Bill Text: NY S00628 | 2009-2010 | General Assembly | Introduced
Bill Title: Enacts "Hannah's law"; requires that every health insurance policy or contract which provides medical, major medical or similar comprehensive-type coverage or coverage for prescription drugs include coverage for the cost of enteral formulas for which a physician has issued a written order and which are medically necessary for the treatment of eosinophilic esophagitis and related eosinophilic disorders.
Spectrum: Strong Partisan Bill (Democrat 12-1)
Status: (Introduced - Dead) 2010-01-06 - REFERRED TO INSURANCE [S00628 Detail]
Download: New_York-2009-S00628-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 628 2009-2010 Regular Sessions I N S E N A T E January 9, 2009 ___________ Introduced by Sen. SAMPSON -- read twice and ordered printed, and when printed to be committed 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 enteral formulas for the treatment of eosinophilic esophagitis and related eosinophilic disorders THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. This act shall be known and may be cited as "Hannah's law". 2 S 2. Paragraph 21 of subsection (i) of section 3216 of the insurance 3 law, as added by chapter 177 of the laws of 1997, is amended to read as 4 follows: 5 (21) Every policy which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 6 COMPREHENSIVE-TYPE COVERAGE OR coverage for prescription drugs shall 7 include coverage for the cost of enteral formulas for home use, WHETHER 8 ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other 9 licensed health care provider legally authorized to prescribe under 10 title eight of the education law has issued a written order. Such writ- 11 ten order shall state that the enteral formula is clearly medically 12 necessary and has been proven effective as a disease-specific treatment 13 regimen for those individuals who are or will become malnourished or 14 suffer from disorders, which if left untreated, cause chronic physical 15 disability, mental retardation or death. Specific diseases for which 16 enteral formulas have been proven effective shall include, but are not 17 limited to, inherited diseases of amino acid or organic acid metabolism; 18 Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC 19 DISORDERS; gastroesophageal reflux with failure to thrive; disorders of 20 gastrointestinal motility such as chronic intestinal pseudo-obstruction; 21 and multiple, severe food allergies which if left untreated will cause 22 malnourishment, chronic physical disability, mental retardation or 23 death. Enteral formulas which are medically necessary and taken under EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05214-01-9 S. 628 2 1 written order from a physician for the treatment of specific diseases 2 shall be distinguished from nutritional supplements taken electively. 3 Coverage for certain inherited diseases of amino acid and organic acid 4 metabolism shall include modified solid food products that are low 5 protein or which contain modified protein which are medically neces- 6 sary[, and such coverage for such modified solid food products for any 7 calendar year or for any continuous period of twelve months for any 8 insured individual shall not exceed two thousand five hundred dollars]. 9 S 3. Paragraph 11 of subsection (k) of section 3221 of the insurance 10 law, as added by chapter 177 of the laws of 1997, is amended to read as 11 follows: 12 (11) Every policy which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 13 COMPREHENSIVE-TYPE COVERAGE OR coverage for prescription drugs shall 14 include coverage for the cost of enteral formulas for home use, WHETHER 15 ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other 16 licensed health care provider legally authorized to prescribe under 17 title eight of the education law has issued a written order. Such writ- 18 ten order shall state that the enteral formula is clearly medically 19 necessary and has been proven effective as a disease-specific treatment 20 regimen for those individuals who are or will become malnourished or 21 suffer from disorders, which if left untreated, cause chronic physical 22 disability, mental retardation or death. Specific diseases for which 23 enteral formulas have been proven effective shall include, but are not 24 limited to, inherited diseases of amino-acid or organic acid metabolism; 25 Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC 26 DISORDERS; gastroesophageal reflux with failure to thrive; disorders of 27 gastrointestinal motility such as chronic intestinal pseudo-obstruction; 28 and multiple, severe food allergies which if left untreated will cause 29 malnourishment, chronic physical disability, mental retardation or 30 death. Enteral formulas which are medically necessary and taken under 31 written order from a physician for the treatment of specific diseases 32 shall be distinguished from nutritional supplements taken electively. 33 Coverage for certain inherited diseases of amino acid and organic acid 34 metabolism shall include modified solid food products that are low 35 protein or which contain modified protein which are medically neces- 36 sary[, and such coverage for such modified solid food products for any 37 calendar year or for any continuous period of twelve months for any 38 insured individual shall not exceed two thousand five hundred dollars]. 39 S 4. Subsection (y) of section 4303 of the insurance law, as added by 40 chapter 177 of the laws of 1997, is amended to read as follows: 41 (y) Every contract which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 42 COMPREHENSIVE-TYPE COVERAGE OR coverage for prescription drugs shall 43 include coverage for the cost of enteral formulas for home use, WHETHER 44 ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other 45 licensed health care provider legally authorized to prescribe under 46 title eight of the education law has issued a written order. Such writ- 47 ten order shall state that the enteral formula is clearly medically 48 necessary and has been proven effective as a disease-specific treatment 49 regimen for those individuals who are or will become malnourished or 50 suffer from disorders, which if left untreated, cause chronic disabili- 51 ty, mental retardation or death. Specific diseases for which enteral 52 formulas have been proven effective shall include, but are not limited 53 to, inherited diseases of amino-acid or organic acid metabolism; Crohn's 54 Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS; 55 gastroesophageal reflux with failure to thrive; disorders of gastroin- 56 testinal motility such as chronic intestinal pseudo-obstruction; and S. 628 3 1 multiple, severe food allergies which if left untreated will cause maln- 2 ourishment, chronic physical disability, mental retardation or death. 3 Enteral formulas which are medically necessary and taken under written 4 order from a physician for the treatment of specific diseases shall be 5 distinguished from nutritional supplements taken electively. Coverage 6 for certain inherited diseases of amino acid and organic acid metabolism 7 shall include modified solid food products that are low protein, or 8 which contain modified protein which are medically necessary[, and such 9 coverage for such modified solid food products for any calendar year or 10 for any continuous period of twelve months for any insured individual 11 shall not exceed two thousand five hundred dollars]. 12 S 5. The opening paragraph of paragraph 25 of subsection (b) of 13 section 4322 of the insurance law, as amended by chapter 554 of the laws 14 of 2002, is amended to read as follows: 15 Prescription drugs, including contraceptive drugs or devices approved 16 by the federal food and drug administration or generic equivalents 17 approved as substitutes by such food and drug administration and nutri- 18 tional supplements (formulas), WHETHER ADMINISTERED ORALLY OR VIA A 19 FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched- 20 chain ketonuria, galactosemia, EOSINOPHILIC ESOPHAGITIS AND RELATED 21 EOSINOPHILIC DISORDERS, and homocystinuria, obtained at a participating 22 pharmacy under a prescription written by an in-plan or out-of-plan 23 provider. Health maintenance organizations, in addition to providing 24 coverage for prescription drugs at a participating pharmacy, may utilize 25 a mail order prescription drug program. Health maintenance organizations 26 may provide prescription drugs pursuant to a drug formulary; however, 27 health maintenance organizations must implement an appeals process so 28 that the use of non-formulary prescription drugs may be requested by a 29 physician or other provider. 30 S 6. This act shall take effect on the first of January next succeed- 31 ing the date on which it shall have become a law and shall apply to all 32 policies and contracts issued, renewed, modified, altered, or amended on 33 or after such date.