Bill Text: NY A01485 | 2019-2020 | General Assembly | Introduced


Bill Title: Authorizes healthcare providers and pregnancy programs to provide information on the adverse health effects of tobacco smoking during pregnancy; encourages healthcare providers to monitor smoking expectant mothers; includes certain respiratory diseases in the disease management demonstration program; includes asthma, obesity and mammography screening in health insurer wellness programs, in addition to other health promotion and disease prevention programs.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2020-01-08 - referred to health [A01485 Detail]

Download: New_York-2019-A01485-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          1485
                               2019-2020 Regular Sessions
                   IN ASSEMBLY
                                    January 15, 2019
                                       ___________
        Introduced  by M. of A. ORTIZ -- read once and referred to the Committee
          on Health
        AN ACT to amend the public health law, in relation to in-utero  exposure
          to tobacco smoke prevention and including certain respiratory diseases
          within  disease  management  demonstration  programs; and to amend the
          insurance law, in relation to health insurers' wellness programs
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
     1    Section  1.  The  public health law is amended by adding a new article
     2  13-I to read as follows:
     3                                ARTICLE 13-I
     4                IN-UTERO EXPOSURE TO TOBACCO SMOKE PREVENTION
     5  Section 1399-xx. In-utero tobacco exposure prevention.
     6          1399-yy. Programs.
     7    §  1399-xx.  In-utero  tobacco  exposure  prevention.  1.  Appropriate
     8  healthcare  providers  and  pregnancy  programs  shall  be encouraged to
     9  distribute information on the adverse health effects of  smoking  during
    10  and  after  pregnancy  for  both firsthand and secondhand tobacco smoke.
    11  Such adverse effects to the infant include  lower  birth  rates,  higher
    12  incidence of asthma and obesity, and cognitive and developmental damage.
    13    2.  Appropriate  healthcare  providers  shall be encouraged to monitor
    14  expectant mothers' smoking statuses and to offer  to  expectant  mothers
    15  tailored  services, counseling and discussion on the advantages to quit-
    16  ting tobacco smoking during and after their pregnancy.
    17    § 1399-yy. Programs. The following programs shall be added to existing
    18  tobacco control programs  for  pregnant  women  or  to  other  pregnancy
    19  related programs:
    20    1. Carbon monoxide monitoring;
    21    2. Referrals for smoking cessation for household members;
    22    3. Ongoing support by counseling and educational materials; and
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05828-01-9

        A. 1485                             2
     1    4.  Financial  incentives including, but not limited to, items such as
     2  diapers or other baby care products or coupons  to  encourage  expectant
     3  mothers to quit smoking for two or more weeks.
     4    § 2. Subdivisions 2 and 4 of section 2111 of the public health law, as
     5  added  by  section  21  of part C of chapter 58 of the laws of 2004, are
     6  amended to read as follows:
     7    2. The department shall establish the criteria  by  which  individuals
     8  will  be  identified  as  eligible  for  enrollment in the demonstration
     9  programs.  Persons eligible for enrollment  in  the  disease  management
    10  demonstration  program  shall  be  limited  to  individuals who: receive
    11  medical assistance pursuant to title  eleven  of  article  five  of  the
    12  social  services  law and may be eligible for benefits pursuant to title
    13  18 of the social security act (Medicare); are not enrolled in a Medicaid
    14  managed care plan, including individuals who are  not  required  or  not
    15  eligible  to  participate  in Medicaid managed care programs pursuant to
    16  section three hundred sixty-four-j of the social services law; are diag-
    17  nosed with chronic health problems as may be  specified  by  the  entity
    18  undertaking the demonstration program, including, but not limited to one
    19  or  more of the following: congestive heart failure, chronic obstructive
    20  pulmonary disease, asthma, emphysema, chronic bronchitis, other  respir-
    21  atory  diseases,  diabetes  or other chronic health conditions as may be
    22  specified by the department; or have experienced or are likely to  expe-
    23  rience  one  or more hospitalizations or are otherwise expected to incur
    24  excessive costs and high utilization of health care services.
    25    4. The demonstration program shall offer evidence-based  services  and
    26  interventions  designed to ensure that the enrollees receive high quali-
    27  ty, preventative and cost-effective care, aimed at reducing the necessi-
    28  ty for hospitalization or emergency room care or at reducing lengths  of
    29  stay  when  hospitalization  is necessary. The demonstration program may
    30  include screening of eligible enrollees,  developing  an  individualized
    31  care  management  plan  for  each  enrollee  and implementing that plan.
    32  Disease management demonstration programs that utilize information tech-
    33  nology systems that allow for continuous application  of  evidence-based
    34  guidelines to medical assistance claims data and other available data to
    35  identify  specific  instances in which clinical interventions are justi-
    36  fied and communicate indicated interventions to physicians, health  care
    37  providers and/or patients, and monitor physician and health care provid-
    38  er  response  to such interventions, shall have the enrollees, or groups
    39  of enrollees, approved by the department for participation. The services
    40  provided by the demonstration program as part  of  the  care  management
    41  plan  may include, but are not limited to, case management, social work,
    42  individualized health counselors, multi-behavioral goals  plans,  claims
    43  data management, health and self-care education, drug therapy management
    44  and  oversight, personal emergency response systems and other monitoring
    45  technologies, systematic chronic health conditions identified for  moni-
    46  toring, telehealth services and similar services designed to improve the
    47  quality and cost-effectiveness of health care services.
    48    §  3.  Subsections  (a),  (b) and (c) of section 3239 of the insurance
    49  law, subsection (a) as added by chapter 592 of the  laws  of  2008,  and
    50  subsections  (b)  and (c) as amended by chapter 180 of the laws of 2016,
    51  are amended to read as follows:
    52    (a) An insurer licensed to write  accident  and  health  insurance,  a
    53  corporation organized pursuant to article forty-three of this chapter, a
    54  health maintenance organization certified pursuant to article forty-four
    55  of  the  public  health  law and a municipal cooperative health benefits
    56  plan may establish a wellness program in conjunction with  its  issuance

