Bill Text: NY A08292 | 2019-2020 | General Assembly | Introduced
Bill Title: Caps the amount paid by an insured for a 30 day supply of prescription insulin at one hundred dollars.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-01-08 - referred to insurance [A08292 Detail]
Download: New_York-2019-A08292-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8292 2019-2020 Regular Sessions IN ASSEMBLY June 13, 2019 ___________ Introduced by M. of A. SIMOTAS -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law, in relation to limiting co-payments for insulin The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 15-a of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 378 of the laws of 1993 such section 3 as renumbered and subparagraph (A) as amended by chapter 338 of the laws 4 of 2003, is amended to read as follows: 5 (15-a) (A) Every policy which provides medical coverage that includes 6 coverage for physician services in a physician's office and every policy 7 which provides major medical or similar comprehensive-type coverage 8 shall include coverage for the following equipment and supplies for the 9 treatment of diabetes, if recommended or prescribed by a physician or 10 other licensed health care provider legally authorized to prescribe 11 under title eight of the education law: blood glucose monitors and blood 12 glucose monitors for the visually impaired, data management systems, 13 test strips for glucose monitors and visual reading and urine testing 14 strips, insulin, injection aids, cartridges for the visually impaired, 15 syringes, insulin pumps and appurtenances thereto, insulin infusion 16 devices, and oral agents for controlling blood sugar. In addition, the 17 commissioner of the department of health shall provide and periodically 18 update by rule or regulation a list of additional diabetes equipment and 19 related supplies such as are medically necessary for the treatment of 20 diabetes, for which there shall also be coverage. Such policies shall 21 also include coverage for diabetes self-management education to ensure 22 that persons with diabetes are educated as to the proper self-management 23 and treatment of their diabetic condition, including information on 24 proper diets. Such coverage for self-management education and education 25 relating to diet shall be limited to visits medically necessary upon the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13090-02-9A. 8292 2 1 diagnosis of diabetes, where a physician diagnoses a significant change 2 in the patient's symptoms or conditions which necessitate changes in a 3 patient's self-management, or where reeducation or refresher education 4 is necessary. Such education may be provided by the physician or other 5 licensed health care provider legally authorized to prescribe under 6 title eight of the education law, or their staff, as part of an office 7 visit for diabetes diagnosis or treatment, or by a certified diabetes 8 nurse educator, certified nutritionist, certified dietitian or regis- 9 tered dietitian upon the referral of a physician or other licensed 10 health care provider legally authorized to prescribe under title eight 11 of the education law. Education provided by the certified diabetes nurse 12 educator, certified nutritionist, certified dietitian or registered 13 dietitian may be limited to group settings wherever practicable. Cover- 14 age for self-management education and education relating to diet shall 15 also include home visits when medically necessary. 16 (B) Such coverage may be subject to annual deductibles and coinsurance 17 as may be deemed appropriate by the superintendent and as are consistent 18 with those established for other benefits within a given policy; 19 provided, however, that a covered person shall not be required to pay an 20 amount in excess of one hundred dollars per thirty day supply of 21 prescription insulin regardless of the amount or type of insulin needed 22 to fill the covered person's prescription, however nothing shall prevent 23 an insurer from reducing such maximum amount. 24 § 2. Paragraph 7 of subsection (k) of section 3221 of the insurance 25 law, as amended by chapter 338 of the laws of 2003, is amended to read 26 as follows: 27 (7)(A) Every group or blanket accident and health insurance policy 28 issued or issued for delivery in this state which provides medical 29 coverage that includes coverage for physician services in a physician's 30 office and every policy which provides major medical or similar compre- 31 hensive-type coverage shall include coverage for the following equipment 32 and supplies for the treatment of diabetes, if recommended or prescribed 33 by a physician or other licensed health care provider legally authorized 34 to prescribe under title eight of the education law: blood glucose moni- 35 tors and blood glucose monitors for the visually impaired, data manage- 36 ment systems, test strips for glucose monitors and visual reading and 37 urine testing strips, insulin, injection aids, cartridges for the visu- 38 ally impaired, syringes, insulin pumps and appurtenances thereto, insu- 39 lin infusion devices, and oral agents for controlling blood sugar. In 40 addition, the commissioner of the department of health shall provide and 41 periodically update by rule or regulation a list of additional diabetes 42 equipment and related supplies such as are medically necessary for the 43 treatment of diabetes, for which there shall also be coverage. Such 44 policies shall also include coverage for diabetes self-management educa- 45 tion to ensure that persons with diabetes are educated as to the proper 46 self-management and treatment of their diabetic condition, including 47 information on proper diets. Such coverage for self-management education 48 and education relating to diet shall be limited to visits medically 49 necessary upon the diagnosis of diabetes, where a physician diagnoses a 50 significant change in the patient's symptoms or conditions which neces- 51 sitate changes in a patient's self-management, or where reeducation or 52 refresher education is necessary. Such education may be provided by the 53 physician or other licensed health care provider legally authorized to 54 prescribe under title eight of the education law, or their staff, as 55 part of an office visit for diabetes diagnosis or treatment, or by a 56 certified diabetes nurse educator, certified nutritionist, certifiedA. 