senate Bill S2186

Amended

Provides that persons with clotting protein deficiencies who are otherwise eligible for certain health insurance programs shall have access to reimbursement for certain treatments

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 14 / Jan / 2013
    • REFERRED TO HEALTH
  • 22 / May / 2013
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 22 / May / 2013
    • PRINT NUMBER 2186A
  • 10 / Jun / 2013
    • REPORTED AND COMMITTED TO FINANCE
  • 18 / Jun / 2013
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 18 / Jun / 2013
    • ORDERED TO THIRD READING CAL.1425
  • 18 / Jun / 2013
    • SUBSTITUTED BY A962A

Summary

Provides 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 concentrates and other necessary treatments and services.

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Bill Details

Versions:
S2186
S2186A
Legislative Cycle:
2013-2014
Law Section:
Public Health Law
Laws Affected:
Amd §2510, Pub Health L; amd §369-ee, Soc Serv L
Versions Introduced in 2011-2012 Legislative Cycle:
S3865, S3865A

Sponsor Memo

BILL NUMBER:S2186

TITLE OF BILL: An act to amend the public health law and the social
services law, in relation to providing that persons with hemophilia and
other clotting protein deficiencies who are otherwise eligible for the
Child Health Plus or Family Health Plus programs shall have access to
reimbursement for outpatient blood clotting factor concentrates and
other necessary treatments and services

PURPOSE: To provide outpatient coverage under the Child Health Plus,
Family Health Plus, and Healthy New York programs for blood clotting
factor concentrates as well as other treatments and services necessary
for individuals with hemophilia and other clotting protein deficiencies.

SUMMARY OF PROVISIONS: Subdivision 7 of section 2510 of the public
health law, as amended by section 21 of part B of chapter 109 of the
laws of 2010, is amended to include:

*outpatient blood clotting factor products and other treatments and
services furnished in connection with the care of hemophilia and other
blood clotting protein deficiencies;

Paragraph a of subdivision 7 of section 2510 of the public health law,
as amended by chapter 526 of the laws of 2002 is amended to include:

* outpatient blood clotting factor products and other treatments and
services furnished in connection with the care of hemophilia and other
blood clotting protein deficiencies;

Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
section 369-ee of the social services law, subparagraph (xv) as amended
and subparagraph (xvi) as added by chapter 526 of the laws of 2002, are
amended and a new paragraph (xvii) is added to read as follows:

(xv) services provided to meet the requirements of 42 D.S.C. 1396d(r);

(xvi)hospice services; and

(xvii) outpatient blood clotting factor products and other treatments
and services furnished in connection with the care of hemophilia and
other blood clotting protein deficiencies as defined by the commissioner
of health in consultation with the superintendent.

Paragraph 13 of subsection (d) of section 4326 of the insurance law, as
added by chapter 1 of the laws of 1999 is amended to read as follows:

*blood and blood products furnished in connection with surgery or inpa-
tient hospital services or outpatient services for hemophilia and other
blood clotting protein deficiencies;

JUSTIFICATION: Hemophilia is a rare hereditary bleeding disorder
affecting roughly 2,000 New Yorkers, resulting from a deficiency in
blood proteins known as clotting factors. without an adequate supply of
clotting factors, individuals can experience prolonged bleeding follow-
ing routine medical and dental procedures, trauma, and a range of phys-
ical activities. Additionally, individuals with hemophilia often experi-
ence spontaneous internal bleeding that can cause severe joint damage,
chronic pain, and even death.

Prior to the 1970's, individuals with hemophilia seldom lived beyond 30.
Early treatment consisted of whole blood and Plasma transfusions at
hospitals. These treatments were difficult, time consuming and only
minimally effective. The advent of commercially prepared blood treat-
ment, both in terms of efficacy and convenience. Most importantly, these
advances allowed for home infusion.

In addition to hemophilia, there are several other disorders resulting
from blood protein deficiencies. These include Von Willebrand Disease
(VWD) , the most common bleeding disorder, affecting approximately two
million Americans. Individuals with the severest form of VWD rely on
clotting factor treatments similar to those used by individuals with
hemophilia.

Clotting factor products produced today {derived from plasma or recombi-
nant technology) are very safe and highly effective medications. Access
to therapies has vastly improved both the health outcomes and quality of
life for the majority of patients and their families. Many patients
today are on a prophylactic regimen to prevent bleeding episodes. This
preventative regimen together with the coordinated care provided by
hemophilia treatment centers have significantly reduced visits to emer-
gency rooms, hospitalizations and joint damage. Further, the ability to
manage hemophilia and other bleeding disorders outside of the hospital
setting has improved attendance for school-aged-children, decreased
absenteeism from work for adult patients and caregivers, vastly improved
the ability of affected persons to join the work force, and minimized
life disruptions for the entire family.

