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S03988 Summary:

BILL NO    S03988B

SAME AS    SAME AS A06233-B

SPONSOR    LANZA

COSPNSR    HASSELL-THOMPSON, ALESI, ADAMS, ADDABBO, AVELLA, DEFRANCISCO, DIAZ,
           GOLDEN, GRISANTI, KENNEDY, KLEIN, KRUEGER, LARKIN, MARTINS, MAZIARZ,
           OPPENHEIMER

MLTSPNSR   

Amd SS3216, 3221 & 4303, Ins L

Requires coverage of orally administered chemotherapy treatments.
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S03988 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                        3988--B

                              2011-2012 Regular Sessions

                                   I N  S E N A T E

                                    March 11, 2011
                                      ___________

       Introduced  by  Sens.  LANZA,  HASSELL-THOMPSON,  ALESI, ADAMS, ADDABBO,
         AVELLA, DeFRANCISCO, DIAZ, GOLDEN, GRISANTI, KENNEDY, KLEIN,  KRUEGER,
         LARKIN, MARTINS, MAZIARZ, OPPENHEIMER -- read twice and ordered print-
         ed,  and when printed to be committed to the Committee on Insurance --
         committee discharged, bill amended, ordered reprinted as  amended  and
         recommitted  to  said committee -- committee discharged, bill amended,
         ordered reprinted as amended and recommitted to said committee

       AN ACT to amend the insurance law, in relation  to  policy  coverage  of
         chemotherapy treatment

         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:

    1    Section 1. Legislative findings. The legislature finds  that  advances
    2  in  medical research have led to significant new developments of various
    3  medical treatments. These treatments offer patients a wide range of  new
    4  choices  to  combat  very serious diseases. The area of cancer treatment
    5  has been one of the fields that has seen these significant  new  medical
    6  advancements.  In  recent  years, oral chemotherapy treatments have been
    7  developed that provide viable alternatives  to  traditional  intravenous
    8  cancer  treatments for patients. This oral chemotherapy treatment offers
    9  the treating physician and the patient a choice in relation to treatment
   10  options. However, this choice is sometimes limited as the oral  chemoth-
   11  erapy treatments are, in most cases, covered under the prescription drug
   12  benefit  of an insurance plan rather than under the major medical insur-
   13  ance benefit of an insurance plan.  This  discrepancy  in  coverage  can
   14  limit  a  patient's  ability  to  choose the oral chemotherapy treatment
   15  because of the cost associated with the disparate treatment.
   16    S 2. Subsection (i) of section 3216 of the insurance law is amended by
   17  adding a new paragraph 12-a to read as follows:
   18    (12-A) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
   19  THAT PROVIDES MEDICAL,  MAJOR  MEDICAL,  OR  SIMILAR  COMPREHENSIVE-TYPE
   20  COVERAGE  AND  PROVIDES COVERAGE FOR PRESCRIPTION DRUGS AND ALSO PROVIDE

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD09290-06-1
       S. 3988--B                          2

