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A00490 Summary:

BILL NOA00490A
 
SAME ASSAME AS S02287-A
 
SPONSORPaulin (MS)
 
COSPNSRGunther, Zebrowski, Katz, Rosenthal, Hooper
 
MLTSPNSRCeretto, Dinowitz
 
Amd SS3216, 3221, 4303 & 4322, Ins L
 
Enacts "Hannah's law"; requires that every health insurance policy or contract which provides coverage for prescription drugs include coverage for the cost of enteral formulas administered orally or via feeding tube.
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A00490 Actions:

BILL NOA00490A
 
01/09/2013referred to insurance
06/07/2013amend (t) and recommit to insurance
06/07/2013print number 490a
06/12/2013reported referred to ways and means
06/12/2013reported referred to rules
06/17/2013reported
06/17/2013rules report cal.290
06/17/2013ordered to third reading rules cal.290
06/18/2013substituted by s2287a
 S02287 AMEND=A BALL
 01/15/2013REFERRED TO INSURANCE
 03/18/2013REPORTED AND COMMITTED TO FINANCE
 04/23/20131ST REPORT CAL.414
 04/24/20132ND REPORT CAL.
 04/29/2013ADVANCED TO THIRD READING
 05/01/2013PASSED SENATE
 05/01/2013DELIVERED TO ASSEMBLY
 05/01/2013referred to insurance
 06/10/2013RECALLED FROM ASSEMBLY
 06/10/2013returned to senate
 06/10/2013VOTE RECONSIDERED - RESTORED TO THIRD READING
 06/10/2013AMENDED ON THIRD READING (T) 2287A
 06/13/2013REPASSED SENATE
 06/13/2013RETURNED TO ASSEMBLY
 06/13/2013referred to ways and means
 06/18/2013substituted for a490a
 06/18/2013ordered to third reading rules cal.290
 06/18/2013passed assembly
 06/18/2013returned to senate
 10/09/2013DELIVERED TO GOVERNOR
 10/21/2013SIGNED CHAP.388
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A00490 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A490A
 
SPONSOR: Paulin (MS)
  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 enteral formulas whether administered orally or via tube feeding   PURPOSE: To update and modify existing laws requiring the coverage of enteral formulas. Section 1: The short title Hannah's Law. Sections 2-4: Respectively, the sections amend the following sections of the insurance law: Paragraph 21 of subsection (i) of section 3216, para- graph 11 of subsection (k) of section 3221, and subsection (y) of section 4303. Each section is amended to require that any insurance policy which covers medical, major medical, or comprehensive-type insur- ance also cover both oral and facing-tube administered enteral formulas. Section 5: Makes a conforming amendment to Insurance law section 4322(b) (25), applicable to standardized individual enrollee direct payment contracts offered by health maintenance organizations. Section 6: Provides the effective date.   JUSTIFICATION: Eosinophilic esochagicis is a life-threatening illness that makes it impossible to eat most foods. In such cases, patients can only receive nourishment from enteral formulas which may be administered orally or via a feeding tube. Most insurance companies, however, only cover the cost of administration via feeding tubes. This bill requires that both methods of administration be covered. This bill was written in response to the case of Hannah De Vane, a six year-old girl with eosinophilic esophagitis. In Hannah's case, oral feeding.is possible. Unfortunately, her family's insurance policy only covers the use of feeding tubes. As a result, her family must choose between feeding Hannah with a feeding tube or paying out-of-pocket for the more than $14,000 a year it costs to purchase and administer the prescription formula orally. This bill will ensure adequate coverage for patients living with condi- tions such as eosinophilic esophagitis and other rare eosinophilic disorders.   LEGISLATIVE HISTORY: A.6413-A, 2011 and 2012 referred to insurance. Same as 8.5034-A, 2011 referred to insurance and 2012 passed senate. A.2186, 2010 held for consideration in insurance; 2009, referred to insurance. Same as S. 628, 2010 and 2009 referred to insurance. A. 11219, 2008 referred to insur- ance.   FISCAL IMPLICATIONS: To be determined.   EFFECTIVE DATE: The bill shall be effective on the first of January following enactment and shall be applicable to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
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A00490 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         490--A
 
                               2013-2014 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2013
                                       ___________
 
        Introduced  by M. of A. PAULIN, GUNTHER, MAISEL, ZEBROWSKI, KATZ, ROSEN-
          THAL, HOOPER -- Multi-Sponsored by -- M. of A.  CERETTO,  DINOWITZ  --
          read  once  and  referred  to  the Committee on Insurance -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted

          to said committee
 
        AN ACT to amend the insurance law,  in  relation  to  requiring  certain
          health  insurance policies to include coverage for the cost of enteral
          formulas whether administered orally or via tube feeding
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Short title.  This act shall be known and may be cited as
     2  "Hannah's law".
     3    § 2. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
     4  law,  as added by chapter 177 of the laws of 1997, is amended to read as
     5  follows:
     6    (21) Every policy which provides coverage for prescription drugs shall
     7  include coverage for the cost of enteral formulas for home use,  whether
     8  administered  orally or via tube feeding, for which a physician or other

     9  licensed health care provider  legally  authorized  to  prescribe  under
    10  title  eight of the education law has issued a written order. Such writ-
    11  ten order shall state that the  enteral  formula  is  clearly  medically
    12  necessary  and has been proven effective as a disease-specific treatment
    13  regimen for those individuals who are or  will  become  malnourished  or
    14  suffer  from  disorders, which if left untreated, cause chronic physical
    15  disability, mental retardation or death.  Specific  diseases  for  which
    16  enteral  formulas  have been proven effective shall include, but are not
    17  limited to, inherited diseases of amino acid or organic acid metabolism;
    18  Crohn's Disease; gastroesophageal reflux with failure to thrive;  disor-
    19  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
    20  struction; and multiple, severe food allergies which if  left  untreated
 

