STATE OF NEW YORK ________________________________________________________________________ 4934 2021-2022 Regular Sessions IN SENATE February 18, 2021 ___________ Introduced by Sens. RIVERA, BAILEY, KAMINSKY, SEPULVEDA -- read twice and ordered printed, and when printed to be committed to the Committee on Health AN ACT to amend the social services law and the insurance law, in relation to coverage for the treatment of asthma The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph (r) of subdivision 2 of section 365-a of the 2 social services law, as added by section 32 of part C of chapter 58 of 3 the laws of 2008, is amended to read as follows: 4 (r) asthma self-management training services for persons or parents of 5 persons diagnosed with asthma including information on proper use of 6 devices such as spacers, valved holding chambers and masks, and triggers 7 in the environment which should be avoided or managed, when such 8 services are ordered by a physician, registered physician's assistant, 9 registered nurse practitioner, or licensed midwife and provided by a 10 licensed, registered, or certified health care professional, as deter- 11 mined by the commissioner of health, who is certified as an asthma 12 educator by the National Asthma Educator Certification Board, or a 13 successor national certification board; provided, however, that the 14 provisions of this paragraph shall not take effect unless all necessary 15 approvals under federal law and regulation have been obtained to receive 16 federal financial participation in the costs of health care services 17 provided pursuant to this paragraph. Nothing in this paragraph shall be 18 construed to modify any licensure, certification or scope of practice 19 provision under title eight of the education law. 20 § 2. Subsection (i) of section 3216 of the insurance law is amended by 21 adding a new paragraph 15-b to read as follows: 22 (15-b) (A) Every policy which provides medical coverage that includes 23 coverage for physician services in a physician's office and every policy 24 which provides major medical or similar comprehensive-type coverage EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD00128-01-1S. 4934 2 1 shall include coverage for the following equipment and supplies for the 2 treatment of asthma, and for children under nineteen years of age addi- 3 tional equipment and supplies for use in school, if recommended or 4 prescribed by a physician or other licensed health care provider legally 5 authorized to prescribe under title eight of the education law: rescue 6 inhaler treatments and nebulizers; spacers, valved holding chambers, 7 masks and/or other such devices used to assist in getting medication 8 into the lungs. In addition, the commissioner of the department of 9 health shall provide and periodically update by rule or regulation a 10 list of additional asthma equipment and related supplies such as are 11 medically necessary for the treatment of asthma, for which there shall 12 also be coverage. Such policies shall also include coverage for asthma 13 self-management education to ensure that persons with asthma, or 14 person's who have a child or children with asthma, are educated as to 15 the proper self-management and treatment of their condition, including 16 information on proper use of devices and triggers in the environment 17 which should be avoided or managed. Such coverage for self-management 18 education and education relating to devices shall be limited to visits 19 medically necessary upon the diagnosis of asthma, where a physician 20 diagnoses a significant change in the patient's symptoms or conditions 21 which necessitate changes in a patient's self-management, or where reed- 22 ucation or refresher education is necessary. Such education may be 23 provided by the physician or other licensed health care provider legally 24 authorized to prescribe under title eight of the education law, or their 25 staff, as part of an office visit for asthma diagnosis or treatment, or 26 by a certified asthma nurse educator, upon the referral of a physician 27 or other licensed health care provider legally authorized to prescribe 28 under title eight of the education law. Education provided by the certi- 29 fied asthma nurse educator, may be limited to group settings wherever 30 practicable. Coverage for self-management education and education relat- 31 ing to devices shall also include home visits when medically necessary. 32 (B) Such coverage may be subject to annual deductibles and coinsurance 33 as may be deemed appropriate by the superintendent and as are consistent 34 with those established for other benefits within a given policy. 35 § 3. Subsection (k) of section 3221 of the insurance law is amended by 36 adding a new paragraph 22 to read as follows: 37 (22) (A) Every policy which provides medical coverage that includes 38 coverage for physician services in a physician's office and every policy 39 which provides major medical or similar comprehensive-type coverage 40 shall include coverage for the following equipment and supplies for the 41 treatment of asthma, and for children under nineteen years of age addi- 42 tional equipment and supplies for use in school, if recommended or 43 prescribed by a physician or other licensed health care provider legally 44 authorized to prescribe under title eight of the education law: rescue 45 inhaler treatments and nebulizers; spacers, valved holding chambers, 46 masks and/or other such devices used to assist in getting medication 47 into the lungs. In addition, the commissioner of the department of 48 health shall provide and periodically update by rule or regulation a 49 list of additional asthma equipment and related supplies such as are 50 medically necessary for the treatment of asthma, for which there shall 51 also be coverage. Such policies shall also include coverage for asthma 52 self-management education to ensure that persons with asthma, or 53 person's who have a child or children with asthma, are educated as to 54 the proper self-management and treatment of their condition, including 55 information on proper use of devices and triggers in the environment 56 which should be avoided or managed. Such coverage for self-managementS. 4934 3 1 education and education relating to devices shall be limited to visits 2 medically necessary upon the diagnosis of asthma, where a physician 3 diagnoses a significant change in the patient's symptoms or conditions 4 which necessitate changes in a patient's self-management, or where reed- 5 ucation or refresher education is necessary. Such education may be 6 provided by the physician or other licensed health care provider legally 7 authorized to prescribe under title eight of the education law, or their 8 staff, as part of an office visit for asthma diagnosis or treatment, or 9 by a certified asthma nurse educator, upon the referral of a physician 10 or other licensed health care provider legally authorized to prescribe 11 under title eight of the education law. Education provided by the certi- 12 fied asthma nurse educator, may be limited to group settings wherever 13 practicable. Coverage for self-management education and education relat- 14 ing to devices shall also include home visits when medically necessary. 15 (B) Such coverage may be subject to annual deductibles and coinsurance 16 as may be deemed appropriate by the superintendent and as are consistent 17 with those established for other benefits within a given policy. 18 § 4. This act shall take effect on the first of January next succeed- 19 ing the date on which it shall have become a law and shall apply to all 20 policies issued, renewed, altered or modified on or after such date.