Bill Text: NY A02451 | 2021-2022 | General Assembly | Introduced


Bill Title: Relates to coverage for the treatment of asthma.

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced) 2021-01-19 - referred to insurance [A02451 Detail]

Download: New_York-2021-A02451-Introduced.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                          2451

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                    January 19, 2021
                                       ___________

        Introduced by M. of A. REYES, LUPARDO, BARRON, DAVILA, SEAWRIGHT, SIMON,
          O'DONNELL,  DARLING  --  read  once  and  referred to the Committee on
          Insurance

        AN ACT to amend the social  services  law  and  the  insurance  law,  in
          relation to coverage for the treatment of asthma

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Paragraph (r) of subdivision 2  of  section  365-a  of  the
     2  social  services  law, as added by section 32 of part C of chapter 58 of
     3  the laws of 2008, is amended to read as follows:
     4    (r) asthma self-management training services for persons or parents of
     5  persons diagnosed with asthma including information  on  proper  use  of
     6  devices such as spacers, valved holding chambers and masks, and triggers
     7  in  the  environment  which  should  be  avoided  or  managed, when such
     8  services are ordered by a physician, registered  physician's  assistant,
     9  registered  nurse  practitioner,  or  licensed midwife and provided by a
    10  licensed, registered, or certified health care professional,  as  deter-
    11  mined  by  the  commissioner  of  health,  who is certified as an asthma
    12  educator by the National  Asthma  Educator  Certification  Board,  or  a
    13  successor  national  certification  board;  provided,  however, that the
    14  provisions of this paragraph shall not take effect unless all  necessary
    15  approvals under federal law and regulation have been obtained to receive
    16  federal  financial  participation  in  the costs of health care services
    17  provided pursuant to this paragraph.  Nothing in this paragraph shall be
    18  construed to modify any licensure, certification or  scope  of  practice
    19  provision under title eight of the education law.
    20    § 2. Subsection (i) of section 3216 of the insurance law is amended by
    21  adding a new paragraph 15-b to read as follows:
    22    (15-b)  (A) Every policy which provides medical coverage that includes
    23  coverage for physician services in a physician's office and every policy
    24  which provides major  medical  or  similar  comprehensive-type  coverage

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00128-01-1

        A. 2451                             2

     1  shall  include coverage for the following equipment and supplies for the
     2  treatment of asthma, and for children under nineteen years of age  addi-
     3  tional  equipment  and  supplies  for  use  in school, if recommended or
     4  prescribed by a physician or other licensed health care provider legally
     5  authorized  to prescribe under title eight of the education law:  rescue
     6  inhaler treatments and nebulizers;  spacers,  valved  holding  chambers,
     7  masks  and/or  other  such  devices used to assist in getting medication
     8  into the lungs. In addition,  the  commissioner  of  the  department  of
     9  health  shall  provide  and  periodically update by rule or regulation a
    10  list of additional asthma equipment and related  supplies  such  as  are
    11  medically  necessary  for the treatment of asthma, for which there shall
    12  also be coverage. Such policies shall also include coverage  for  asthma
    13  self-management  education  to  ensure  that  persons  with  asthma,  or
    14  person's who have a child or children with asthma, are  educated  as  to
    15  the  proper  self-management and treatment of their condition, including
    16  information on proper use of devices and  triggers  in  the  environment
    17  which  should  be  avoided or managed. Such coverage for self-management
    18  education and education relating to devices shall be limited  to  visits
    19  medically  necessary  upon  the  diagnosis  of asthma, where a physician
    20  diagnoses a significant change in the patient's symptoms  or  conditions
    21  which necessitate changes in a patient's self-management, or where reed-
    22  ucation  or  refresher  education  is  necessary.  Such education may be
    23  provided by the physician or other licensed health care provider legally
    24  authorized to prescribe under title eight of the education law, or their
    25  staff, as part of an office visit for asthma diagnosis or treatment,  or
    26  by  a  certified asthma nurse educator, upon the referral of a physician
    27  or other licensed health care provider legally authorized  to  prescribe
    28  under title eight of the education law. Education provided by the certi-
    29  fied  asthma  nurse  educator, may be limited to group settings wherever
    30  practicable. Coverage for self-management education and education relat-
    31  ing to devices shall also include home visits when medically necessary.
    32    (B) Such coverage may be subject to annual deductibles and coinsurance
    33  as may be deemed appropriate by the superintendent and as are consistent
    34  with those established for other benefits within a given policy.
    35    § 3. Subsection (k) of section 3221 of the insurance law is amended by
    36  adding a new paragraph 22 to read as follows:
    37    (22) (A) Every policy which provides medical  coverage  that  includes
    38  coverage for physician services in a physician's office and every policy
    39  which  provides  major  medical  or  similar comprehensive-type coverage
    40  shall include coverage for the following equipment and supplies for  the
    41  treatment  of asthma, and for children under nineteen years of age addi-
    42  tional equipment and supplies for  use  in  school,  if  recommended  or
    43  prescribed by a physician or other licensed health care provider legally
    44  authorized  to  prescribe under title eight of the education law: rescue
    45  inhaler treatments and nebulizers;  spacers,  valved  holding  chambers,
    46  masks  and/or  other  such  devices used to assist in getting medication
    47  into the lungs. In addition,  the  commissioner  of  the  department  of
    48  health  shall  provide  and  periodically update by rule or regulation a
    49  list of additional asthma equipment and related  supplies  such  as  are
    50  medically  necessary  for the treatment of asthma, for which there shall
    51  also be coverage. Such policies shall also include coverage  for  asthma
    52  self-management  education  to  ensure  that  persons  with  asthma,  or
    53  person's who have a child or children with asthma, are  educated  as  to
    54  the  proper  self-management and treatment of their condition, including
    55  information on proper use of devices and  triggers  in  the  environment
    56  which  should  be  avoided or managed. Such coverage for self-management

        A. 2451                             3

     1  education and education relating to devices shall be limited  to  visits
     2  medically  necessary  upon  the  diagnosis  of asthma, where a physician
     3  diagnoses a significant change in the patient's symptoms  or  conditions
     4  which necessitate changes in a patient's self-management, or where reed-
     5  ucation  or  refresher  education  is  necessary.  Such education may be
     6  provided by the physician or other licensed health care provider legally
     7  authorized to prescribe under title eight of the education law, or their
     8  staff, as part of an office visit for asthma diagnosis or treatment,  or
     9  by  a  certified asthma nurse educator, upon the referral of a physician
    10  or other licensed health care provider legally authorized  to  prescribe
    11  under title eight of the education law. Education provided by the certi-
    12  fied  asthma  nurse  educator, may be limited to group settings wherever
    13  practicable. Coverage for self-management education and education relat-
    14  ing to devices shall also include home visits when medically necessary.
    15    (B) Such coverage may be subject to annual deductibles and coinsurance
    16  as may be deemed appropriate by the superintendent and as are consistent
    17  with those established for other benefits within a given policy.
    18    § 4. This act shall take effect on the first of January next  succeed-
    19  ing  the date on which it shall have become a law and shall apply to all
    20  policies issued, renewed, altered or modified on or after such date.
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