Bill Text: NY A05464 | 2011-2012 | General Assembly | Introduced
Bill Title: Requires health insurance policies to cover the cost of equipment, supplies and tests for the diagnosis and treatment of thalassemia; authorizes a medicaid buy-in program for people with thalassemia.
Spectrum: Partisan Bill (Democrat 4-0)
Status: (Introduced - Dead) 2011-04-20 - enacting clause stricken [A05464 Detail]
Download: New_York-2011-A05464-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
5464
2011-2012 Regular Sessions
I N A S S E M B L Y
February 22, 2011
___________
Introduced by M. of A. TOWNS -- Multi-Sponsored by -- M. of A. PHEFFER
-- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to requiring health
insurance policies to cover the cost of equipment, supplies and tests
for the diagnosis and treatment of thalassemia, or Cooley's anemia,
and relating to the medicaid buy-in program for people with thalasse-
mia
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. Legislative findings and intent. The legislature finds and
2 declares that the cost of medical care in the United States has steadily
3 risen in the last five years, outpacing both employer wages and
4 inflation. Chronic disease consumes approximately seventy-eight percent
5 of health expenditures. Patients with thalassemia, an inherited blood
6 disorder, require frequent red blood cell transfusions and iron chela-
7 tion therapy for survival. Patients with thalassemia are the largest
8 chronic consumers of blood in the United States. Patients surveyed in
9 New York state claim their out-of-pocket costs average $555 per month.
10 Eighty-five percent of patients with thalassemia pay between 3 to 5
11 co-pays per month, with co-pays ranging from $15 to $30 a visit. Nearly
12 fifty percent of patients contributed a portion to their employer's
13 payment of premiums or paid their health insurance premiums outright.
14 Fifty percent of the patients surveyed had deductibles greater than
15 $1,000 that had to be satisfied before coverage began. Patients with
16 thalassemia require numerous prescription drugs, on average between 3 to
17 4 prescription drugs a month with the average cost to the patient, rang-
18 ing between $150 to $200 a month. The legislature therefore finds that
19 with new treatments being expensive and for those with 50 percent co-in-
20 surance on prescription drugs, with the average cost being $1,500 a
21 month, it would benefit residents of the state to require health insur-
22 ance policies to cover the cost of equipment, supplies and tests for the
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD09645-01-1
A. 5464 2
1 diagnosis and treatment of thalassemia and to create a medicaid buy-in
2 programs for people with thalassemia.
3 S 2. There shall be a medicaid buy-in program for people with
4 thalassemia. The commissioner of the department of health shall promul-
5 gate rules and regulations to determine the criteria for such program.
6 Such rules and regulations shall increase the medicaid buy-in salary
7 level for individuals with thalassemia to account for the increased
8 out-of-pocket costs associated with the disease.
9 S 3. Subsection (i) of section 3216 of the insurance law is amended by
10 adding a new paragraph 15-b to read as follows:
11 (15-B) (A) EVERY POLICY WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES
12 COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY
13 WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE
14 SHALL INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES AND TESTS FOR THE
15 DIAGNOSIS AND TREATMENT OF THALASSEMIA, IF RECOMMENDED OR PRESCRIBED BY
16 A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
17 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
18 (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL MEAN THE
19 MEDICAL CONDITION KNOWN AS THALASSEMIA MAJOR/INTERMEDIA OR COOLEY'S
20 ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE FAIL-
21 URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
22 S 4. Subsection (k) of section 3221 of the insurance law is amended by
23 adding a new paragraph 7-a to read as follows:
24 (7-A)(A) EVERY GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY
25 ISSUED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES MEDICAL
26 COVERAGE THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S
27 OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR COMPRE-
28 HENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES
29 AND TESTS FOR THE DIAGNOSIS AND TREATMENT OF THALASSEMIA. IF RECOMMENDED
30 OR PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER
31 LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
32 (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL MEAN THE
33 MEDICAL CONDITION KNOWN AS THALASSEMIA MAJOR/INTERMEDIA OR COOLEY'S
34 ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE FAIL-
35 URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
36 S 5. Section 4303 of the insurance law is amended by adding a new
37 subsection (u-1) to read as follows:
38 (U-1)(A) A MEDICAL EXPENSE INDEMNITY CORPORATION OR A HEALTH SERVICE
39 CORPORATION WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR
40 PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY WHICH
41 PROVIDES MAJOR MEDICAL OR SIMILAR COMPREHENSIVE-TYPE COVERAGE SHALL
42 INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES AND TESTS FOR THE DIAGNOSIS
43 AND TREATMENT OF THALASSEMIA, IF RECOMMENDED OR PRESCRIBED BY A PHYSI-
44 CIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
45 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
46 (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL MEAN THE
47 MEDICAL CONDITION KNOWN AS THALASSEMIA MAJOR/INTERMEDIA OR COOLEY'S
48 ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE FAIL-
49 URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
50 S 6. This act shall take effect on the first of January next succeed-
51 ing the date on which it shall have become a law and shall apply to all
52 policies and contracts issued, renewed, modified, altered, or amended on
53 or after such date.
