Bill S2287A-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

  • Oct 21, 2013: SIGNED CHAP.388
  • Oct 9, 2013: DELIVERED TO GOVERNOR
  • Jun 18, 2013: returned to senate
  • Jun 18, 2013: passed assembly
  • Jun 18, 2013: ordered to third reading rules cal.290
  • Jun 18, 2013: substituted for a490a
  • Jun 13, 2013: referred to ways and means
  • Jun 13, 2013: RETURNED TO ASSEMBLY
  • Jun 13, 2013: REPASSED SENATE
  • Jun 10, 2013: AMENDED ON THIRD READING (T) 2287A
  • 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

Calendars

Votes

Memo

BILL NUMBER:S2287A

TITLE OF BILL: An act to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of enteral formulas whether administered orally or via tube feeding

PURPOSE: To update and modify existing laws requiring the coverage of enteral formulas.

Section 1: The short title Hannah's Law.

Sections 2-4: Respectively, the sections amend the following sections of the insurance law: Paragraph 21 of subsection (I) of section 3216, paragraph 11 of subsection (k) of section 3221, and subsection (y) of section 4303. Each section is amended to require that any insurance policy which covers medical, major medical, or comprehensive-type insurance also covers both oral and facing-tube administered enteral formulas.

Section 5: Makes a conforming amendment to Insurance law section 4322(b) (25), applicable to standardized individual enrollee direct payment contracts offered by health maintenance organizations.

Section 6: Provides the effective date.

JUSTIFICATION: Eosinophilic esophagitis is a life-threatening illness that makes it impossible to eat most foods. In such cases, patients can only receive nourishment from enteral formulas which may be administered orally or via a feeding tube. Most insurance companies, however, only cover the cost of administration via feeding tubes. This bill requires that both methods of administration be covered.

This bill was written in response to the case of Hannah De Vane, a six year-old girl with eosinophilic esophagitis. In Hannah's case, oral feeding is possible. Unfortunately, her family's insurance policy only covers the use of feeding tubes. As a result, her family must choose between feeding Hannah with a feeding tube or paying out-of-pocket for the more than $14,000 a year it costs to purchase and administer the prescription formula orally.

This bill will ensure adequate coverage for patients living with conditions such as eosinophilic esophagitis and other rare eosinoptilic disorders.

LEGISLATIVE HISTORY:

A.8413-A, 2011 and 2012 referred to insurance. Same as S.5034-A, 2011 referred to insurance and 2012 passed senate. A.2188, 2010 held for consideration in insurance; 2009, referred to insurance. Same as S. 628, 2010 and 2009 referred to insurance. A. 11219, 2008 referred to insurance.

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: The bill shall be effective on the first of January following enactment and shall be applicable to all policies and

contracts issued, renewed, modified, altered or amended on or after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 2287--A Cal. No. 414 2013-2014 Regular Sessions IN SENATE January 15, 2013 ___________
Introduced by Sens. BALL, O'BRIEN -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance -- reported favorably from said committee and committed to the Committee on Finance -- reported favorably from said committee, ordered to first and second report, ordered to a third reading, passed by Senate and delivered to the Assembly, recalled, vote reconsidered, restored to third reading, amended and ordered reprinted, retaining its place in the order of third reading AN ACT to amend the insurance law, in relation to requiring certain health insurance policies to include coverage for the cost of enteral formulas whether administered orally or via tube feeding 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; gastroesophageal reflux with failure to thrive; disor-
ders of gastrointestinal motility such as chronic intestinal pseudo-ob- struction; and multiple, severe food allergies which if left untreated will cause malnourishment, chronic physical disability, mental retarda- tion 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 elec- tively. Coverage for certain inherited diseases of amino acid and organ- ic acid metabolism shall include modified solid food products that are low protein or which contain modified protein which are medically neces- sary, 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 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; gastroesophageal reflux with failure to thrive; disor- ders of gastrointestinal motility such as chronic intestinal pseudo-ob- struction; and multiple, severe food allergies which if left untreated will cause malnourishment, chronic physical disability, mental retarda- tion 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 elec- tively. Coverage for certain inherited diseases of amino acid and organ- ic acid metabolism shall include modified solid food products that are low protein or which contain modified protein which are medically neces- sary, 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 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; 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 neces- sary, 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 and homocystinuria, obtained at a partic- ipating 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 formu- lary; 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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