        A. 1485                             3
     1  of  a  group  accident  and  health insurance policy or group subscriber
     2  contract. A "wellness program" is a program designed to  promote  health
     3  and  prevent disease that may contain rewards and incentives for partic-
     4  ipation.  Participation  in  the  wellness program shall be available to
     5  similarly-situated members of the group and shall be  voluntary  on  the
     6  part  of the member. The specific terms of the wellness program shall be
     7  set forth in the policy or contract, or in a separate document  provided
     8  to insureds and members which shall be consistent with the provisions of
     9  this section.
    10    (b) A wellness program may include, but is not limited to, the follow-
    11  ing programs or services:
    12    (1) the use of a health risk assessment tool;
    13    (2) a smoking cessation program;
    14    (3) a weight management program;
    15    (4) a stress and/or hypertension management program;
    16    (5) a worker injury prevention program;
    17    (6) a nutrition education program;
    18    (7) health or fitness incentive programs;
    19    (8)  a coordinated weight management, nutrition, stress management and
    20  physical fitness program to combat  the  high  incidence  of  adult  and
    21  childhood obesity, asthma and other chronic respiratory conditions;
    22    (9) a substance or alcohol abuse cessation program; [and]
    23    (10) a program to manage and cope with chronic pain[.];
    24    (11)  assistance,  financial or otherwise, provided to an employer for
    25  health promotion and disease prevention; and
    26    (12) incentives for insureds or members to access preventive services,
    27  such as asthma, obesity and mammography screening.
    28    (c)(1) A wellness program may use rewards and incentives  for  partic-
    29  ipation  provided  that  where  the  group  health  insurance  policy or
    30  subscriber contract is required to be community-rated, the  rewards  and
    31  incentives  shall  not  include a discounted premium rate or a rebate or
    32  refund of premium.
    33    (2) Permissible rewards and incentives may include:
    34    (A) full or partial reimbursement of  the  cost  of  participating  in
    35  smoking cessation, weight management, stress and/or hypertension, worker
    36  injury  prevention, asthma mitigation or treatment, nutrition education,
    37  substance or alcohol abuse cessation, or  chronic  pain  management  and
    38  coping programs;
    39    (B)  full  or  partial  reimbursement  of  the cost of membership in a
    40  health club or fitness center;
    41    (C) the waiver or reduction of copayments, coinsurance and deductibles
    42  for preventive services covered under the  group  policy  or  subscriber
    43  contract;
    44    (D)  monetary  rewards in the form of gift cards or gift certificates,
    45  so long as the recipient of the reward is encouraged to use  the  reward
    46  for  a  product  or a service that promotes good health, such as healthy
    47  cook books, over the counter vitamins or exercise equipment;
    48    (E) full or partial reimbursement of the cost of  participating  in  a
    49  stress management program or activity; and
    50    (F)  full  or  partial reimbursement of the cost of participating in a
    51  health or fitness program.
    52    (3) Where the reward involves a group  member's  meeting  a  specified
    53  standard based on a health condition, the wellness program must meet the
    54  requirements of 45 CFR Part 146.
    55    (4)  A reward or incentive which involves a discounted premium rate or
    56  a rebate or refund of premium shall be based on actuarial  demonstration

        A. 1485                             4
     1  that  the  wellness  program can reasonably be expected to result in the
     2  overall good health and well being of the group.
     3    §  4. This act shall take effect immediately, except that sections one
     4  and three of this act shall take effect on the one hundred eightieth day
     5  after this act shall have become a law. Effective immediately, the addi-
     6  tion, amendment and/or repeal of any rule or  regulation  necessary  for
     7  the  implementation  of this act on its effective date are authorized to
     8  be made and completed on or before such date.
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