Bill Text: NY A08413 | 2011-2012 | General Assembly | Introduced
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 for which a physician has issued a written order and which are medically necessary for the treatment of eosinophilic esophagitis and related eosinophilic disorders.
Spectrum: Slight Partisan Bill (Democrat 8-4)
Status: (Introduced - Dead) 2012-02-27 - print number 8413a [A08413 Detail]
Download: New_York-2011-A08413-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 8413 2011-2012 Regular Sessions I N A S S E M B L Y June 15, 2011 ___________ Introduced by M. of A. PAULIN, GUNTHER, MAISEL, REILLY, ZEBROWSKI, CASTELLI, KATZ, BURLING -- Multi-Sponsored by -- M. of A. CERETTO, DINOWITZ -- read once and referred 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. This act shall be known and may be cited as "Hannah's law". 2 S 2. Paragraph 21 of subsection (i) of section 3216 of the insurance 3 law, as added by chapter 177 of the laws of 1997, is amended to read as 4 follows: 5 (21) Every policy which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 6 COMPREHENSIVE-TYPE COVERAGE OR 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 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08040-01-1 A. 8413 2 1 death. Enteral formulas which are medically necessary and taken under 2 written order from a physician for the treatment of specific diseases 3 shall be distinguished from nutritional supplements taken electively. 4 Coverage for certain inherited diseases of amino acid and organic acid 5 metabolism shall include modified solid food products that are low 6 protein or which contain modified protein which are medically neces- 7 sary[, and such coverage for such modified solid food products for any 8 calendar year or for any continuous period of twelve months for any 9 insured individual shall not exceed two thousand five hundred dollars]. 10 S 3. Paragraph 11 of subsection (k) of section 3221 of the insurance 11 law, as added by chapter 177 of the laws of 1997, is amended to read as 12 follows: 13 (11) Every policy which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 14 COMPREHENSIVE-TYPE COVERAGE OR coverage for prescription drugs shall 15 include coverage for the cost of enteral formulas for home use, WHETHER 16 ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other 17 licensed health care provider legally authorized to prescribe under 18 title eight of the education law has issued a written order. Such writ- 19 ten order shall state that the enteral formula is clearly medically 20 necessary and has been proven effective as a disease-specific treatment 21 regimen for those individuals who are or will become malnourished or 22 suffer from disorders, which if left untreated, cause chronic physical 23 disability, mental retardation or death. Specific diseases for which 24 enteral formulas have been proven effective shall include, but are not 25 limited to, inherited diseases of amino-acid or organic acid metabolism; 26 Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC 27 DISORDERS; gastroesophageal reflux with failure to thrive; disorders of 28 gastrointestinal motility such as chronic intestinal pseudo-obstruction; 29 and multiple, severe food allergies which if left untreated will cause 30 malnourishment, chronic physical disability, mental retardation or 31 death. Enteral formulas which are medically necessary and taken under 32 written order from a physician for the treatment of specific diseases 33 shall be distinguished from nutritional supplements taken electively. 34 Coverage for certain inherited diseases of amino acid and organic acid 35 metabolism shall include modified solid food products that are low 36 protein or which contain modified protein which are medically neces- 37 sary[, and such coverage for such modified solid food products for any 38 calendar year or for any continuous period of twelve months for any 39 insured individual shall not exceed two thousand five hundred dollars]. 40 S 4. Subsection (y) of section 4303 of the insurance law, as added by 41 chapter 177 of the laws of 1997, is amended to read as follows: 42 (y) Every contract which provides MEDICAL, MAJOR MEDICAL OR SIMILAR 43 COMPREHENSIVE-TYPE COVERAGE OR coverage for prescription drugs shall 44 include coverage for the cost of enteral formulas for home use, WHETHER 45 ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other 46 licensed health care provider legally authorized to prescribe under 47 title eight of the education law has issued a written order. Such writ- 48 ten order shall state that the enteral formula is clearly medically 49 necessary and has been proven effective as a disease-specific treatment 50 regimen for those individuals who are or will become malnourished or 51 suffer from disorders, which if left untreated, cause chronic disabili- 52 ty, mental retardation or death. Specific diseases for which enteral 53 formulas have been proven effective shall include, but are not limited 54 to, inherited diseases of amino-acid or organic acid metabolism; Crohn's 55 Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS; 56 gastroesophageal reflux with failure to thrive; disorders of gastroin- A. 8413 3 1 testinal motility such as chronic intestinal pseudo-obstruction; and 2 multiple, severe food allergies which if left untreated will cause maln- 3 ourishment, chronic physical disability, mental retardation or death. 4 Enteral formulas which are medically necessary and taken under written 5 order from a physician for the treatment of specific diseases shall be 6 distinguished from nutritional supplements taken electively. Coverage 7 for certain inherited diseases of amino acid and organic acid metabolism 8 shall include modified solid food products that are low protein, or 9 which contain modified protein which are medically necessary[, and such 10 coverage for such modified solid food products for any calendar year or 11 for any continuous period of twelve months for any insured individual 12 shall not exceed two thousand five hundred dollars]. 13 S 5. The opening paragraph of paragraph 25 of subsection (b) of 14 section 4322 of the insurance law, as amended by chapter 554 of the laws 15 of 2002, is amended to read as follows: 16 Prescription drugs, including contraceptive drugs or devices approved 17 by the federal food and drug administration or generic equivalents 18 approved as substitutes by such food and drug administration and nutri- 19 tional supplements (formulas), WHETHER ADMINISTERED ORALLY OR VIA A 20 FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched- 21 chain ketonuria, galactosemia, EOSINOPHILIC ESOPHAGITIS AND RELATED 22 EOSINOPHILIC DISORDERS, and homocystinuria, obtained at a participating 23 pharmacy under a prescription written by an in-plan or out-of-plan 24 provider. Health maintenance organizations, in addition to providing 25 coverage for prescription drugs at a participating pharmacy, may utilize 26 a mail order prescription drug program. Health maintenance organizations 27 may provide prescription drugs pursuant to a drug formulary; however, 28 health maintenance organizations must implement an appeals process so 29 that the use of non-formulary prescription drugs may be requested by a 30 physician or other provider. 31 S 6. This act shall take effect on the first of January next succeed- 32 ing the date on which it shall have become a law and shall apply to all 33 policies and contracts issued, renewed, modified, altered, or amended on 34 or after such date.