8292 3 1 dietitian or registered dietitian upon the referral of a physician or 2 other licensed health care provider legally authorized to prescribe 3 under title eight of the education law. Education provided by the certi- 4 fied diabetes nurse educator, certified nutritionist, certified dieti- 5 tian or registered dietitian may be limited to group settings wherever 6 practicable. Coverage for self-management education and education 7 relating to diet shall also include home visits when medically neces- 8 sary. 9 (B) Such coverage may be subject to annual deductibles and coinsurance 10 as may be deemed appropriate by the superintendent and as are consistent 11 with those established for other benefits within a given policy; 12 provided, however, that a covered person shall not be required to pay an 13 amount in excess of one hundred dollars per thirty day supply of 14 prescription insulin regardless of the amount or type of insulin needed 15 to fill the covered person's prescription, however nothing shall prevent 16 an insurer from reducing such maximum amount. 17 (C) This paragraph shall not apply to a policy which covers persons 18 employed in more than one state or the benefit structure of which was 19 the subject of collective bargaining affecting persons employed in more 20 than one state unless such policy is issued under the New York state 21 health insurance plan established under article eleven of the civil 22 service law or issued to or through a local government. 23 § 3. Subsection (u) of section 4303 of the insurance law, as amended 24 by chapter 338 of the laws of 2003, is amended to read as follows: 25 (u) (1) A medical expense indemnity corporation or a health service 26 corporation which provides medical coverage that includes coverage for 27 physician services in a physician's office and every policy which 28 provides major medical or similar comprehensive-type coverage shall 29 include coverage for the following equipment and supplies for the treat- 30 ment of diabetes, if recommended or prescribed by a physician or other 31 licensed health care provider legally authorized to prescribe under 32 title eight of the education law: blood glucose monitors and blood 33 glucose monitors for the visually impaired, data management systems, 34 test strips for glucose monitors and visual reading and urine testing 35 strips, insulin, injection aids, cartridges for the visually impaired, 36 syringes, insulin pumps and appurtenances thereto, insulin infusion 37 devices, and oral agents for controlling blood sugar. In addition, the 38 commissioner of the department of health shall provide and periodically 39 update by rule or regulation a list of additional diabetes equipment and 40 related supplies such as are medically necessary for the treatment of 41 diabetes, for which there shall also be coverage. Such policies shall 42 also include coverage for diabetes self-management education to ensure 43 that persons with diabetes are educated as to the proper self-management 44 and treatment of their diabetic condition, including information on 45 proper diets. Such coverage for self-management education and education 46 relating to diet shall be limited to visits medically necessary upon the 47 diagnosis of diabetes, where a physician diagnoses a significant change 48 in the patient's symptoms or conditions which necessitate changes in a 49 patient's self-management, or where reeducation or refresher education 50 is necessary. Such education may be provided by the physician or other 51 licensed health care provider legally authorized to prescribe under 52 title eight of the education law, or their staff, as part of an office 53 visit for diabetes diagnosis or treatment, or by a certified diabetes 54 nurse educator, certified nutritionist, certified dietitian or regis- 55 tered dietitian upon the referral of a physician or other licensed 56 health care provider legally authorized to prescribe under title eightA. 8292 4 1 of the education law. Education provided by the certified diabetes nurse 2 educator, certified nutritionist, certified dietitian or registered 3 dietitian may be limited to group settings wherever practicable. Cover- 4 age for self-management education and education relating to diet shall 5 also include home visits when medically necessary. 6 (2) Such coverage may be subject to annual deductibles and coinsurance 7 as may be deemed appropriate by the superintendent and as are consistent 8 with those established for other benefits within a given policy; 9 provided, however, that a covered person shall not be required to pay an 10 amount in excess of one hundred dollars per thirty day supply of 11 prescription insulin regardless of the amount or type of insulin needed 12 to fill the covered person's prescription, however nothing shall prevent 13 an insurer from reducing such maximum amount. 14 (3) This subsection shall not apply to a policy which covers persons 15 employed in more than one state or the benefit structure of which was 16 the subject of collective bargaining affecting persons employed in more 17 than one state unless such policy is issued under the New York state 18 health insurance plan established under article eleven of the civil 19 service law or issued to or through a local government. 20 § 4. This act shall take effect January 1, 2020 and shall apply to all 21 policies and contracts issued, renewed, modified, altered or amended on 22 or after such date.
