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A00962 Summary:

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A00962 Floor Votes:

A00962 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         962--A
 
                               2013-2014 Regular Sessions
 
                   IN ASSEMBLY
 
                                       (Prefiled)
 
                                     January 9, 2013
                                       ___________
 
        Introduced  by M. of A. KELLNER, CROUCH, FINCH, GOTTFRIED -- Multi-Spon-
          sored by -- M.  of A. CURRAN, CUSICK, HEVESI, LENTOL, LUPARDO, MARKEY,
          MOSLEY, WALTER -- read once and referred to the Committee on Health --
          reported and referred to the Committee on Ways and Means --  committee

          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee
 
        AN  ACT  to  amend  the public health law, in relation to providing that
          persons with hemophilia and other clotting  protein  deficiencies  who
          are  otherwise  eligible  for the Child Health Plus program shall have
          access to reimbursement for outpatient blood clotting  factor  concen-
          trates and other necessary treatments and services
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1.   Legislative findings. Hemophilia  is  a  rare  hereditary
     2  bleeding disorder resulting from a deficiency in blood proteins known as
     3  clotting factors.  Without an adequate supply of clotting factors, indi-
     4  viduals  can experience prolonged bleeding following routine medical and

     5  dental procedures, trauma, and a range  of  physical  activities.  Addi-
     6  tionally,  individuals  with  hemophilia  often  experience  spontaneous
     7  internal bleeding that can cause severe joint damage, chronic pain,  and
     8  even death.
     9    Prior  to  the  1970s, individuals with hemophilia seldom lived beyond
    10  the age of 30 years. Early treatment consisted of whole blood and plasma
    11  transfusions at hospitals. These treatments were difficult, time consum-
    12  ing and only minimally effective. The advent  of  commercially  prepared
    13  blood  clotting  factors  in  the  1980s  represented a major advance in
    14  treatment, both in terms of efficacy and convenience. Most  importantly,
    15  these advances allowed for home infusion.
    16    In addition to hemophilia, there are several other disorders resulting
    17  from  blood  protein  deficiencies. These include Von Willebrand Disease
 

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02168-04-3
        A. 962--A                           2
 
     1  (VWD), the most common bleeding disorder,  affecting  approximately  two
     2  million  Americans.  Individuals  with  the severest form of VWD rely on
     3  clotting factor treatments similar to those  used  by  individuals  with
     4  hemophilia.
     5    Clotting factor products produced today (derived from plasma or recom-
     6  binant  technology)  are  very  safe  and  highly effective medications.
     7  Access to therapies has vastly improved both  the  health  outcomes  and
     8  quality  of  life  for the majority of patients and their families. Many

     9  patients today  are  on  a  prophylactic  regimen  to  prevent  bleeding
    10  episodes.  This  preventative regimen together with the coordinated care
    11  provided by hemophilia  treatment  centers  have  significantly  reduced
    12  visits  to  emergency rooms, hospitalizations and joint damage. Further,
    13  the ability to manage hemophilia and other bleeding disorders outside of
    14  the hospital setting have  helped  improve  attendance  for  school-aged
    15  children,  decreased  absenteeism from work for adult patients and care-
    16  givers, vastly improved the ability of affected persons to join the work
    17  force, and minimized life disruptions for the entire family.
    18    Presently, New York state is the only state  in  the  U.S.  preventing
    19  access to lifesaving outpatient clotting factor products for individuals
    20  that qualify for the State Children's Health Insurance Program.

    21    The  legislature  finds  that having a policy that prohibits otherwise
    22  eligible individuals from  accessing  lifesaving  medications  not  only
    23  violates  the  spirit of these very important programs, it discriminates
    24  against a vulnerable group of individuals whose health  care  costs  are
    25  deemed  to  be  high  and fundamentally undermines the programs' overall
    26  goal of ensuring that low-income children and families  have  access  to
    27  quality  health  care.  The  legislature further finds that costs to the
    28  state for allowing individuals who qualify  for  Child  Health  Plus  to
    29  access  the  outpatient clotting products at home, the recommended model
    30  of care, will be much less than the long-term costs the state will  very
    31  likely  end  up  paying through the Medicaid program for individuals who
    32  later develop debilitating complications and are deemed unable to work.

    33    This legislation is intended to modify existing state law by  allowing
    34  for  the  coverage of lifesaving clotting factor products prescribed for
    35  use at home by persons with hemophilia and other clotting protein  defi-
    36  ciencies who are eligible for the Child Health Plus program.
    37    §  2.  Subdivision  7  of  section  2510  of the public health law, as
    38  amended by section 21 of part B of chapter 109 of the laws of  2010,  is
    39  amended to read as follows:
    40    7.  "Covered  health care services" means: the services of physicians,
    41  optometrists, nurses, nurse practitioners, midwives  and  other  related
    42  professional  personnel  which  are  provided  on  an  outpatient basis,
    43  including routine well-child visits; diagnosis and treatment of  illness
    44  and injury; inpatient health care services; laboratory tests; diagnostic

    45  x-rays;  prescription  and  non-prescription  drugs  and durable medical
    46  equipment; radiation  therapy;  chemotherapy;  hemodialysis;  outpatient
    47  blood  clotting  factor  products  and  other  treatments  and  services
    48  furnished in connection with the care  of  hemophilia  and  other  blood
    49  clotting   protein   deficiencies;   emergency  room  services;  hospice
    50  services; emergency,  preventive  and  routine  dental  care,  including
    51  medically necessary orthodontia but excluding cosmetic surgery; emergen-
    52  cy, preventive and routine vision care, including eyeglasses; speech and
    53  hearing  services;  and, inpatient and outpatient mental health, alcohol
    54  and substance abuse services as defined by the commissioner in consulta-
    55  tion with the superintendent. "Covered health care services"  shall  not

    56  include  drugs,  procedures  and  supplies for the treatment of erectile
        A. 962--A                           3
 
     1  dysfunction when provided to, or prescribed for use by, a person who  is
     2  required  to register as a sex offender pursuant to article six-C of the
     3  correction law, provided that any denial  of  coverage  of  such  drugs,
     4  procedures  or  supplies  shall  provide  the  patient with the means of
     5  obtaining additional information concerning  both  the  denial  and  the
     6  means of challenging such denial.
     7    § 3. Paragraph a of subdivision 7 of section 2510 of the public health
     8  law,  as  amended by chapter 526 of the laws of 2002, is amended to read
     9  as follows:
    10    a. "Primary and preventive health care services" means:  the  services
    11  of  physicians,  optometrists, nurses, nurse practitioners, midwives and

    12  other related professional personnel which are provided on an outpatient
    13  basis, including routine well-child visits; diagnosis and  treatment  of
    14  illness  and  injury;  laboratory tests; diagnostic x-rays; prescription
    15  drugs; radiation therapy; chemotherapy; hemodialysis;  outpatient  blood
    16  clotting  factor products and other treatments and services furnished in
    17  connection with the care of hemophilia and other blood clotting  protein
    18  deficiencies; emergency room services; hospice services; and, outpatient
    19  alcohol  and  substance abuse services as defined by the commissioner in
    20  consultation with the superintendent.
    21    § 4.  This act shall take effect on the first of April next succeeding
    22  the date upon which it shall have become a law, provided that the amend-
    23  ments to subdivision 7 of section 2510 of the public health law made  by

    24  section two of this act shall be subject to the expiration and reversion
    25  of such subdivision pursuant to subdivision 4 of section 47 of chapter 2
    26  of  the  laws of 1998, as amended, when upon such date the provisions of
    27  section three of this act shall take effect.