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05057-02-3

        A. 490--A                           2
 
     1  will  cause malnourishment, chronic physical disability, mental retarda-
     2  tion or death. Enteral formulas which are medically necessary and  taken
     3  under  written  order  from  a  physician  for the treatment of specific
     4  diseases shall be distinguished from nutritional supplements taken elec-
     5  tively. Coverage for certain inherited diseases of amino acid and organ-
     6  ic  acid  metabolism shall include modified solid food products that are
     7  low protein or which contain modified protein which are medically neces-
     8  sary, and such coverage for such modified solid food  products  for  any

     9  calendar  year  or  for  any  continuous period of twelve months for any
    10  insured individual shall not exceed two thousand five hundred dollars.
    11    § 3. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
    12  law,  as added by chapter 177 of the laws of 1997, is amended to read as
    13  follows:
    14    (11) Every policy which provides coverage for prescription drugs shall
    15  include coverage for the cost of enteral formulas for home use,  whether
    16  administered  orally or via tube feeding, for which a physician or other
    17  licensed health care provider  legally  authorized  to  prescribe  under
    18  title  eight of the education law has issued a written order. Such writ-
    19  ten order shall state that the  enteral  formula  is  clearly  medically
    20  necessary  and has been proven effective as a disease-specific treatment

    21  regimen for those individuals who are or  will  become  malnourished  or
    22  suffer  from  disorders, which if left untreated, cause chronic physical
    23  disability, mental retardation or death.  Specific  diseases  for  which
    24  enteral  formulas  have been proven effective shall include, but are not
    25  limited to, inherited diseases of amino-acid or organic acid metabolism;
    26  Crohn's Disease; gastroesophageal reflux with failure to thrive;  disor-
    27  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
    28  struction; and multiple, severe food allergies which if  left  untreated
    29  will  cause malnourishment, chronic physical disability, mental retarda-
    30  tion or death. Enteral formulas which are medically necessary and  taken
    31  under  written  order  from  a  physician  for the treatment of specific
    32  diseases shall be distinguished from nutritional supplements taken elec-

    33  tively. Coverage for certain inherited diseases of amino acid and organ-
    34  ic acid metabolism shall include modified solid food products  that  are
    35  low protein or which contain modified protein which are medically neces-
    36  sary,  and  such  coverage for such modified solid food products for any
    37  calendar year or for any continuous period  of  twelve  months  for  any
    38  insured individual shall not exceed two thousand five hundred dollars.
    39    §  4. Subsection (y) of section 4303 of the insurance law, as added by
    40  chapter 177 of the laws of 1997, is amended to read as follows:
    41    (y) Every contract which  provides  coverage  for  prescription  drugs
    42  shall  include  coverage  for the cost of enteral formulas for home use,
    43  whether administered orally or via tube feeding, for which  a  physician
    44  or  other  licensed health care provider legally authorized to prescribe

    45  under title eight of the education law has issued a written order.  Such
    46  written  order shall state that the enteral formula is clearly medically
    47  necessary and has been proven effective as a disease-specific  treatment
    48  regimen  for  those  individuals  who are or will become malnourished or
    49  suffer from disorders, which if left untreated, cause chronic  disabili-
    50  ty,  mental  retardation  or  death. Specific diseases for which enteral
    51  formulas have been proven effective shall include, but are  not  limited
    52  to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
    53  Disease;  gastroesophageal  reflux  with failure to thrive; disorders of
    54  gastrointestinal motility such as chronic intestinal pseudo-obstruction;
    55  and multiple, severe food allergies which if left untreated  will  cause
    56  malnourishment,  chronic  physical  disability,  mental  retardation  or

        A. 490--A                           3
 
     1  death. Enteral formulas which are medically necessary  and  taken  under
     2  written  order  from  a physician for the treatment of specific diseases
     3  shall be distinguished from nutritional  supplements  taken  electively.
     4  Coverage  for  certain inherited diseases of amino acid and organic acid
     5  metabolism shall include modified  solid  food  products  that  are  low
     6  protein,  or  which  contain modified protein which are medically neces-
     7  sary, and such coverage for such modified solid food  products  for  any
     8  calendar  year  or  for  any  continuous period of twelve months for any
     9  insured individual shall not exceed two thousand five hundred dollars.
    10    § 5. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
    11  section 4322 of the insurance law, as amended by chapter 554 of the laws

    12  of 2002, is amended to read as follows:
    13    Prescription  drugs, including contraceptive drugs or devices approved
    14  by the federal food  and  drug  administration  or  generic  equivalents
    15  approved  as substitutes by such food and drug administration and nutri-
    16  tional supplements (formulas), whether  administered  orally  or  via  a
    17  feeding tube for the therapeutic treatment of phenylketonuria, branched-
    18  chain  ketonuria, galactosemia and homocystinuria, obtained at a partic-
    19  ipating pharmacy under a prescription written by an in-plan  or  out-of-
    20  plan   provider.   Health  maintenance  organizations,  in  addition  to
    21  providing coverage for prescription drugs at a  participating  pharmacy,
    22  may  utilize  a mail order prescription drug program. Health maintenance
    23  organizations may provide prescription drugs pursuant to a  drug  formu-

    24  lary;  however,  health  maintenance  organizations  must  implement  an
    25  appeals process so that the use of non-formulary prescription drugs  may
    26  be requested by a physician or other provider.
    27    §  6. This act shall take effect on the first of January next succeed-
    28  ing the date on which it shall have become a law and shall apply to  all
    29  policies and contracts issued, renewed, modified, altered, or amended on
    30  or after such date.
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