NY State Senate Bill 2019-S2305

Senate Bill S2305

2019-2020 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 08, 2020	referred to insurance
Jan 24, 2019	referred to insurance

2019-S2305 (ACTIVE) - Details

See Assembly Version of this Bill:: A5053
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
2017-2018: S3345, A6206, A10576
2021-2022: S3386, A1831
2023-2024: S1234, A1500

2019-S2305 (ACTIVE) - Summary

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

2019-S2305 (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S2305

SPONSOR: BAILEY
 
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 retarda-
tion or death.

 
SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that coverage by any policy which provides
coveragò for prescription drugs must provide coverage for the cost of

infant and baby formulas which are proven effective as a disease-specif-
ic 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; abdo-
minal 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.  Espe-
cially 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:

2017-18: Referred to Insurance

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

2019-S2305 (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2305
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                             January 24, 2019
                                ___________
 
 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 469 of the laws of 2018, 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. Specific  diseases  and  disorders
 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;
 disorders of gastrointestinal motility such as chronic intestinal  pseu-
 do-obstruction;  and  multiple, severe food allergies including, but not
 limited to immunoglobulin E and nonimmunoglobulin  E-mediated  allergies
 to  multiple  food  proteins;  severe food protein induced enterocolitis
 syndrome; eosinophilic disorders; and impaired absorption  of  nutrients
 caused  by disorders affecting the absorptive surface, function, length,
 and motility of the gastrointestinal tract.  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 distin-
 guished from nutritional  supplements  taken  electively.  Coverage  for
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD05414-02-9

 S. 2305                             2
 
 certain  inherited diseases of amino acid and organic acid metabolism as
 well as severe protein allergic conditions shall include modified  solid
 food products that are low protein or which contain modified protein, or
 are  amino  acid  based 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.
   §  2.  Paragraph 11 of subsection (k) of section 3221 of the insurance
 law, as amended by chapter 469 of the laws of 2018, 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. Specific diseases and disorders
 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;
 disorders  of gastrointestinal motility such as chronic intestinal pseu-
 do-obstruction; and multiple, severe food allergies including,  but  not
 limited  to  immunoglobulin E and nonimmunoglobulin E-mediated allergies
 to multiple food proteins; severe  food  protein  induced  enterocolitis
 syndrome;  eosinophilic  disorders  and impaired absorption of nutrients
 caused by disorders affecting the absorptive surface, function,  length,
 and  motility  of  the  gastrointestinal tract. 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 distin-
 guished  from  nutritional  supplements  taken  electively. Coverage for
 certain inherited diseases of amino acid and organic acid metabolism  as
 well  as severe protein allergic conditions shall include modified solid
 food products that are low protein or which contain modified protein, or
 are amino acid based 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.
   § 3. Subsection (y) of section 4303 of the insurance law,  as  amended
 by chapter 469 of the laws of 2018, 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. Specific diseases and disorders
 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;
 disorders  of gastrointestinal motility such as chronic intestinal pseu-

 S. 2305                             3
 
 do-obstruction; and multiple, severe food allergies including,  but  not
 limited  to  immunoglobulin E and nonimmunoglobulin E-mediated allergies
 to multiple food proteins; severe  food  protein  induced  enterocolitis
 syndrome;  eosinophilic  disorders; and impaired absorption of nutrients
 caused by disorders affecting the absorptive surface, function,  length,
 and  motility  of  the  gastrointestinal tract. 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 distin-
 guished  from  nutritional  supplements  taken  electively. Coverage for
 certain inherited diseases of amino acid and organic acid metabolism  as
 well  as severe protein allergic conditions shall include modified solid
 food products that are low protein, or which contain  modified  protein,
 or are amino acid based 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.

 S. 2305                             4
 
   § 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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