Bill Text: NY A06206 | 2017-2018 | General Assembly | Introduced
Bill Title: Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-02-27 - referred to insurance [A06206 Detail]
Download: New_York-2017-A06206-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 6206 2017-2018 Regular Sessions IN ASSEMBLY February 27, 2017 ___________ Introduced by M. of A. MOYA -- 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 chapter 388 of the laws of 2013, is amended 3 to read as follows: 4 (21) Every policy which 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 for those individuals who are or 12 will become malnourished or suffer from disorders, which if left 13 untreated, cause chronic physical disability, mental retardation or 14 death. Specific diseases for which enteral, infant and baby formulas 15 have been proven effective shall include, but are not limited to, inher- 16 ited diseases of amino acid or organic acid metabolism; Crohn's Disease; 17 gastroesophageal reflux with failure to thrive; disorders of gastroin- 18 testinal motility such as chronic intestinal pseudo-obstruction; and 19 multiple, severe food allergies which if left untreated will cause maln- 20 ourishment, chronic physical disability, mental retardation or death. 21 Enteral, infant and baby formulas which are medically necessary and 22 taken under written order from a physician for the treatment of specific 23 diseases shall be distinguished from nutritional supplements taken elec- 24 tively. Coverage for certain inherited diseases of amino acid and organ- 25 ic acid metabolism shall include modified solid food products that are 26 low protein or which contain modified protein which are medically neces- 27 sary, and such coverage for such modified solid food products for any EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07096-01-7A. 6206 2 1 calendar year or for any continuous period of twelve months for any 2 insured individual shall not exceed two thousand five hundred dollars. 3 Coverage for infant and baby formulas for any calendar year or any 4 continuous period of twelve months for any insured individual shall be 5 no less than three thousand dollars. 6 § 2. Paragraph 11 of subsection (k) of section 3221 of the insurance 7 law, as amended by chapter 388 of the laws of 2013, is amended to read 8 as follows: 9 (11) Every policy which provides coverage for prescription drugs shall 10 include coverage for the cost of enteral, infant and baby formulas for 11 home use, whether administered orally or via tube feeding, for which a 12 physician or other licensed health care provider legally authorized to 13 prescribe under title eight of the education law has issued a written 14 order. Such written order shall state that the enteral, infant and baby 15 formula is clearly medically necessary and has been proven effective as 16 a disease-specific treatment regimen for those individuals who are or 17 will become malnourished or suffer from disorders, which if left 18 untreated, cause chronic physical disability, mental retardation or 19 death. Specific diseases for which enteral, infant and baby formulas 20 have been proven effective shall include, but are not limited to, inher- 21 ited diseases of amino-acid or organic acid metabolism; Crohn's Disease; 22 gastroesophageal reflux with failure to thrive; disorders of gastroin- 23 testinal motility such as chronic intestinal pseudo-obstruction; and 24 multiple, severe food allergies which if left untreated will cause maln- 25 ourishment, chronic physical disability, mental retardation or death. 26 Enteral, infant and baby formulas which are medically necessary and 27 taken under written order from a physician for the treatment of specific 28 diseases shall be distinguished from nutritional supplements taken elec- 29 tively. Coverage for certain inherited diseases of amino acid and organ- 30 ic acid metabolism shall include modified solid food products that are 31 low protein or which contain modified protein which are medically neces- 32 sary, and such coverage for such modified solid food products for any 33 calendar year or for any continuous period of twelve months for any 34 insured individual shall not exceed two thousand five hundred dollars. 35 Coverage for infant and baby formulas for any calendar year or any 36 continuous period of twelve months for any insured individual shall be 37 no less than three thousand dollars. 