Bill Text: NY S02305 | 2019-2020 | 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) 2020-01-08 - REFERRED TO INSURANCE [S02305 Detail]
Download: New_York-2019-S02305-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2305 2019-2020 Regular Sessions IN SENATE January 24, 2019 ___________ Introduced by Sen. BAILEY -- 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 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 469 of the laws of 2018, 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. Specific diseases and disorders 12 for which enteral, infant and baby formulas have been proven effective 13 shall include, but are not limited to, inherited diseases of amino acid 14 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 15 disorders of gastrointestinal motility such as chronic intestinal pseu- 16 do-obstruction; and multiple, severe food allergies including, but not 17 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies 18 to multiple food proteins; severe food protein induced enterocolitis 19 syndrome; eosinophilic disorders; and impaired absorption of nutrients 20 caused by disorders affecting the absorptive surface, function, length, 21 and motility of the gastrointestinal tract. Enteral, infant and baby 22 formulas which are medically necessary and taken under written order 23 from a physician for the treatment of specific diseases shall be distin- 24 guished from nutritional supplements taken electively. Coverage for EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05414-02-9S. 2305 2 1 certain inherited diseases of amino acid and organic acid metabolism as 2 well as severe protein allergic conditions shall include modified solid 3 food products that are low protein or which contain modified protein, or 4 are amino acid based which are medically necessary, and such coverage 5 for such modified solid food products for any calendar year or for any 6 continuous period of twelve months for any insured individual shall not 7 exceed two thousand five hundred dollars. Coverage for infant and baby 8 formulas for any calendar year or any continuous period of twelve months 9 for any insured individual shall be no less than three thousand dollars. 10 § 2. Paragraph 11 of subsection (k) of section 3221 of the insurance 11 law, as amended by chapter 469 of the laws of 2018, is amended to read 12 as follows: 13 (11) Every policy which provides coverage for prescription drugs shall 14 include coverage for the cost of enteral, infant and baby formulas for 15 home use, whether administered orally or via tube feeding, for which a 16 physician or other licensed health care provider legally authorized to 17 prescribe under title eight of the education law has issued a written 18 order. Such written order shall state that the enteral, infant and baby 19 formula is clearly medically necessary and has been proven effective as 20 a disease-specific treatment regimen. Specific diseases and disorders 21 for which enteral, infant and baby formulas have been proven effective 22 shall include, but are not limited to, inherited diseases of amino-acid 23 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 24 disorders of gastrointestinal motility such as chronic intestinal pseu- 25 do-obstruction; and multiple, severe food allergies including, but not 26 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies 27 to multiple food proteins; severe food protein induced enterocolitis 28 syndrome; eosinophilic disorders and impaired absorption of nutrients 29 caused by disorders affecting the absorptive surface, function, length, 30 and motility of the gastrointestinal tract. Enteral, infant and baby 31 formulas which are medically necessary and taken under written order 32 from a physician for the treatment of specific diseases shall be distin- 33 guished from nutritional supplements taken electively. Coverage for 34 certain inherited diseases of amino acid and organic acid metabolism as 35 well as severe protein allergic conditions shall include modified solid 36 food products that are low protein or which contain modified protein, or 37 are amino acid based which are medically necessary, and such coverage 38 for such modified solid food products for any calendar year or for any 39 continuous period of twelve months for any insured individual shall not 40 exceed two thousand five hundred dollars. Coverage for infant and baby 41 formulas for any calendar year or any continuous period of twelve months 42 for any insured individual shall be no less than three thousand dollars. 