Bill S6055-2011

Relates to coverage for oral chemotherapy

Relates to coverage for oral chemotherapy.

Details

Actions

  • Feb 6, 2012: SUBSTITUTED BY A8906
  • Jan 9, 2012: ORDERED TO THIRD READING CAL.12
  • Jan 9, 2012: REPORTED AND COMMITTED TO RULES
  • Jan 4, 2012: REFERRED TO INSURANCE

Votes


Text

STATE OF NEW YORK ________________________________________________________________________ 6055 IN SENATE (PREFILED) January 4, 2012 ___________
Introduced by Sen. LANZA -- 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 coverage of oral chemotherapy treatment THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Paragraph 12-a of subsection (i) of section 3216 of the insurance law, as added by chapter 559 of the laws of 2011, is amended to read as follows: (12-a) (A) Every policy delivered or issued for delivery in this state that provides medical, major medical, or similar comprehensive-type coverage and provides coverage for prescription drugs and also [provide] PROVIDES coverage for cancer chemotherapy treatment shall provide cover- age for [a] prescribed, orally administered anticancer [medication] MEDICATIONS used to kill or slow the growth of cancerous cells [and shall apply the lower cost sharing of either (i) anticancer medication under the prescription drug benefit or (ii)]. SUCH COVERAGE MAY BE SUBJECT TO CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN INSURED AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER- AGE FOR intravenous or injected anticancer medications. [For the purposes of this section "cost sharing" shall include co-pays, coinsu- rance, and deductibles as deemed appropriate by the superintendent.] (B) An insurer providing coverage under this paragraph and any partic- ipating entity through which the insurer offers health services shall not: (i) vary the terms of the policy for the purpose or with the effect of avoiding compliance with this paragraph; (ii) provide incentives (monetary or otherwise) to encourage a covered person to accept less than the minimum protections available under this paragraph;
(iii) penalize in any way or reduce or limit the compensation of a health care practitioner for recommending or providing care to a covered person in accordance with this paragraph; (iv) provide incentives (monetary or otherwise) to a health care prac- titioner relating to the services provided pursuant to this paragraph intended to induce or have the effect of inducing such practitioner to provide care to a covered person in a manner inconsistent with this paragraph; or (v) achieve compliance with this paragraph by imposing an increase in cost sharing for an intravenous or injected anticancer medication. S 2. Paragraph 12-a of subsection (1) of section 3221 of the insurance law, as added by chapter 559 of the laws of 2011, is amended to read as follows: (12-a) (A) Every policy delivered or issued for delivery in this state that provides medical, major medical, or similar comprehensive-type coverage and provides coverage for prescription drugs and also provides coverage for cancer chemotherapy treatment shall provide coverage for [a] prescribed, orally administered anticancer [medication] MEDICATIONS used to kill or slow the growth of cancerous cells [and shall apply the lower cost sharing of either (i) anticancer medication under the prescription drug benefit or (ii)]. SUCH COVERAGE MAY BE SUBJECT TO CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE CO-PAYS, COINSU- RANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN INSURED AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVERAGE FOR intrave- nous or injected anticancer medications. [For the purposes of this section "cost sharing" shall include co-pays, coinsurance, and deduct- ibles as deemed appropriate by the superintendent.] (B) An insurer providing coverage under this paragraph and any partic- ipating entity through which the insurer offers health services shall not: (i) vary the terms of the policy for the purpose or with the effect of avoiding compliance with this paragraph; (ii) provide incentives (monetary or otherwise) to encourage a covered person to accept less than the minimum protections available under this paragraph; (iii) penalize in any way or reduce or limit the compensation of a health care practitioner for recommending or providing care to a covered person in accordance with this paragraph; (iv) provide incentives (monetary or otherwise) to a health care prac- titioner relating to the services provided pursuant to this paragraph intended to induce or have the effect of inducing such practitioner to provide care to a covered person in a manner inconsistent with this paragraph; or (v) achieve compliance with this paragraph by imposing an increase in cost sharing for an intravenous or injected anticancer medication. S 3. Subsection (q-1) of section 4303 of the insurance law, as added by chapter 559 of the laws of 2011, is amended to read as follows: (q-1) (1) Every [policy] CONTRACT issued by a medical expense indem- nity corporation, a hospital service corporation or a health service corporation for delivery in this state that provides medical, major medical or similar comprehensive-type coverage and provides coverage for prescription drugs and for cancer chemotherapy treatment shall provide coverage for [a] prescribed, orally administered anticancer [medication] MEDICATIONS used to kill or slow the growth of cancerous cells [and shall apply the lower cost sharing of either (A) anticancer medication under the prescription drug benefit or (B)]. SUCH COVERAGE MAY BE
SUBJECT TO CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN INSURED AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER- AGE FOR intravenous or injected anticancer medications. [For the purposes of this section "cost sharing" shall include co-payments, coin- surance, and deductibles as deemed appropriate by the superintendent.] (2) An insurer providing coverage under this paragraph and any partic- ipating entity through which the insurer offers health services shall not: (A) vary the terms of the [policy] CONTRACT for the purpose or with the effect of avoiding compliance with this paragraph; (B) provide incentives (monetary or otherwise) to encourage a covered person to accept less than the minimum protections available under this paragraph; (C) penalize in any way or reduce or limit the compensation of a health care practitioner for recommending or providing care to a covered person in accordance with this paragraph; (D) provide incentives (monetary or otherwise) to a health care prac- titioner relating to the services provided pursuant to this paragraph intended to induce or have the effect of inducing such practitioner to provide care to a covered person in a manner inconsistent with this paragraph; or (E) achieve compliance with this paragraph by imposing an increase in cost sharing for an intravenous or injected anticancer medication. S 4. This act shall take effect on the same date and in the same manner as chapter 559 of the laws of 2011, takes effect.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Discuss!

blog comments powered by Disqus