    1  COVERAGE FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR  A
    2  PRESCRIBED,  ORALLY  ADMINISTERED  ANTICANCER MEDICATION USED TO KILL OR
    3  SLOW THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST  SHAR-
    4  ING  OF  EITHER  (I)  ANTICANCER  MEDICATION UNDER THE PRESCRIPTION DRUG
    5  BENEFIT OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR  THE
    6  PURPOSES  OF  THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYS, COINSU-
    7  RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
    8    (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
    9  IPATING ENTITY THROUGH WHICH THE INSURER OFFERS  HEALTH  SERVICES  SHALL
   10  NOT:
   11    (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
   12  AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
   13    (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
   14  PERSON  TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER THIS
   15  PARAGRAPH;
   16    (III) PENALIZE IN ANY WAY OR REDUCE OR LIMIT  THE  COMPENSATION  OF  A
   17  HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
   18  PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
   19    (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
   20  TITIONER  RELATING  TO  THE SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH
   21  INTENDED TO INDUCE OR HAVE THE EFFECT OF INDUCING SUCH  PRACTITIONER  TO
   22  PROVIDE  CARE  TO  A  COVERED  PERSON IN A MANNER INCONSISTENT WITH THIS
   23  PARAGRAPH; OR
   24    (V) ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE  IN
   25  COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
   26    S 3. Subsection (l) of section 3221 of the insurance law is amended by
   27  adding a new paragraph 12-a to read as follows:
   28    (12-A) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
   29  THAT  PROVIDES  MEDICAL,  MAJOR  MEDICAL,  OR SIMILAR COMPREHENSIVE-TYPE
   30  COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS AND ALSO  PROVIDES
   31  COVERAGE  FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A
   32  PRESCRIBED, ORALLY ADMINISTERED ANTICANCER MEDICATION USED  TO  KILL  OR
   33  SLOW  THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST SHAR-
   34  ING OF EITHER (I) ANTICANCER  MEDICATION  UNDER  THE  PRESCRIPTION  DRUG
   35  BENEFIT  OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR THE
   36  PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE  CO-PAYS,  COINSU-
   37  RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
   38    (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
   39  IPATING  ENTITY  THROUGH  WHICH THE INSURER OFFERS HEALTH SERVICES SHALL
   40  NOT:
   41    (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
   42  AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
   43    (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
   44  PERSON TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER  THIS
   45  PARAGRAPH;
   46    (III)  PENALIZE  IN  ANY  WAY OR REDUCE OR LIMIT THE COMPENSATION OF A
   47  HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
   48  PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
   49    (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
   50  TITIONER RELATING TO THE SERVICES PROVIDED PURSUANT  TO  THIS  PARAGRAPH
   51  INTENDED  TO  INDUCE OR HAVE THE EFFECT OF INDUCING SUCH PRACTITIONER TO
   52  PROVIDE CARE TO A COVERED PERSON IN  A  MANNER  INCONSISTENT  WITH  THIS
   53  PARAGRAPH; OR
   54    (V)  ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE IN
   55  COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
       S. 3988--B                          3

    1    S 4. Section 4303 of the insurance law is  amended  by  adding  a  new
    2  subsection  (q-l) to read as follows:
    3    (Q-1)  (1)  EVERY  POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
    4  RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH  SERVICE  CORPORATION
    5  FOR DELIVERY IN THIS STATE THAT PROVIDES MEDICAL, MAJOR MEDICAL OR SIMI-
    6  LAR  COMPREHENSIVE-TYPE  COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION
    7  DRUGS AND FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A
    8  PRESCRIBED, ORALLY ADMINISTERED ANTICANCER MEDICATION USED  TO  KILL  OR
    9  SLOW  THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST SHAR-
   10  ING OF EITHER (A) ANTICANCER  MEDICATION  UNDER  THE  PRESCRIPTION  DRUG
   11  BENEFIT  OR  (B) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR THE
   12  PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYMENTS, COIN-
   13  SURANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
   14    (2) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
   15  IPATING ENTITY THROUGH WHICH THE INSURER OFFERS  HEALTH  SERVICES  SHALL
   16  NOT:
   17    (A) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
   18  AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
   19    (B)  PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
   20  PERSON TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER  THIS
   21  PARAGRAPH;
   22    (C)  PENALIZE  IN  ANY  WAY  OR  REDUCE OR LIMIT THE COMPENSATION OF A
   23  HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
   24  PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
   25    (D) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE  PRAC-
   26  TITIONER  RELATING  TO  THE SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH
   27  INTENDED TO INDUCE OR HAVE THE EFFECT OF  INDUCING SUCH PRACTITIONER  TO
   28  PROVIDE  CARE  TO  A  COVERED  PERSON IN A MANNER INCONSISTENT WITH THIS
   29  PARAGRAPH; OR
   30    (E) ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE  IN
   31  COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
   32    S  5. This act shall take effect on the first of January next succeed-
   33  ing the date on which it shall have become a law and shall apply to  all
   34  policies  and contracts issued, renewed, modified, altered or amended on
   35  or after such effective date.
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