Child Health Plus, Family Health Plus and Healthy New York presently do
not cover clotting factor therapies prescribed for use at home by indi-
viduals with hemophilia and other clotting protein deficiencies. more-
over, New York state is the only state in the U.S. not currently provid-
ing coverage for outpatient clotting factor products used by individuals
who are eligible for the State Children's Health Insurance Program
(i.e., Child Health Plus). All three programs - Child Health Plus, Fami-
ly Health Plus and Healthy New York - were created to improve access to
health care for low-income individuals. Having a policy in place that
prevents otherwise eligible individuals with hemophilia and other bleed-
ing disorders from accessing lifesaving medications not only violates
the spirit of the policy, it is discriminating against a selected group
whose health care costs are deemed to be high and fundamentally under-
mines the programs' overall goal of ensuring that low-income children
and families have access to the quality health care.

PRIOR LEGISLATIVE HISTORY: 2011 Referred to Health 2012 Referred to
Health

FISCAL IMPLICATIONS: Unknown.

EFFECTIVE DATE: This act shall take effect on the first of April next
succeeding the date upon which it shall have become law, provided that
the amendments to the subdivision 7 of section 2510 of the public health
law made by section two of this act shall be subject to the expiration
and reversion of such subdivision pursuant to subdivision 4 of section
47 of chapter 2 of the laws of 1998, as amended, when upon such date the
provisions of section three of this act shall take effect.

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

                                  2186

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 14, 2013
                               ___________

Introduced  by  Sen.  ROBACH -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT to amend the public health law and the social  services  law,  in
  relation  to providing that persons with hemophilia and other clotting
  protein deficiencies who are otherwise eligible for the  Child  Health
  Plus or Family Health Plus programs shall have access to reimbursement
  for  outpatient blood clotting factor concentrates and other necessary
  treatments and services

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

  Section  1.    Legislative  findings.  Hemophilia is a rare hereditary
bleeding disorder resulting from a deficiency in blood proteins known as
clotting factors.  Without an adequate supply of clotting factors, indi-
viduals can experience prolonged bleeding following routine medical  and
dental  procedures,  trauma,  and  a range of physical activities. Addi-
tionally,  individuals  with  hemophilia  often  experience  spontaneous
internal  bleeding that can cause severe joint damage, chronic pain, and
even death.
  Prior to the 1970s, individuals with hemophilia  seldom  lived  beyond
the age of 30 years. Early treatment consisted of whole blood and plasma
transfusions at hospitals. These treatments were difficult, time consum-
ing  and  only  minimally effective. The advent of commercially prepared
blood clotting factors in the  1980s  represented  a  major  advance  in
treatment,  both in terms of efficacy and convenience. Most importantly,
these advances allowed for home infusion.
  In addition to hemophilia, there are several other disorders resulting
from blood protein deficiencies. These include  Von  Willebrand  Disease
(VWD),  the  most  common bleeding disorder, affecting approximately two
million Americans. Individuals with the severest form  of  VWD  rely  on
clotting  factor  treatments  similar  to those used by individuals with
hemophilia.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD02168-01-3