38 § 3. Subsection (y) of section 4303 of the insurance law, as amended 39 by chapter 388 of the laws of 2013, is amended to read as follows: 40 (y) Every contract which provides coverage for prescription drugs 41 shall include coverage for the cost of enteral, infant and baby formulas 42 for home use, whether administered orally or via tube feeding, for which 43 a physician or other licensed health care provider legally authorized to 44 prescribe under title eight of the education law has issued a written 45 order. Such written order shall state that the enteral, infant and baby 46 formula is clearly medically necessary and has been proven effective as 47 a disease-specific treatment regimen for those individuals who are or 48 will become malnourished or suffer from disorders, which if left 49 untreated, cause chronic disability, mental retardation or death. 50 Specific diseases for which enteral, infant and baby formulas have been 51 proven effective shall include, but are not limited to, inherited 52 diseases of amino-acid or organic acid metabolism; Crohn's Disease; 53 gastroesophageal reflux with failure to thrive; disorders of gastroin- 54 testinal motility such as chronic intestinal pseudo-obstruction; and 55 multiple, severe food allergies which if left untreated will cause maln- 56 ourishment, chronic physical disability, mental retardation or death.A. 6206 3 1 Enteral, infant and baby formulas which are medically necessary and 2 taken under written order from a physician for the treatment of specific 3 diseases shall be distinguished from nutritional supplements taken elec- 4 tively. Coverage for certain inherited diseases of amino acid and organ- 5 ic acid metabolism shall include modified solid food products that are 6 low protein, or which contain modified protein which are medically 7 necessary, and such coverage for such modified solid food products for 8 any calendar year or for any continuous period of twelve months for any 9 insured individual shall not exceed two thousand five hundred dollars. 10 Coverage for infant and baby formulas for any calendar year or any 11 continuous period of twelve months for any insured individual shall be 12 no less than three thousand dollars. 13 § 4. The opening paragraph of paragraph 25 of subsection (b) of 14 section 4322 of the insurance law, as amended by chapter 388 of the laws 15 of 2013, is amended to read as follows: 16 Prescription drugs, obtained at a participating pharmacy under a 17 prescription written by an in-plan or out-of-plan provider, including 18 contraceptive drugs or devices approved by the federal food and drug 19 administration or generic equivalents approved as substitutes by such 20 food and drug administration [and], nutritional supplements (formulas), 21 whether administered orally or via a feeding tube for the therapeutic 22 treatment of phenylketonuria, branched-chain ketonuria, galactosemia and 23 homocystinuria[, obtained at a participating pharmacy under a24prescription written by an in-plan or out-of-plan provider] and infant 25 and baby formulas for home use for which a physician or other licensed 26 health care provider legally authorized to prescribe under title eight 27 of the education law has issued a written order. Such written order 28 shall state that the infant or baby formula is clearly medically neces- 29 sary and has been proven effective as a disease-specific treatment regi- 30 men for those individuals who are or will become malnourished or suffer 31 from disorders, which if left untreated, cause chronic physical disabil- 32 ity, mental retardation or death. Specific diseases for which infant and 33 baby formulas have been proven effective shall include, but are not 34 limited to, inherited diseases of amino acid or organic acid metabolism; 35 Crohn's Disease; gastroesophageal reflux with failure to thrive; disor- 36 ders of gastrointestinal motility such as chronic intestinal pseudo-ob- 37 struction; and multiple, severe food allergies which if left untreated 38 will cause malnourishment, chronic physical disability, mental retarda- 39 tion or death. Infant and baby formulas which are medically necessary 40 and taken under written order from a physician for the treatment of 41 specific diseases shall be distinguished from nutritional supplements 42 taken electively. Coverage for infant and baby formulas for any calendar 43 year or any continuous period of twelve months for any insured individ- 44 ual shall be no less than three thousand dollars. Health maintenance 45 organizations, in addition to providing coverage for prescription drugs 46 at a participating pharmacy, may utilize a mail order prescription drug 47 program. Health maintenance organizations may provide prescription drugs 48 pursuant to a drug formulary; however, health maintenance organizations 49 must implement an appeals process so that the use of non-formulary 50 prescription drugs may be requested by a physician or other provider. 51 § 5. This act shall take effect on the first of January next succeed- 52 ing the date on which it shall have become a law and shall apply to all 53 policies and contracts issued, renewed, modified, altered, or amended on 54 or after such date.
