NY State Senate Bill 2017-S3345

Senate Bill S3345

2017-2018 Legislative Session

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

download bill text pdf

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 03, 2018	referred to insurance
Jan 20, 2017	referred to insurance

2017-S3345 (ACTIVE) - Details

See Assembly Version of this Bill:: A10576
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S8326, A10450
2011-2012: S3270, A4492
2013-2014: S3321, A5282
2015-2016: S2043, A3732
2019-2020: S2305, A5053
2021-2022: S3386, A1831
2023-2024: S1234, A1500

2017-S3345 (ACTIVE) - Summary

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

2017-S3345 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S3345

 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 be
less than $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 :

2009-10: S.8326/A.10450-B (Meng) - Passed Assembly - Referred to Rules
2011-12: S.3270/A.4492(Meng)- Passed Assembly - Referred to Rules
2013-14: S.3321/A.5282(Moya)- Referred to Insurance
2015-16: S.2043/A.3732(Moya)- Referred to Insurance

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

2017-S3345 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   3345
 
                        2017-2018 Regular Sessions
 
                             I N  S E N A T E
 
                             January 20, 2017
                                ___________
 
 Introduced  by  Sen.  BAILEY -- 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 amended by chapter 388 of the laws of 2013, 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,  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, INFANT AND  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  disorders,  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, inher-
 ited diseases of amino acid or organic acid metabolism; Crohn's Disease;
 gastroesophageal reflux with failure to thrive; disorders  of  gastroin-
 testinal  motility  such  as  chronic intestinal pseudo-obstruction; and
 multiple, severe food allergies which if left untreated will cause maln-
 ourishment, 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 elec-
 tively. Coverage for certain inherited diseases of amino acid and organ-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD07096-01-7

 S. 3345                             2
 
 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.
 COVERAGE  FOR  INFANT  AND  BABY  FORMULAS  FOR ANY CALENDAR YEAR OR ANY
 CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL  SHALL  BE
 NO LESS THAN THREE THOUSAND DOLLARS.
   §  2.  Paragraph 11 of subsection (k) of section 3221 of the insurance
 law, as amended by chapter 388 of the laws of 2013, 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, 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, INFANT AND 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  disorders,  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, inher-
 ited diseases of amino-acid or organic acid metabolism; Crohn's Disease;
 gastroesophageal  reflux  with failure to thrive; disorders of gastroin-
 testinal motility such as  chronic  intestinal  pseudo-obstruction;  and
 multiple, severe food allergies which if left untreated will cause maln-
 ourishment,  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 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.
 COVERAGE  FOR  INFANT  AND  BABY  FORMULAS  FOR ANY CALENDAR YEAR OR ANY
 CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL  SHALL  BE
 NO LESS THAN THREE THOUSAND DOLLARS.
   §  3.  Subsection (y) of section 4303 of the insurance law, as amended
 by chapter 388 of the laws of 2013, 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, 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, INFANT AND  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  disorders,  which  if left
 untreated,  cause  chronic  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; disorders  of  gastroin-

 S. 3345                             3
 
 testinal  motility  such  as  chronic intestinal pseudo-obstruction; and
 multiple, severe food allergies which if left untreated will cause maln-
 ourishment, 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 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
 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 INDIVIDUAL  SHALL  BE
 NO LESS THAN THREE THOUSAND DOLLARS.
   §  4.  The  opening  paragraph  of  paragraph  25 of subsection (b) of
 section 4322 of the insurance law, as amended by chapter 388 of the laws
 of 2013, 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),
 whether  administered  orally  or via a feeding tube for the therapeutic
 treatment of phenylketonuria, branched-chain ketonuria, galactosemia and
 homocystinuria[,  obtained  at  a   participating   pharmacy   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  WRITTEN  ORDER
 SHALL  STATE THAT THE INFANT OR BABY FORMULA IS CLEARLY MEDICALLY NECES-
 SARY AND HAS BEEN PROVEN EFFECTIVE AS A DISEASE-SPECIFIC TREATMENT REGI-
 MEN FOR THOSE INDIVIDUALS WHO ARE OR WILL BECOME MALNOURISHED OR  SUFFER
 FROM DISORDERS, WHICH IF LEFT UNTREATED, CAUSE CHRONIC PHYSICAL DISABIL-
 ITY, 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;  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. 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 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.    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 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.
   §  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

 S. 3345                             4
 
 policies and contracts issued, renewed, modified, altered, or amended on
 or after such date.

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