S. 2186                             2

  Clotting factor products produced today (derived from plasma or recom-
binant technology) are  very  safe  and  highly  effective  medications.
Access  to  therapies  has  vastly improved both the health outcomes and
quality of life for the majority of patients and  their  families.  Many
patients  today  are  on  a  prophylactic  regimen  to  prevent bleeding
episodes. This preventative regimen together with the  coordinated  care
provided  by  hemophilia  treatment  centers  have significantly reduced
visits to emergency rooms, hospitalizations and joint  damage.  Further,
the ability to manage hemophilia and other bleeding disorders outside of
the  hospital  setting  have  helped  improve attendance for school-aged
children, decreased absenteeism from work for adult patients  and  care-
givers, vastly improved the ability of affected persons to join the work
force, and minimized life disruptions for the entire family.
  Presently,  New  York  state  is the only state in the U.S. preventing
access to lifesaving outpatient clotting factor products for individuals
that qualify for the State Children's Health Insurance Program.
  The legislature finds that having a policy  that  prohibits  otherwise
eligible  individuals  from  accessing  lifesaving  medications not only
violates the spirit of these very important programs,  it  discriminates
against  a  vulnerable  group of individuals whose health care costs are
deemed to be high and fundamentally  undermines  the  programs'  overall
goal  of  ensuring  that low-income children and families have access to
quality health care. The legislature further finds  that  costs  to  the
state  for  allowing  individuals  who  qualify for Child Health Plus or
Family Health Plus to access the outpatient clotting products  at  home,
the  recommended  model  of  care,  will be much less than the long-term
costs the state will very likely end  up  paying  through  the  Medicaid
program for individuals who later develop debilitating complications and
are deemed unable to work.
  This  legislation is intended to modify existing state law by allowing
for the coverage of lifesaving clotting factor products  prescribed  for
use  at home by persons with hemophilia and other clotting protein defi-
ciencies who are eligible for the Child Health  Plus  or  Family  Health
Plus program.
  S  2.  Subdivision  7  of  section  2510  of the public health law, as
amended by section 21 of part B of chapter 109 of the laws of  2010,  is
amended to read as follows:
  7.  "Covered  health care services" means: the services of physicians,
optometrists, nurses, nurse practitioners, midwives  and  other  related
professional  personnel  which  are  provided  on  an  outpatient basis,
including routine well-child visits; diagnosis and treatment of  illness
and injury; inpatient health care services; laboratory tests; diagnostic
x-rays;  prescription  and  non-prescription  drugs  and durable medical
equipment; radiation  therapy;  chemotherapy;  hemodialysis;  OUTPATIENT
BLOOD  CLOTTING  FACTOR  PRODUCTS  AND  OTHER  TREATMENTS  AND  SERVICES
FURNISHED IN CONNECTION WITH THE CARE  OF  HEMOPHILIA  AND  OTHER  BLOOD
CLOTTING   PROTEIN   DEFICIENCIES;   emergency  room  services;  hospice
services; emergency,  preventive  and  routine  dental  care,  including
medically necessary orthodontia but excluding cosmetic surgery; emergen-
cy, preventive and routine vision care, including eyeglasses; speech and
hearing  services;  and, inpatient and outpatient mental health, alcohol
and substance abuse services as defined by the commissioner in consulta-
tion with the superintendent. "Covered health care services"  shall  not
include  drugs,  procedures  and  supplies for the treatment of erectile
dysfunction when provided to, or prescribed for use by, a person who  is
required  to register as a sex offender pursuant to article six-C of the

S. 2186                             3

correction law, provided that any denial  of  coverage  of  such  drugs,
procedures  or  supplies  shall  provide  the  patient with the means of
obtaining additional information concerning  both  the  denial  and  the
means of challenging such denial.
  S 3. Paragraph a of subdivision 7 of section 2510 of the public health
law,  as  amended by chapter 526 of the laws of 2002, is amended to read
as follows:
  a. "Primary and preventive health care services" means:  the  services
of  physicians,  optometrists, nurses, nurse practitioners, midwives and
other related professional personnel which are provided on an outpatient
basis, including routine well-child visits; diagnosis and  treatment  of
illness  and  injury;  laboratory tests; diagnostic x-rays; prescription
drugs; radiation therapy; chemotherapy; hemodialysis;  OUTPATIENT  BLOOD
CLOTTING  FACTOR PRODUCTS AND OTHER TREATMENTS AND SERVICES FURNISHED IN
CONNECTION WITH THE CARE OF HEMOPHILIA AND OTHER BLOOD CLOTTING  PROTEIN
DEFICIENCIES; emergency room services; hospice services; and, outpatient
alcohol  and  substance abuse services as defined by the commissioner in
consultation with the superintendent.
  S 4. Subparagraphs (xv) and (xvi) of paragraph (e) of subdivision 1 of
section 369-ee of the social services law, subparagraph (xv) as  amended
and  subparagraph (xvi) as added by chapter 526 of the laws of 2002, are
amended and a new paragraph (xvii) is added to read as follows:
  (xv) services provided to meet the requirements of 42 U.S.C. 1396d(r);
[and]
  (xvi) hospice services[.]; AND
  (XVII) OUTPATIENT BLOOD CLOTTING FACTOR PRODUCTS AND OTHER  TREATMENTS
AND  SERVICES  FURNISHED  IN  CONNECTION WITH THE CARE OF HEMOPHILIA AND
OTHER BLOOD CLOTTING PROTEIN DEFICIENCIES AS DEFINED BY THE COMMISSIONER
OF HEALTH IN CONSULTATION WITH THE SUPERINTENDENT.
  S 5.  This act shall take effect on the first of April next succeeding
the date upon which it shall have become a law, provided that the amend-
ments to subdivision 7 of section 2510 of the public health law made  by
section two of this act shall be subject to the expiration and reversion
of such subdivision pursuant to subdivision 4 of section 47 of chapter 2
of  the  laws of 1998, as amended, when upon such date the provisions of
section three of this act shall take effect.

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