S3865A-2011 Actions

• Jan 4, 2012: REFERRED TO HEALTH
• Jun 15, 2011: PRINT NUMBER 3865A
• Jun 15, 2011: AMEND (T) AND RECOMMIT TO FINANCE
• May 3, 2011: REPORTED AND COMMITTED TO FINANCE
• Mar 8, 2011: REFERRED TO HEALTH

S3865A-2011 Memo

BILL NUMBER:S3865A

TITLE OF BILL:
An act
to amend the public health law, the social services law and the
insurance law, in relation to providing that persons with hemophilia and
other clotting protein deficiencies who are otherwise eligible for the
Child Health Plus, Family Health Plus, and Healthy New York programs
shall have access to reimbursement for outpatient blood clotting factor
concentrates and other necessary treatments and services

PURPOSE OF BILL:
To provide outpatient coverage under
the Child Health
Plus, Family Health Plus, and Healthy New York programs for blood
clotting factor concentrates as well as other treatments and services
necessary for individuals with hemophilia and other clotting protein
deficiencies.

SUMMARY OF PROVISIONS:
Subdivision 7 of section 2510 of the public health law, as amended by
section 21 of part B of chapter 109 of the laws of 2010, is amended
to include:

*outpatient blood clotting factor products and other treatments and
services furnished in connection with the care of hemophilia and
other blood clotting protein deficiencies;

Paragraph a of subdivision 7 of section 2510 of the public health law,
as amended by chapter 526 of the laws of 2002 is amended to include:

* outpatient blood clotting factor products and other treatments and
services furnished in connection with the care of hemophilia and
other blood clotting protein deficiencies;

Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
section 369-ee of the social services law, subparagraph (xv) as
amended and subparagraph (xvi) as added by chapter 526 of the laws of
2002, are amended and a new paragraph (xvii) is added to read as
follows:

* (xv) services provided to meet the requirements of 42 D.S.C. 1396d(r);

(xvi)hospice services; and

(xvii) outpatient blood clotting factor products and other treatments
and services furnished in connection with the care of hemophilia and
other blood clotting protein deficiencies as defined by the
commissioner of health in consultation with the superintendent.

Paragraph 13 of subsection (d) of section 4326 of the insurance law,
as added by chapter 1 of the laws of 1999 is amended to read as
follows:


*blood and blood products furnished in connection with surgery or
inpatient hospital services or outpatient services for hemophilia and
other blood clotting protein deficiencies;

JUSTIFICATION:
Hemophilia is a rare hereditary bleeding disorder
affecting roughly 2,000 New Yorkers, resulting from a deficiency in
blood proteins known as clotting factors. without an adequate supply
of clotting factors, individuals can experience prolonged bleeding
following routine medical and dental procedures, trauma, and a range
of physical activities. Additionally, individuals with hemophilia
often experience spontaneous internal bleeding that can cause severe
joint damage, chronic pain, and even death.

Prior to the 1970's, individuals with hemophilia seldom lived beyond 3D.
Early treatment consisted of whole blood and Plasma transfusions at
hospitals. These treatments were difficult, time consuming and only
minimally effective. The advent of commercially prepared blood
treatment, both in terms of efficacy and convenience. Most
importantly, these advances allowed for home infusion.

In addition to hemophilia, there are several other disorders resulting
from blood protein deficiencies. These include Von Willebrand Disease
(VWD) , the most common bleeding disorder, affecting approximately
two million Americans. Individuals with the severest form of VWD rely
on clotting factor treatments similar to those used by individuals
with hemophilia.

Clotting factor products produced today (derived from plasma or
recombinant technology) are very safe and highly effective
medications. Access to therapies has vastly improved both the health
outcomes and quality of life for the majority of patients and their
families. Many patients today are on a prophylactic regimen to
prevent bleeding episodes. This preventative regimen together with
the coordinated care provided by hemophilia treatment centers have
significantly reduced visits to emergency rooms, hospitalizations and
joint damage. Further, the ability to manage hemophilia and other
bleeding disorders outside of the hospital setting has improved
attendance for school-aged-children, decreased absenteeism from work
for adult patients and caregivers, vastly improved the ability of
affected persons to join the work force, and minimized life
disruptions for the entire family.

