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S07336 Summary:

BILL NOS07336
 
SAME ASSAME AS A10086
 
SPONSORRIVERA
 
COSPNSRKAMINSKY, BAILEY, MONTGOMERY, SEPULVEDA
 
MLTSPNSR
 
Amd §365-a, Soc Serv L; amd §§3216 & 3221, Ins L
 
Relates to coverage for the treatment of asthma.
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S07336 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7336
 
                    IN SENATE
 
                                    January 17, 2020
                                       ___________
 
        Introduced  by Sens. RIVERA, KAMINSKY -- read twice and ordered printed,
          and when printed to be committed to the Committee on Health
 
        AN ACT to amend the social  services  law  and  the  insurance  law,  in
          relation to coverage for the treatment of asthma
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Paragraph (r) of subdivision 2  of  section  365-a  of  the
     2  social  services  law, as added by section 32 of part C of chapter 58 of
     3  the laws of 2008, is amended to read as follows:
     4    (r) asthma self-management training services for persons or parents of
     5  persons diagnosed with asthma including information  on  proper  use  of
     6  devices such as spacers, valved holding chambers and masks, and triggers
     7  in  the  environment  which  should  be  avoided  or  managed, when such
     8  services are ordered by a physician, registered  physician's  assistant,
     9  registered  nurse  practitioner,  or  licensed midwife and provided by a
    10  licensed, registered, or certified health care professional,  as  deter-
    11  mined  by  the  commissioner  of  health,  who is certified as an asthma
    12  educator by the National  Asthma  Educator  Certification  Board,  or  a
    13  successor  national  certification  board;  provided,  however, that the
    14  provisions of this paragraph shall not take effect unless all  necessary
    15  approvals under federal law and regulation have been obtained to receive
    16  federal  financial  participation  in  the costs of health care services
    17  provided pursuant to this paragraph.  Nothing in this paragraph shall be
    18  construed to modify any licensure, certification or  scope  of  practice
    19  provision under title eight of the education law.
    20    § 2. Subsection (i) of section 3216 of the insurance law is amended by
    21  adding a new paragraph 15-b to read as follows:
    22    (15-b)  (A) Every policy which provides medical coverage that includes
    23  coverage for physician services in a physician's office and every policy
    24  which provides major  medical  or  similar  comprehensive-type  coverage
    25  shall  include coverage for the following equipment and supplies for the
    26  treatment of asthma, and for children under nineteen years of age  addi-
    27  tional  equipment  and  supplies  for  use  in school, if recommended or
    28  prescribed by a physician or other licensed health care provider legally
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14651-01-0

        S. 7336                             2
 
     1  authorized to prescribe under title eight of the education law:   rescue
     2  inhaler  treatments  and  nebulizers;  spacers, valved holding chambers,
     3  masks and/or other such devices used to  assist  in  getting  medication
     4  into  the  lungs.  In  addition,  the  commissioner of the department of
     5  health shall provide and periodically update by  rule  or  regulation  a
     6  list  of  additional  asthma  equipment and related supplies such as are
     7  medically necessary for the treatment of asthma, for which  there  shall
     8  also  be  coverage. Such policies shall also include coverage for asthma
     9  self-management  education  to  ensure  that  persons  with  asthma,  or
    10  person's  who  have  a child or children with asthma, are educated as to
    11  the proper self-management and treatment of their  condition,  including
    12  information  on  proper  use  of devices and triggers in the environment
    13  which should be avoided or managed. Such  coverage  for  self-management
    14  education  and  education relating to devices shall be limited to visits
    15  medically necessary upon the diagnosis  of  asthma,  where  a  physician
    16  diagnoses  a  significant change in the patient's symptoms or conditions
    17  which necessitate changes in a patient's self-management, or where reed-
    18  ucation or refresher education  is  necessary.  Such  education  may  be
    19  provided by the physician or other licensed health care provider legally
    20  authorized to prescribe under title eight of the education law, or their
    21  staff,  as part of an office visit for asthma diagnosis or treatment, or
    22  by a certified asthma nurse educator, upon the referral of  a  physician
    23  or  other  licensed health care provider legally authorized to prescribe
    24  under title eight of the education law. Education provided by the certi-
    25  fied asthma nurse educator, may be limited to  group  settings  wherever
    26  practicable. Coverage for self-management education and education relat-
    27  ing to devices shall also include home visits when medically necessary.
    28    (B) Such coverage may be subject to annual deductibles and coinsurance
    29  as may be deemed appropriate by the superintendent and as are consistent
    30  with those established for other benefits within a given policy.
    31    § 3. Subsection (k) of section 3221 of the insurance law is amended by
    32  adding a new paragraph 22 to read as follows:
    33    (22)  (A)  Every  policy which provides medical coverage that includes
    34  coverage for physician services in a physician's office and every policy
    35  which provides major  medical  or  similar  comprehensive-type  coverage
    36  shall  include coverage for the following equipment and supplies for the
    37  treatment of asthma, and for children under nineteen years of age  addi-
    38  tional  equipment  and  supplies  for  use  in school, if recommended or
    39  prescribed by a physician or other licensed health care provider legally
    40  authorized to prescribe under title eight of the education  law:  rescue
    41  inhaler  treatments  and  nebulizers;  spacers, valved holding chambers,
    42  masks and/or other such devices used to  assist  in  getting  medication
    43  into  the  lungs.  In  addition,  the  commissioner of the department of
    44  health shall provide and periodically update by  rule  or  regulation  a
    45  list  of  additional  asthma  equipment and related supplies such as are
    46  medically necessary for the treatment of asthma, for which  there  shall
    47  also  be  coverage. Such policies shall also include coverage for asthma
    48  self-management  education  to  ensure  that  persons  with  asthma,  or
    49  person's  who  have  a child or children with asthma, are educated as to
    50  the proper self-management and treatment of their  condition,  including
    51  information  on  proper  use  of devices and triggers in the environment
    52  which should be avoided or managed. Such  coverage  for  self-management
    53  education  and  education relating to devices shall be limited to visits
    54  medically necessary upon the diagnosis  of  asthma,  where  a  physician
    55  diagnoses  a  significant change in the patient's symptoms or conditions
    56  which necessitate changes in a patient's self-management, or where reed-

        S. 7336                             3
 
     1  ucation or refresher education  is  necessary.  Such  education  may  be
     2  provided by the physician or other licensed health care provider legally
     3  authorized to prescribe under title eight of the education law, or their
     4  staff,  as part of an office visit for asthma diagnosis or treatment, or
     5  by a certified asthma nurse educator, upon the referral of  a  physician
     6  or  other  licensed health care provider legally authorized to prescribe
     7  under title eight of the education law. Education provided by the certi-
     8  fied asthma nurse educator, may be limited to  group  settings  wherever
     9  practicable. Coverage for self-management education and education relat-
    10  ing to devices shall also include home visits when medically necessary.
    11    (B) Such coverage may be subject to annual deductibles and coinsurance
    12  as may be deemed appropriate by the superintendent and as are consistent
    13  with those established for other benefits within a given policy.
    14    §  4. This act shall take effect on the first of January next succeed-
    15  ing the date on which it shall have become a law and shall apply to  all
    16  policies issued, renewed, altered or modified on or after such date.
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