergic conditions shall include modified solid 4 food products that are low protein, contain modified protein, or are 5 amino acid based that are medically necessary. Coverage for infant and 6 baby formulas for any calendar year or any continuous period of twelve 7 months for any insured individual shall be no less than three thousand 8 dollars. 9 § 2. Paragraph 11 of subsection (k) of section 3221 of the insurance 10 law, as amended by section 14 of subpart B of part J of chapter 57 of 11 the laws of 2019, is amended to read as follows: 12 (11) Every policy that provides coverage for prescription drugs shall 13 include coverage for the cost of enteral, infant and baby formulas for 14 home use, whether administered orally or via tube feeding, for which a 15 physician or other licensed health care provider legally authorized to 16 prescribe under title eight of the education law has issued a written 17 order. Such written order shall state that the enteral, infant and baby 18 formula is clearly medically necessary and has been proven effective as 19 a disease-specific treatment regimen. Specific diseases and disorders 20 for which enteral, infant and baby formulas have been proven effective 21 shall include, but are not limited to, inherited diseases of amino-acid 22 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 23 disorders of gastrointestinal motility such as chronic intestinal pseu- 24 do-obstruction; and multiple, severe food allergies including, but not 25 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies 26 to multiple food proteins; severe food protein induced enterocolitis 27 syndrome; eosinophilic disorders and impaired absorption of nutrients 28 caused by disorders affecting the absorptive surface, function, length, 29 and motility of the gastrointestinal tract. Enteral, infant and baby 30 formulas that are medically necessary and taken under written order from 31 a physician for the treatment of specific diseases shall be distin- 32 guished from nutritional supplements taken electively. Coverage for 33 certain inherited diseases of amino acid and organic acid metabolism as 34 well as severe protein allergic conditions shall include modified solid 35 food products that are low protein, contain modified protein, or are 36 amino acid based that are medically necessary. Coverage for infant and 37 baby formulas for any calendar year or any continuous period of twelve 38 months for any insured individual shall be no less than three thousand 39 dollars. 40 § 3. Subsection (y) of section 4303 of the insurance law, as amended 41 by section 27 of subpart B of part J of chapter 57 of the laws of 2019, 42 is amended to read as follows: 43 (y) Every contract that provides coverage for prescription drugs shall 44 include coverage for the cost of enteral, infant and baby formulas for 45 home use, whether administered orally or via tube feeding, for which a 46 physician or other licensed health care provider legally authorized to 47 prescribe under title eight of the education law has issued a written 48 order. Such written order shall state that the enteral, infant and baby 49 formula is clearly medically necessary and has been proven effective as 50 a disease-specific treatment regimen. Specific diseases and disorders 51 for which enteral, infant and baby formulas have been proven effective 52 shall include, but are not limited to, inherited diseases of amino-acid 53 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 54 disorders of gastrointestinal motility such as chronic intestinal pseu- 55 do-obstruction; and multiple, severe food allergies including, but not 56 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergiesA. 1500 3 1 to multiple food proteins; severe food protein induced enterocolitis 2 syndrome; eosinophilic disorders; and impaired absorption of nutrients 3 caused by disorders affecting the absorptive surface, function, length, 4 and motility of the gastrointestinal tract. Enteral, infant and baby 5 formulas that are medically necessary and taken under written order from 6 a physician for the treatment of specific diseases shall be distin- 7 guished from nutritional supplements taken electively. Coverage for 8 certain inherited diseases of amino acid and organic acid metabolism as 9 well as severe protein allergic conditions shall include modified solid 10 food products that are low protein, contain modified protein, or are 11 amino acid based that are medically necessary. Coverage for infant and 12 baby formulas for any calendar year or any continuous period of twelve 13 months for any insured individual shall be no less than three thousand 14 dollars. 15 § 4. The opening paragraph of paragraph 25 of subsection (b) of 16 section 4322 of the insurance law, as amended by chapter 388 of the laws 17 of 2013, is amended to read as follows: 18 Prescription drugs, obtained at a participating pharmacy under a 19 prescription written by an in-plan or out-of-plan provider, including 20 contraceptive drugs or devices approved by the federal food and drug 21 administration or generic equivalents approved as substitutes by such 22 food and drug administration [and], nutritional supplements (formulas), 23 whether administered orally or via a feeding tube for the therapeutic 24 treatment of phenylketonuria, branched-chain ketonuria, galactosemia and 25 homocystinuria[, obtained at a participating pharmacy under a26prescription written by an in-plan or out-of-plan provider] and infant 27 and baby formulas for home use for which a physician or other licensed 28 health care provider legally authorized to prescribe under title eight 29 of the education law has issued a written order. Such written order 30 shall state that the infant or baby formula is clearly medically neces- 31 sary and has been proven effective as a disease-specific treatment regi- 32 men for those individuals who are or will become malnourished or suffer 33 from disorders, which if left untreated, cause chronic physical disabil- 34 ity, mental retardation or death. Specific diseases for which infant and 35 baby formulas have been proven effective shall include, but are not 36 limited to, inherited diseases of amino acid or organic acid metabolism; 37 Crohn's Disease; gastroesophageal reflux with failure to thrive; disor- 38 ders of gastrointestinal motility such as chronic intestinal pseudo-ob- 39 struction; and multiple, severe food allergies which if left untreated 40 will cause malnourishment, chronic physical disability, mental retarda- 41 tion or death. Infant and baby formulas which are medically necessary 42 and taken under written order from a physician for the treatment of 43 specific diseases shall be distinguished from nutritional supplements 44 taken electively. Coverage for infant and baby formulas for any calendar 45 year or any continuous period of twelve months for any insured individ- 46 ual shall be no less than three thousand dollars. Health maintenance 47 organizations, in addition to providing coverage for prescription drugs 48 at a participating pharmacy, may utilize a mail order prescription drug 49 program. Health maintenance organizations may provide prescription drugs 50 pursuant to a drug formulary; however, health maintenance organizations 51 must implement an appeals process so that the use of non-formulary 52 prescription drugs may be requested by a physician or other provider. 53 § 5. This act shall take effect on the first of January next succeed- 54 ing the date on which it shall have become a law and shall apply to all 55 policies and contracts issued, renewed, modified, altered, or amended on 56 or after such date.