Child Health Plus, Family Health Plus and Healthy New York presently
do not cover clotting factor therapies prescribed for use at home by
individuals with hemophilia and other clotting protein deficiencies.
moreover, New York state is the only state in the U.S. not currently
providing coverage for outpatient clotting factor products used by
individuals who are eligible for the State Children's Health
Insurance Program (i.e., Child Health Plus). All three programs -
Child Health Plus, Family Health Plus and Healthy New York - were
created to improve access to health care for low-income individuals.
Having a policy in place that prevents otherwise eligible individuals
with hemophilia and other bleeding disorders from accessing
lifesaving medications not only violates the spirit of the policy, it
is discriminating against a selected group whose health care costs
are deemed to be high and fundamentally undermines the programs'


overall goal of ensuring that low-income children and families have
access to the quality health care.

PRIOR LEGISLATIVE HISTORY:
None.

FISCAL IMPLICATIONS:
Unknown.

EFFECTIVE DATE:
This act shall take effect on the first of April next
succeeding the date upon which it shall have become law, provided
that the amendments to the subdivision 7 of section 2510 of the
public health law made by section two of this act shall be subject to
the expiration and reversion of such subdivision pursuant to
subdivision 4 of section 47 of chapter 2 of the laws of 1998, as
amended, when upon such date the provisions of section three of this
act shall take effect.

S3865A-2011 Text

 S T A T E   O F   N E W   Y O R K
 
 3865--A
 2011-2012 Regular Sessions
 I N  SENATE
 March 8, 2011
 
 Introduced  by  Sens. ROBACH, KRUEGER -- read twice and ordered printed,
 and when printed to  be  committed  to  the  Committee  on  Health  -
 reported  favorably from said committee and committed to the Committee
 on Finance -- committee discharged, bill amended, ordered reprinted as
 amended and recommitted to said committee
 

AN ACT to amend the public health law, the social services law  and  the
 insurance  law,  in relation to providing that persons with hemophilia
 and other clotting protein deficiencies who are otherwise eligible for
 the Child Health Plus or Family Health Plus programs shall have access
 to reimbursement for outpatient blood clotting factor concentrates and
 other necessary treatments and services
 THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM
 BLY, DO ENACT AS FOLLOWS:

 

Section  1.    Legislative  findings.  Hemophilia is a rare hereditary
 bleeding disorder resulting from a deficiency in blood proteins known as
 clotting factors.  Without an adequate supply of clotting factors, indi
 viduals can experience prolonged bleeding following routine medical  and
 dental  procedures,  trauma,  and  a range of physical activities. Addi
 tionally,  individuals  with  hemophilia  often  experience  spontaneous
 internal  bleeding that can cause severe joint damage, chronic pain, and
 even death.
 Prior to the 1970s, individuals with hemophilia  seldom  lived  beyond
 the age of 30 years. Early treatment consisted of whole blood and plasma
 transfusions at hospitals. These treatments were difficult, time consum
 ing  and  only  minimally effective. The advent of commercially prepared
 blood clotting factors in the  1980s  represented  a  major  advance  in
 treatment,  both in terms of efficacy and convenience. Most importantly,
 these advances allowed for home infusion.
 In addition to hemophilia, there are several other disorders resulting
 from blood protein deficiencies. These include  Von  Willebrand  Disease
 (VWD),  the  most  common bleeding disorder, affecting approximately two
 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD09788-02-1
 
       S. 3865--A                          2
 million Americans. Individuals with the severest form  of  VWD  rely  on
 clotting  factor  treatments  similar  to those used by individuals with
 hemophilia.
 Clotting factor products produced today (derived from plasma or recom
 binant  technology)  are  very  safe  and  highly effective medications.
 Access to therapies has vastly improved both  the  health  outcomes  and
 quality  of  life  for the majority of patients and their families. Many
 patients today  are  on  a  prophylactic  regimen  to  prevent  bleeding
 episodes.  This  preventative regimen together with the coordinated care
 provided by hemophilia  treatment  centers  have  significantly  reduced
 visits  to  emergency rooms, hospitalizations and joint damage. Further,
 the ability to manage hemophilia and other bleeding disorders outside of
 the hospital setting have  helped  improve  attendance  for  school-aged
 children,  decreased  absenteeism from work for adult patients and care
 givers, vastly improved the ability of affected persons to join the work
 force, and minimized life disruptions for the entire family.
 Presently, New York state is the only state  in  the  U.S.  preventing
 access to lifesaving outpatient clotting factor products for individuals
 that qualify for the State Children's Health Insurance Program.
 The  legislature  finds  that having a policy that prohibits otherwise
 eligible individuals from  accessing  lifesaving  medications  not  only
 violates  the  spirit of these very important programs, it discriminates
 against a vulnerable group of individuals whose health  care  costs  are
 deemed  to  be  high  and fundamentally undermines the programs' overall
 goal of ensuring that low-income children and families  have  access  to
 quality  health  care.  The  legislature further finds that costs to the
 state for allowing individuals who qualify  for  Child  Health  Plus  or
 Family  Health  Plus to access the outpatient clotting products at home,
 the recommended model of care, will be  much  less  than  the  long-term
 costs  the  state  will  very  likely end up paying through the Medicaid
 program for individuals who later develop debilitating complications and
 are deemed unable to work.
 This legislation is intended to modify existing state law by  allowing
 for  the  coverage of lifesaving clotting factor products prescribed for
 use at home by persons with hemophilia and other clotting protein  defi
 ciencies  who  are  eligible  for the Child Health Plus or Family Health
 Plus program.
 

