Bill S3270-2011

Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas

Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas.

Details

Actions

  • Mar 12, 2012: COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • Mar 12, 2012: NOTICE OF COMMITTEE CONSIDERATION - REQUESTED
  • Jan 4, 2012: REFERRED TO INSURANCE
  • Feb 15, 2011: REFERRED TO INSURANCE

Memo

BILL NUMBER:S3270

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 certain infant and baby formulas

PURPOSE: To allow parents to affordably provide medically necessary formulas for infants who would become malnourished or suffer from disorders if these particular formulas were made unavailable to them. These disorders, if left untreated, may cause chronic physical disability, mental retardation or death.

SUMMARY OF SPECIFIC PROVISIONS: This bill would require that coverage by any policy which provides coverage for prescription drugs must provide coverage for the cost of infant and baby formulas which are proven effective as a disease-specific regimen. Such formulas must be prescribed by a physician or other license health care professional. Coverage for certain infant and baby formulas for any twelve months shall not exceed $3000.

JUSTIFICATION: Many infants have been prescribed medically necessary formulas which have been proven effective as a disease-specific treatment regimen for infants who are, or will become, malnourished or suffer from disorders, which, if left untreated, may cause chronic physical disability, mental retardation or death. Specific diseases for which infant formulas have been proven effective include: inherited diseases of amino acid; Crohn's disease; gastroesophageal reflux with failure to thrive; and multiple, severe food allergies. Symptoms of such allergies may also include: loose stools, which may contain blood; vomiting; hives; diarrhea; abdominal cramps; coughing or wheezing; runny nose; watery eyes; itchy skin rash, often around the mouth; and colic.

Infant and baby formulas, which must be purchased to prevent symptoms from occurring, are often more expensive than regular formulas. Especially during these difficult economic times, parents need help to provide the food that is best and safest for their infants.

Currently, in New York State, insurance companies are not required to cover these medically necessary formulas. However, other states, such as Arizona, Colorado, Louisiana, and Massachusetts do have provisions which require insurance companies to cover such infant formulas.

LEGISLATIVE HISTORY: Senate: 2009-10: S.8326 - Referred to Rules Assembly: 2009-10: A.10450 (Meng) - Passed Assembly

EFFECTIVE DATE:

First of January next succeeding the date it becomes a law.


Text

STATE OF NEW YORK ________________________________________________________________________ 3270 2011-2012 Regular Sessions IN SENATE February 15, 2011 ___________
Introduced by Sen. HASSELL-THOMPSON -- 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 certain infant and baby formulas THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. 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, INFANT AND BABY formulas for home use 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, INFANT OR BABY 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 disor- ders, which if left untreated, cause chronic physical disability, mental retardation or death. Specific diseases for which enteral, INFANT AND BABY 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, INFANT AND BABY formulas which are medically necessary and taken under written order from a physician for the treat- ment 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. COVERAGE FOR INFANT AND BABY FORMULAS FOR ANY CALENDAR YEAR OR ANY CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVID- UAL SHALL BE NO LESS THAN THREE THOUSAND DOLLARS. S 2. 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, INFANT AND BABY formulas for home use 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, INFANT OR BABY 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 disor- ders, which if left untreated, cause chronic physical disability, mental retardation or death. Specific diseases for which enteral, INFANT AND BABY 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, INFANT AND BABY formulas which are medically necessary and taken under written order from a physician for the treat- ment 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. COVERAGE FOR INFANT AND BABY FORMULAS FOR ANY CALENDAR YEAR OR ANY CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVID- UAL SHALL BE NO LESS THAN THREE THOUSAND DOLLARS. S 3. 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, INFANT AND BABY formulas for home use for which a physician or other licensed health care provid- er legally authorized to prescribe under title eight of the education law has issued a written order. Such written order shall state that the enteral, INFANT OR BABY 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 disor- ders, which if left untreated, cause chronic disability, mental retarda- tion or death. Specific diseases for which enteral, INFANT AND BABY 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, INFANT AND BABY 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. COVERAGE FOR INFANT AND BABY FORMULAS FOR ANY CALENDAR YEAR OR ANY CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVID- UAL SHALL BE NO LESS THAN THREE THOUSAND DOLLARS. S 4. 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, OBTAINED AT A PARTICIPATING PHARMACY UNDER A PRESCRIPTION WRITTEN BY AN IN-PLAN OR OUT-OF-PLAN PROVIDER, 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], nutritional supplements (formulas) for the therapeutic treatment of phenylketonuria, branched-chain ketonu- ria, galactosemia and homocystinuria[, obtained at a participating phar- macy under a prescription written by an in-plan or out-of-plan provider] AND INFANT AND BABY FORMULAS FOR HOME USE 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 INFANT OR BABY FORMULA IS CLEARLY MEDICALLY NECESSARY AND HAS BEEN PROVEN EFFECTIVE AS A DISEASE-SPECIFIC TREATMENT REGIMEN FOR THOSE INDIVIDUALS WHO ARE OR WILL BECOME MALNOUR- ISHED OR SUFFER FROM DISORDERS, WHICH IF LEFT UNTREATED, CAUSE CHRONIC PHYSICAL DISABILITY, MENTAL RETARDATION OR DEATH. SPECIFIC DISEASES FOR WHICH INFANT AND BABY 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 INTESTI- NAL PSEUDO-OBSTRUCTION; AND MULTIPLE, SEVERE FOOD ALLERGIES WHICH IF LEFT UNTREATED WILL CAUSE MALNOURISHMENT, CHRONIC PHYSICAL DISABILITY, MENTAL RETARDATION OR DEATH. INFANT AND BABY FORMULAS WHICH ARE MEDICALLY NECESSARY AND TAKEN UNDER WRITTEN ORDER FROM A PHYSICIAN FOR THE TREATMENT OF SPECIFIC DISEASES SHALL BE DISTINGUISHED FROM NUTRI- TIONAL SUPPLEMENTS TAKEN ELECTIVELY. COVERAGE FOR INFANT AND BABY FORMU- LAS FOR ANY CALENDAR YEAR OR ANY CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL SHALL BE NO LESS THAN THREE THOUSAND DOLLARS. 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 mainte- nance 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 5. 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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