Bill Text: NY S02287 | 2013-2014 | General Assembly | Amended


Bill Title: Enacts "Hannah's law"; requires that every health insurance policy or contract which provides coverage for prescription drugs include coverage for the cost of enteral formulas whether administered orally or via feeding tube.

Spectrum: Bipartisan Bill

Status: (Passed) 2013-10-21 - SIGNED CHAP.388 [S02287 Detail]

Download: New_York-2013-S02287-Amended.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        2287--A
           Cal. No. 414
                              2013-2014 Regular Sessions
                                   I N  S E N A T E
                                   January 15, 2013
                                      ___________
       Introduced by Sens. BALL, O'BRIEN -- read twice and ordered printed, and
         when printed to be committed to the Committee on Insurance -- reported
         favorably  from  said  committee  and  committed  to  the Committee on
         Finance -- reported favorably from said committee,  ordered  to  first
         and  second  report,  ordered to a third reading, passed by Senate and
         delivered to the Assembly, recalled, vote  reconsidered,  restored  to
         third  reading,  amended and ordered reprinted, retaining its place in
         the order of third reading
       AN ACT to amend the insurance law,  in  relation  to  requiring  certain
         health  insurance policies to include coverage for the cost of enteral
         formulas whether administered orally or via tube feeding
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Short title.  This act shall be known and may be cited as
    2  "Hannah's law".
    3    S 2. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
    4  law,  as added by chapter 177 of the laws of 1997, is amended to read as
    5  follows:
    6    (21) Every policy which provides 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; gastroesophageal reflux with failure to thrive;  disor-
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD05057-03-3
       S. 2287--A                          2
    1  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
    2  struction; and multiple, severe food allergies which if  left  untreated
    3  will  cause malnourishment, chronic physical disability, mental retarda-
    4  tion  or death. Enteral formulas which are medically necessary and taken
    5  under written order from a  physician  for  the  treatment  of  specific
    6  diseases shall be distinguished from nutritional supplements taken elec-
    7  tively. Coverage for certain inherited diseases of amino acid and organ-
    8  ic  acid  metabolism shall include modified solid food products that are
    9  low protein or which contain modified protein which are medically neces-
   10  sary, and such coverage for such modified solid food  products  for  any
   11  calendar  year  or  for  any  continuous period of twelve months for any
   12  insured individual shall not exceed two thousand five hundred dollars.
   13    S 3. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
   14  law,  as added by chapter 177 of the laws of 1997, is amended to read as
   15  follows:
   16    (11) Every policy which provides coverage for prescription drugs shall
   17  include coverage for the cost of enteral formulas for home use,  WHETHER
   18  ADMINISTERED  ORALLY OR VIA TUBE FEEDING, for which a physician or other
   19  licensed health care provider  legally  authorized  to  prescribe  under
   20  title  eight of the education law has issued a written order. Such writ-
   21  ten order shall state that the  enteral  formula  is  clearly  medically
   22  necessary  and has been proven effective as a disease-specific treatment
   23  regimen for those individuals who are or  will  become  malnourished  or
   24  suffer  from  disorders, which if left untreated, cause chronic physical
   25  disability, mental retardation or death.  Specific  diseases  for  which
   26  enteral  formulas  have been proven effective shall include, but are not
   27  limited to, inherited diseases of amino-acid or organic acid metabolism;
   28  Crohn's Disease; gastroesophageal reflux with failure to thrive;  disor-
   29  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
   30  struction; and multiple, severe food allergies which if  left  untreated
   31  will  cause malnourishment, chronic physical disability, mental retarda-
   32  tion or death. Enteral formulas which are medically necessary and  taken
   33  under  written  order  from  a  physician  for the treatment of specific
   34  diseases shall be distinguished from nutritional supplements taken elec-
   35  tively. Coverage for certain inherited diseases of amino acid and organ-
   36  ic acid metabolism shall include modified solid food products  that  are
   37  low protein or which contain modified protein which are medically neces-
   38  sary,  and  such  coverage for such modified solid food products for any
   39  calendar year or for any continuous period  of  twelve  months  for  any
   40  insured individual shall not exceed two thousand five hundred dollars.
   41    S  4. Subsection (y) of section 4303 of the insurance law, as added by
   42  chapter 177 of the laws of 1997, is amended to read as follows:
   43    (y) Every contract which  provides  coverage  for  prescription  drugs
   44  shall  include  coverage  for the cost of enteral formulas for home use,
   45  WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which  a  physician
   46  or  other  licensed health care provider legally authorized to prescribe
   47  under title eight of the education law has issued a written order.  Such
   48  written  order shall state that the enteral formula is clearly medically
   49  necessary and has been proven effective as a disease-specific  treatment
   50  regimen  for  those  individuals  who are or will become malnourished or
   51  suffer from disorders, which if left untreated, cause chronic  disabili-
   52  ty,  mental  retardation  or  death. Specific diseases for which enteral
   53  formulas have been proven effective shall include, but are  not  limited
   54  to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
   55  Disease;  gastroesophageal  reflux  with failure to thrive; disorders of
   56  gastrointestinal motility such as chronic intestinal pseudo-obstruction;
       S. 2287--A                          3
    1  and multiple, severe food allergies which if left untreated  will  cause
    2  malnourishment,  chronic  physical  disability,  mental  retardation  or
    3  death. Enteral formulas which are medically necessary  and  taken  under
    4  written  order  from  a physician for the treatment of specific diseases
    5  shall be distinguished from nutritional  supplements  taken  electively.
    6  Coverage  for  certain inherited diseases of amino acid and organic acid
    7  metabolism shall include modified  solid  food  products  that  are  low
    8  protein,  or  which  contain modified protein which are medically neces-
    9  sary, and such coverage for such modified solid food  products  for  any
   10  calendar  year  or  for  any  continuous period of twelve months for any
   11  insured individual 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 and homocystinuria, obtained at a partic-
   21  ipating pharmacy under a prescription written by an in-plan  or  out-of-
   22  plan   provider.   Health  maintenance  organizations,  in  addition  to
   23  providing coverage for prescription drugs at a  participating  pharmacy,
   24  may  utilize  a mail order prescription drug program. Health maintenance
   25  organizations may provide prescription drugs pursuant to a  drug  formu-
   26  lary;  however,  health  maintenance  organizations  must  implement  an
   27  appeals process so that the use of non-formulary prescription drugs  may
   28  be requested by a physician or other provider.
   29    S  6. This act shall take effect on the first of January next succeed-
   30  ing the date on which it shall have become a law and shall apply to  all
   31  policies and contracts issued, renewed, modified, altered, or amended on
   32  or after such date.
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