S 2. Subdivision 7 of section  2510  of  the  public  health  law,  as
 amended  by  section 21 of part B of chapter 109 of the laws of 2010, is
 amended to read as follows:

 7. "Covered health care services" means: the services  of  physicians,
 optometrists,  nurses,  nurse  practitioners, midwives and other related
 professional personnel  which  are  provided  on  an  outpatient  basis,
 including  routine well-child visits; diagnosis and treatment of illness
 and injury; inpatient health care services; laboratory tests; diagnostic
 x-rays; prescription and  non-prescription  drugs  and  durable  medical
 equipment;  radiation  therapy;  chemotherapy;  hemodialysis; OUTPATIENT
 BLOOD  CLOTTING  FACTOR  PRODUCTS  AND  OTHER  TREATMENTS  AND  SERVICES
 FURNISHED  IN  CONNECTION  WITH  THE  CARE OF HEMOPHILIA AND OTHER BLOOD
 CLOTTING  PROTEIN  DEFICIENCIES;  emergency   room   services;   hospice
 services;  emergency,  preventive  and  routine  dental  care, including
 medically necessary orthodontia but excluding cosmetic surgery; emergen
 cy, preventive and routine vision care, including eyeglasses; speech and
 hearing services; and, inpatient and outpatient mental  health,  alcohol
 and substance abuse services as defined by the commissioner in consulta
 tion  with  the superintendent. "Covered health care services" shall not
 
       S. 3865--A                          3
 include drugs, procedures and supplies for  the  treatment  of  erectile
 dysfunction  when provided to, or prescribed for use by, a person who is
 required to register as a sex offender pursuant to article six-C of  the
 correction  law,  provided  that  any  denial of coverage of such drugs,
 procedures or supplies shall provide  the  patient  with  the  means  of
 obtaining  additional  information  concerning  both  the denial and the
 means of challenging such denial.
 

S 3. Paragraph a of subdivision 7 of section 2510 of the public health
 law, as amended by chapter 526 of the laws of 2002, is amended  to  read
 as follows:

 a.  "Primary  and preventive health care services" means: the services
 of physicians, optometrists, nurses, nurse practitioners,  midwives  and
 other related professional personnel which are provided on an outpatient
 basis,  including  routine well-child visits; diagnosis and treatment of
 illness and injury; laboratory tests;  diagnostic  x-rays;  prescription
 drugs;  radiation  therapy; chemotherapy; hemodialysis; OUTPATIENT BLOOD
 CLOTTING FACTOR PRODUCTS AND OTHER TREATMENTS AND SERVICES FURNISHED  IN
 CONNECTION  WITH THE CARE OF HEMOPHILIA AND OTHER BLOOD CLOTTING PROTEIN
 DEFICIENCIES; emergency room services; hospice services; and, outpatient
 alcohol and substance abuse services as defined by the  commissioner  in
 consultation with the superintendent.
 

S 4. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
 section  369-ee of the social services law, subparagraph (xv) as amended
 and subparagraph (xvi) as added by chapter 526 of the laws of 2002,  are
 amended and a new paragraph (xvii) is added to read as follows:

 (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
 [and]
 (xvi) hospice services[.]; AND
 (XVII)  OUTPATIENT BLOOD CLOTTING FACTOR PRODUCTS AND OTHER TREATMENTS
 AND SERVICES FURNISHED IN CONNECTION WITH THE  CARE  OF  HEMOPHILIA  AND
 OTHER BLOOD CLOTTING PROTEIN DEFICIENCIES AS DEFINED BY THE COMMISSIONER
 OF HEALTH IN CONSULTATION WITH THE SUPERINTENDENT.
 

S 5.  This act shall take effect on the first of April next succeeding
 the date upon which it shall have become a law, provided that the amend
 ments  to subdivision 7 of section 2510 of the public health law made by
 section two of this act shall be subject to the expiration and reversion
 of such subdivision pursuant to subdivision 4 of section 47 of chapter 2
 of the laws of 1998, as amended, when upon such date the  provisions  of
 section three of this act shall take effect.

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