Provides that persons with hemophilia and other clotting protein deficiencies who are otherwise eligible for the Child Health Plus or Family Health Plus program shall have access to reimbursement for outpatient blood clotting factor concentrates and other necessary treatments and services.

---

S3865A-2011 Actions

• Jun 5, 2012: REPORTED AND COMMITTED TO FINANCE
• 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 Meetings

Health: Jun 5, 2012

S3865A-2011 Votes

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.