Bill Text: NY A08413 | 2011-2012 | General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Amended.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        8413--A
                              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, ROSENTHAL, HOOPER -- Multi-Sponsored by -- M.
         of A. CERETTO, DINOWITZ -- read once and referred to the Committee  on
         Insurance  --  recommitted to the Committee on Insurance in accordance
         with Assembly Rule 3, sec. 2 -- committee  discharged,  bill  amended,
         ordered reprinted as amended and recommitted to said committee
       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.  Short title.  This act shall be known and may be cited as
    2  "Hannah's law".
    3    S 2. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
    4  law,  as added by chapter 177 of the laws of 1997, is amended to read as
    5  follows:
    6    (21) Every policy which provides 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
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD08040-03-2
       A. 8413--A                          2
    1  gastrointestinal motility such as chronic intestinal pseudo-obstruction;
    2  and multiple, severe food allergies which if left untreated  will  cause
    3  malnourishment,  chronic  physical  disability,  mental  retardation  or
    4  death.  Enteral  formulas  which are medically necessary and taken under
    5  written order from a physician for the treatment  of  specific  diseases
    6  shall  be  distinguished  from nutritional supplements taken electively.
    7  Coverage for certain inherited diseases of amino acid and  organic  acid
    8  metabolism  shall  include  modified  solid  food  products that are low
    9  protein or which contain modified protein which are medically necessary,
   10  and such coverage for such modified solid food products for any calendar
   11  year or for any continuous period of twelve months for any insured indi-
   12  vidual shall not exceed two thousand five hundred dollars.
   13    S 3. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
   14  law,  as added by chapter 177 of the laws of 1997, is amended to read as
   15  follows:
   16    (11) Every policy which provides coverage for prescription drugs shall
   17  include coverage for the cost of enteral formulas for home use,  WHETHER
   18  ADMINISTERED  ORALLY OR VIA TUBE FEEDING, for which a physician or other
   19  licensed health care provider  legally  authorized  to  prescribe  under
   20  title  eight of the education law has issued a written order. Such writ-
   21  ten order shall state that the  enteral  formula  is  clearly  medically
   22  necessary  and has been proven effective as a disease-specific treatment
   23  regimen for those individuals who are or  will  become  malnourished  or
   24  suffer  from  disorders, which if left untreated, cause chronic physical
   25  disability, mental retardation or death.  Specific  diseases  for  which
   26  enteral  formulas  have been proven effective shall include, but are not
   27  limited to, inherited diseases of amino-acid or organic acid metabolism;
   28  Crohn's  Disease;  EOSINOPHILIC  ESOPHAGITIS  AND  RELATED  EOSINOPHILIC
   29  DISORDERS;  gastroesophageal reflux with failure to thrive; disorders of
   30  gastrointestinal motility such as chronic intestinal pseudo-obstruction;
   31  and multiple, severe food allergies which if left untreated  will  cause
   32  malnourishment,  chronic  physical  disability,  mental  retardation  or
   33  death. Enteral formulas which are medically necessary  and  taken  under
   34  written  order  from  a physician for the treatment of specific diseases
   35  shall be distinguished from nutritional  supplements  taken  electively.
   36  Coverage  for  certain inherited diseases of amino acid and organic acid
   37  metabolism shall include modified  solid  food  products  that  are  low
   38  protein or which contain modified protein which are medically necessary,
   39  and such coverage for such modified solid food products for any calendar
   40  year or for any continuous period of twelve months for any insured indi-
   41  vidual shall not exceed two thousand five hundred dollars.
   42    S  4. Subsection (y) of section 4303 of the insurance law, as added by
   43  chapter 177 of the laws of 1997, is amended to read as follows:
   44    (y) Every contract which  provides  coverage  for  prescription  drugs
   45  shall  include  coverage  for the cost of enteral formulas for home use,
   46  WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which  a  physician
   47  or  other  licensed health care provider legally authorized to prescribe
   48  under title eight of the education law has issued a written order.  Such
   49  written  order shall state that the enteral formula is clearly medically
   50  necessary and has been proven effective as a disease-specific  treatment
   51  regimen  for  those  individuals  who are or will become malnourished or
   52  suffer from disorders, which if left untreated, cause chronic  disabili-
   53  ty,  mental  retardation  or  death. Specific diseases for which enteral
   54  formulas have been proven effective shall include, but are  not  limited
   55  to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
   56  Disease;  EOSINOPHILIC  ESOPHAGITIS  AND RELATED EOSINOPHILIC DISORDERS;
       A. 8413--A                          3
    1  gastroesophageal reflux with failure to thrive; disorders  of  gastroin-
    2  testinal  motility  such  as  chronic intestinal pseudo-obstruction; and
    3  multiple, severe food allergies which if left untreated will cause maln-
    4  ourishment,  chronic  physical  disability, mental retardation or death.
    5  Enteral formulas which are medically necessary and taken  under  written
    6  order  from  a physician for the treatment of specific diseases shall be
    7  distinguished from nutritional supplements  taken  electively.  Coverage
    8  for certain inherited diseases of amino acid and organic acid metabolism
    9  shall  include  modified  solid  food  products that are low protein, or
   10  which contain modified protein which are medically necessary,  and  such
   11  coverage  for such modified solid food products for any calendar year or
   12  for any continuous period of twelve months for  any  insured  individual
   13  shall not exceed two thousand five hundred dollars.
   14    S  5.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
   15  section 4322 of the insurance law, as amended by chapter 554 of the laws
   16  of 2002, is amended to read as follows:
   17    Prescription drugs, including contraceptive drugs or devices  approved
   18  by  the  federal  food  and  drug  administration or generic equivalents
   19  approved as substitutes by such food and drug administration and  nutri-
   20  tional  supplements  (formulas),  WHETHER  ADMINISTERED  ORALLY OR VIA A
   21  FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched-
   22  chain ketonuria,  galactosemia,  EOSINOPHILIC  ESOPHAGITIS  AND  RELATED
   23  EOSINOPHILIC  DISORDERS, and homocystinuria, obtained at a participating
   24  pharmacy under a prescription  written  by  an  in-plan  or  out-of-plan
   25  provider.  Health  maintenance  organizations,  in addition to providing
   26  coverage for prescription drugs at a participating pharmacy, may utilize
   27  a mail order prescription drug program. Health maintenance organizations
   28  may provide prescription drugs pursuant to a  drug  formulary;  however,
   29  health  maintenance  organizations  must implement an appeals process so
   30  that the use of non-formulary prescription drugs may be requested  by  a
   31  physician or other provider.
   32    S  6. This act shall take effect on the first of January next succeed-
   33  ing the date on which it shall have become a law and shall apply to  all
   34  policies and contracts issued, renewed, modified, altered, or amended on
   35  or after such date.