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S02287 Summary:

BILL NOS02287A
 
SAME ASSAME AS A00490-A
 
SPONSORBALL
 
COSPNSRO'BRIEN
 
MLTSPNSR
 
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 whether administered orally or via feeding tube.
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S02287 Actions:

BILL NOS02287A
 
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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S02287 Memo:

Memo not available
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S02287 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2287--A
            Cal. No. 414
 
                               2013-2014 Regular Sessions
 
                    IN SENATE
 
                                    January 15, 2013
                                       ___________
 
        Introduced by Sens. BALL, O'BRIEN -- read twice and ordered printed, and
          when printed to be committed to the Committee on Insurance -- reported
          favorably  from  said  committee  and  committed  to  the Committee on
          Finance -- reported favorably from said committee,  ordered  to  first

          and  second  report,  ordered to a third reading, passed by Senate and
          delivered to the Assembly, recalled, vote  reconsidered,  restored  to
          third  reading,  amended and ordered reprinted, retaining its place in
          the order of third reading
 
        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-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05057-03-3

        S. 2287--A                          2
 
     1  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
     2  struction; and multiple, severe food allergies which if  left  untreated
     3  will  cause malnourishment, chronic physical disability, mental retarda-
     4  tion  or death. Enteral formulas which are medically necessary and taken
     5  under written order from a  physician  for  the  treatment  of  specific
     6  diseases shall be distinguished from nutritional supplements taken elec-
     7  tively. Coverage for certain inherited diseases of amino acid and organ-

     8  ic  acid  metabolism shall include modified solid food products that are
     9  low protein or which contain modified protein which are medically neces-
    10  sary, and such coverage for such modified solid food  products  for  any
    11  calendar  year  or  for  any  continuous period of twelve months for any
    12  insured individual shall not exceed two thousand five hundred dollars.
    13    § 3. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
    14  law,  as added by chapter 177 of the laws of 1997, is amended to read as
    15  follows:
    16    (11) Every policy which provides coverage for prescription drugs shall
    17  include coverage for the cost of enteral formulas for home use,  whether
    18  administered  orally or via tube feeding, for which a physician or other
    19  licensed health care provider  legally  authorized  to  prescribe  under

    20  title  eight of the education law has issued a written order. Such writ-
    21  ten order shall state that the  enteral  formula  is  clearly  medically
    22  necessary  and has been proven effective as a disease-specific treatment
    23  regimen for those individuals who are or  will  become  malnourished  or
    24  suffer  from  disorders, which if left untreated, cause chronic physical
    25  disability, mental retardation or death.  Specific  diseases  for  which
    26  enteral  formulas  have been proven effective shall include, but are not
    27  limited to, inherited diseases of amino-acid or organic acid metabolism;
    28  Crohn's Disease; gastroesophageal reflux with failure to thrive;  disor-
    29  ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
    30  struction; and multiple, severe food allergies which if  left  untreated
    31  will  cause malnourishment, chronic physical disability, mental retarda-

    32  tion or death. Enteral formulas which are medically necessary and  taken
    33  under  written  order  from  a  physician  for the treatment of specific
    34  diseases shall be distinguished from nutritional supplements taken elec-
    35  tively. Coverage for certain inherited diseases of amino acid and organ-
    36  ic acid metabolism shall include modified solid food products  that  are
    37  low protein or which contain modified protein which are medically neces-
    38  sary,  and  such  coverage for such modified solid food products for any
    39  calendar year or for any continuous period  of  twelve  months  for  any
    40  insured individual shall not exceed two thousand five hundred dollars.
    41    §  4. Subsection (y) of section 4303 of the insurance law, as added by
    42  chapter 177 of the laws of 1997, is amended to read as follows:
    43    (y) Every contract which  provides  coverage  for  prescription  drugs

    44  shall  include  coverage  for the cost of enteral formulas for home use,
    45  whether administered orally or via tube feeding, for which  a  physician
    46  or  other  licensed health care provider legally authorized to prescribe
    47  under title eight of the education law has issued a written order.  Such
    48  written  order shall state that the enteral formula is clearly medically
    49  necessary and has been proven effective as a disease-specific  treatment
    50  regimen  for  those  individuals  who are or will become malnourished or
    51  suffer from disorders, which if left untreated, cause chronic  disabili-
    52  ty,  mental  retardation  or  death. Specific diseases for which enteral
    53  formulas have been proven effective shall include, but are  not  limited
    54  to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
    55  Disease;  gastroesophageal  reflux  with failure to thrive; disorders of

    56  gastrointestinal motility such as chronic intestinal pseudo-obstruction;

        S. 2287--A                          3
 
     1  and multiple, severe food allergies which if left untreated  will  cause
     2  malnourishment,  chronic  physical  disability,  mental  retardation  or
     3  death. Enteral formulas which are medically necessary  and  taken  under
     4  written  order  from  a physician for the treatment of specific diseases
     5  shall be distinguished from nutritional  supplements  taken  electively.
     6  Coverage  for  certain inherited diseases of amino acid and organic acid
     7  metabolism shall include modified  solid  food  products  that  are  low
     8  protein,  or  which  contain modified protein which are medically neces-
     9  sary, and such coverage for such modified solid food  products  for  any
    10  calendar  year  or  for  any  continuous period of twelve months for any

    11  insured individual shall not exceed two thousand five hundred dollars.
    12    § 5. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
    13  section 4322 of the insurance law, as amended by chapter 554 of the laws
    14  of 2002, is amended to read as follows:
    15    Prescription  drugs, including contraceptive drugs or devices approved
    16  by the federal food  and  drug  administration  or  generic  equivalents
    17  approved  as substitutes by such food and drug administration and nutri-
    18  tional supplements (formulas), whether  administered  orally  or  via  a
    19  feeding tube for the therapeutic treatment of phenylketonuria, branched-
    20  chain  ketonuria, galactosemia and homocystinuria, obtained at a partic-
    21  ipating pharmacy under a prescription written by an in-plan  or  out-of-
    22  plan   provider.   Health  maintenance  organizations,  in  addition  to

    23  providing coverage for prescription drugs at a  participating  pharmacy,
    24  may  utilize  a mail order prescription drug program. Health maintenance
    25  organizations may provide prescription drugs pursuant to a  drug  formu-
    26  lary;  however,  health  maintenance  organizations  must  implement  an
    27  appeals process so that the use of non-formulary prescription drugs  may
    28  be requested by a physician or other provider.
    29    §  6. This act shall take effect on the first of January next succeed-
    30  ing the date on which it shall have become a law and shall apply to  all
    31  policies and contracts issued, renewed, modified, altered, or amended on
    32  or after such date.
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