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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         2287
                              2013-2014 Regular Sessions
                                   I N  S E N A T E
                                   January 15, 2013
                                      ___________
       Introduced  by  Sen.  BALL  --  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. 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;  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.
                                                                  LBD05057-01-3
       S. 2287                             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 necessary,
    6  and such coverage for such modified solid food products for any calendar
    7  year or for any continuous period of twelve months for any insured indi-
    8  vidual 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 coverage for prescription drugs shall
   13  include coverage for the cost of enteral formulas for home use,  WHETHER
   14  ADMINISTERED  ORALLY OR VIA TUBE FEEDING, for which a physician or other
   15  licensed health care provider  legally  authorized  to  prescribe  under
   16  title  eight of the education law has issued a written order. Such writ-
   17  ten order shall state that the  enteral  formula  is  clearly  medically
   18  necessary  and has been proven effective as a disease-specific treatment
   19  regimen for those individuals who are or  will  become  malnourished  or
   20  suffer  from  disorders, which if left untreated, cause chronic physical
   21  disability, mental retardation or death.  Specific  diseases  for  which
   22  enteral  formulas  have been proven effective shall include, but are not
   23  limited to, inherited diseases of amino-acid or organic acid metabolism;
   24  Crohn's  Disease;  EOSINOPHILIC  ESOPHAGITIS  AND  RELATED  EOSINOPHILIC
   25  DISORDERS;  gastroesophageal reflux with failure to thrive; disorders of
   26  gastrointestinal motility such as chronic intestinal pseudo-obstruction;
   27  and multiple, severe food allergies which if left untreated  will  cause
   28  malnourishment,  chronic  physical  disability,  mental  retardation  or
   29  death. Enteral formulas which are medically necessary  and  taken  under
   30  written  order  from  a physician for the treatment of specific diseases
   31  shall be distinguished from nutritional  supplements  taken  electively.
   32  Coverage  for  certain inherited diseases of amino acid and organic acid
   33  metabolism shall include modified  solid  food  products  that  are  low
   34  protein or which contain modified protein which are medically necessary,
   35  and such coverage for such modified solid food products for any calendar
   36  year or for any continuous period of twelve months for any insured indi-
   37  vidual shall not exceed two thousand five hundred dollars.
   38    S  4. Subsection (y) of section 4303 of the insurance law, as added by
   39  chapter 177 of the laws of 1997, 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 formulas for home use,
   42  WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which  a  physician
   43  or  other  licensed health care provider legally authorized to prescribe
   44  under title eight of the education law has issued a written order.  Such
   45  written  order shall state that the enteral formula is clearly medically
   46  necessary and has been proven effective as a disease-specific  treatment
   47  regimen  for  those  individuals  who are or will become malnourished or
   48  suffer from disorders, which if left untreated, cause chronic  disabili-
   49  ty,  mental  retardation  or  death. Specific diseases for which enteral
   50  formulas have been proven effective shall include, but are  not  limited
   51  to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
   52  Disease;  EOSINOPHILIC  ESOPHAGITIS  AND RELATED EOSINOPHILIC DISORDERS;
   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.
       S. 2287                             3
    1  Enteral  formulas  which are medically necessary and taken under written
    2  order from a physician for the treatment of specific diseases  shall  be
    3  distinguished  from  nutritional  supplements taken electively. Coverage
    4  for certain inherited diseases of amino acid and organic acid metabolism
    5  shall  include  modified  solid  food  products that are low protein, or
    6  which contain modified protein which are medically necessary,  and  such
    7  coverage  for such modified solid food products for any calendar year or
    8  for any continuous period of twelve months for  any  insured  individual
    9  shall not exceed two thousand five hundred dollars.
   10    S  5.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
   11  section 4322 of the insurance law, as amended by chapter 554 of the laws
   12  of 2002, is amended to read as follows:
   13    Prescription drugs, including contraceptive drugs or devices  approved
   14  by  the  federal  food  and  drug  administration or generic equivalents
   15  approved as substitutes by such food and drug administration and  nutri-
   16  tional  supplements  (formulas),  WHETHER  ADMINISTERED  ORALLY OR VIA A
   17  FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched-
   18  chain ketonuria,  galactosemia,  EOSINOPHILIC  ESOPHAGITIS  AND  RELATED
   19  EOSINOPHILIC  DISORDERS, and homocystinuria, obtained at a participating
   20  pharmacy under a prescription  written  by  an  in-plan  or  out-of-plan
   21  provider.  Health  maintenance  organizations,  in addition to providing
   22  coverage for prescription drugs at a participating pharmacy, may utilize
   23  a mail order prescription drug program. Health maintenance organizations
   24  may provide prescription drugs pursuant to a  drug  formulary;  however,
   25  health  maintenance  organizations  must implement an appeals process so
   26  that the use of non-formulary prescription drugs may be requested  by  a
   27  physician or other provider.
   28    S  6. This act shall take effect on the first of January next succeed-
   29  ing the date on which it shall have become a law and shall apply to  all
   30  policies and contracts issued, renewed, modified, altered, or amended on
   31  or after such date.