This bill has been amended

Bill S2287-2013

Enacts "Hannah's law"; requires certain insurance policies to include coverage for the cost of enteral formulas

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 whether administered orally or via feeding tube.

Details

Actions

  • Jun 10, 2013: VOTE RECONSIDERED - RESTORED TO THIRD READING
  • Jun 10, 2013: returned to senate
  • Jun 10, 2013: RECALLED FROM ASSEMBLY
  • May 1, 2013: referred to insurance
  • May 1, 2013: DELIVERED TO ASSEMBLY
  • May 1, 2013: PASSED SENATE
  • Apr 29, 2013: ADVANCED TO THIRD READING
  • Apr 24, 2013: 2ND REPORT CAL.
  • Apr 23, 2013: 1ST REPORT CAL.414
  • Mar 18, 2013: REPORTED AND COMMITTED TO FINANCE
  • Jan 15, 2013: REFERRED TO INSURANCE

Votes

VOTE: COMMITTEE VOTE: - Insurance - Mar 18, 2013
Ayes (19): Seward, Carlucci, Flanagan, Golden, Grisanti, Lanza, Larkin, LaValle, Martins, O'Mara, Valesky, Young, Breslin, Espaillat, Kennedy, Parker, Stavisky, O'Brien, Peralta

Text

STATE OF NEW YORK ________________________________________________________________________ 2287 2013-2014 Regular Sessions IN SENATE January 15, 2013 ___________
Introduced by Sen. BALL -- read twice and ordered printed, and when printed to be committed 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: Section 1. Short title. This act shall be known and may be cited as "Hannah's law". S 2. Paragraph 21 of subsection (i) of section 3216 of the insurance law, as added by chapter 177 of the laws of 1997, is amended to read as follows: (21) Every policy which provides coverage for prescription drugs shall include coverage for the cost of enteral formulas for home use, WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such writ- ten order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical disability, mental retardation or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino acid or organic acid metabolism; Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies which if left untreated will cause malnourishment, chronic physical disability, mental retardation or death. Enteral formulas which are medically necessary and taken under
written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for certain inherited diseases of amino acid and organic acid metabolism shall include modified solid food products that are low protein or which contain modified protein which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured indi- vidual shall not exceed two thousand five hundred dollars. S 3. Paragraph 11 of subsection (k) of section 3221 of the insurance law, as added by chapter 177 of the laws of 1997, is amended to read as follows: (11) Every policy which provides coverage for prescription drugs shall include coverage for the cost of enteral formulas for home use, WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such writ- ten order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic physical disability, mental retardation or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino-acid or organic acid metabolism; Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS; gastroesophageal reflux with failure to thrive; disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies which if left untreated will cause malnourishment, chronic physical disability, mental retardation or death. Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for certain inherited diseases of amino acid and organic acid metabolism shall include modified solid food products that are low protein or which contain modified protein which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured indi- vidual shall not exceed two thousand five hundred dollars. S 4. Subsection (y) of section 4303 of the insurance law, as added by chapter 177 of the laws of 1997, is amended to read as follows: (y) Every contract which provides coverage for prescription drugs shall include coverage for the cost of enteral formulas for home use, WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which a physician or other licensed health care provider legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the enteral formula is clearly medically necessary and has been proven effective as a disease-specific treatment regimen for those individuals who are or will become malnourished or suffer from disorders, which if left untreated, cause chronic disabili- ty, mental retardation or death. Specific diseases for which enteral formulas have been proven effective shall include, but are not limited to, inherited diseases of amino-acid or organic acid metabolism; Crohn's Disease; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS; gastroesophageal reflux with failure to thrive; disorders of gastroin- testinal motility such as chronic intestinal pseudo-obstruction; and multiple, severe food allergies which if left untreated will cause maln- ourishment, chronic physical disability, mental retardation or death.
Enteral formulas which are medically necessary and taken under written order from a physician for the treatment of specific diseases shall be distinguished from nutritional supplements taken electively. Coverage for certain inherited diseases of amino acid and organic acid metabolism shall include modified solid food products that are low protein, or which contain modified protein which are medically necessary, and such coverage for such modified solid food products for any calendar year or for any continuous period of twelve months for any insured individual shall not exceed two thousand five hundred dollars. S 5. The opening paragraph of paragraph 25 of subsection (b) of section 4322 of the insurance law, as amended by chapter 554 of the laws of 2002, is amended to read as follows: Prescription drugs, including contraceptive drugs or devices approved by the federal food and drug administration or generic equivalents approved as substitutes by such food and drug administration and nutri- tional supplements (formulas), WHETHER ADMINISTERED ORALLY OR VIA A FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched- chain ketonuria, galactosemia, EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS, and homocystinuria, obtained at a participating pharmacy under a prescription written by an in-plan or out-of-plan provider. Health maintenance organizations, in addition to providing coverage for prescription drugs at a participating pharmacy, may utilize a mail order prescription drug program. Health maintenance organizations may provide prescription drugs pursuant to a drug formulary; however, health maintenance organizations must implement an appeals process so that the use of non-formulary prescription drugs may be requested by a physician or other provider. S 6. This act shall take effect on the first of January next succeed- ing the date on which it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered, or amended on or after such date.

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