43 § 3. Subsection (y) of section 4303 of the insurance law, as amended 44 by chapter 469 of the laws of 2018, is amended to read as follows: 45 (y) Every contract which provides coverage for prescription drugs 46 shall include coverage for the cost of enteral, infant and baby formulas 47 for home use, whether administered orally or via tube feeding, for which 48 a physician or other licensed health care provider legally authorized to 49 prescribe under title eight of the education law has issued a written 50 order. Such written order shall state that the enteral, infant and baby 51 formula is clearly medically necessary and has been proven effective as 52 a disease-specific treatment regimen. Specific diseases and disorders 53 for which enteral, infant and baby formulas have been proven effective 54 shall include, but are not limited to, inherited diseases of amino-acid 55 or organic acid metabolism; Crohn's Disease; gastroesophageal reflux; 56 disorders of gastrointestinal motility such as chronic intestinal pseu-S. 2305 3 1 do-obstruction; and multiple, severe food allergies including, but not 2 limited to immunoglobulin E and nonimmunoglobulin E-mediated allergies 3 to multiple food proteins; severe food protein induced enterocolitis 4 syndrome; eosinophilic disorders; and impaired absorption of nutrients 5 caused by disorders affecting the absorptive surface, function, length, 6 and motility of the gastrointestinal tract. Enteral, infant and baby 7 formulas which are medically necessary and taken under written order 8 from a physician for the treatment of specific diseases shall be distin- 9 guished from nutritional supplements taken electively. Coverage for 10 certain inherited diseases of amino acid and organic acid metabolism as 11 well as severe protein allergic conditions shall include modified solid 12 food products that are low protein, or which contain modified protein, 13 or are amino acid based which are medically necessary, and such coverage 14 for such modified solid food products for any calendar year or for any 15 continuous period of twelve months for any insured individual shall not 16 exceed two thousand five hundred dollars. Coverage for infant and baby 17 formulas for any calendar year or any continuous period of twelve months 18 for any insured individual shall be no less than three thousand dollars. 19 § 4. The opening paragraph of paragraph 25 of subsection (b) of 20 section 4322 of the insurance law, as amended by chapter 388 of the laws 21 of 2013, is amended to read as follows: 22 Prescription drugs, obtained at a participating pharmacy under a 23 prescription written by an in-plan or out-of-plan provider, including 24 contraceptive drugs or devices approved by the federal food and drug 25 administration or generic equivalents approved as substitutes by such 26 food and drug administration [and], nutritional supplements (formulas), 27 whether administered orally or via a feeding tube for the therapeutic 28 treatment of phenylketonuria, branched-chain ketonuria, galactosemia and 29 homocystinuria[, obtained at a participating pharmacy under a30prescription written by an in-plan or out-of-plan provider] and infant 31 and baby formulas for home use for which a physician or other licensed 32 health care provider legally authorized to prescribe under title eight 33 of the education law has issued a written order. Such written order 34 shall state that the infant or baby formula is clearly medically neces- 35 sary and has been proven effective as a disease-specific treatment regi- 36 men for those individuals who are or will become malnourished or suffer 37 from disorders, which if left untreated, cause chronic physical disabil- 38 ity, mental retardation or death. Specific diseases for which infant and 39 baby formulas have been proven effective shall include, but are not 40 limited to, inherited diseases of amino acid or organic acid metabolism; 41 Crohn's Disease; gastroesophageal reflux with failure to thrive; disor- 42 ders of gastrointestinal motility such as chronic intestinal pseudo-ob- 43 struction; and multiple, severe food allergies which if left untreated 44 will cause malnourishment, chronic physical disability, mental retarda- 45 tion or death. Infant and baby formulas which are medically necessary 46 and taken under written order from a physician for the treatment of 47 specific diseases shall be distinguished from nutritional supplements 48 taken electively. Coverage for infant and baby formulas for any calendar 49 year or any continuous period of twelve months for any insured individ- 50 ual shall be no less than three thousand dollars. Health maintenance 51 organizations, in addition to providing coverage for prescription drugs 52 at a participating pharmacy, may utilize a mail order prescription drug 53 program. Health maintenance organizations may provide prescription drugs 54 pursuant to a drug formulary; however, health maintenance organizations 55 must implement an appeals process so that the use of non-formulary 56 prescription drugs may be requested by a physician or other provider.S. 2305 4 1 § 5. This act shall take effect on the first of January next succeed- 2 ing the date on which it shall have become a law and shall apply to all 3 policies and contracts issued, renewed, modified, altered, or amended on 4 or after such date.