senate Bill S2287A

Signed by Governor

Enacts "Hannah's law"; requires certain insurance policies to include coverage for the cost of enteral formulas

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Bill Status


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

  • 15 / Jan / 2013
    • REFERRED TO INSURANCE
  • 18 / Mar / 2013
    • REPORTED AND COMMITTED TO FINANCE
  • 23 / Apr / 2013
    • 1ST REPORT CAL.414
  • 24 / Apr / 2013
    • 2ND REPORT CAL.
  • 29 / Apr / 2013
    • ADVANCED TO THIRD READING
  • 01 / May / 2013
    • PASSED SENATE
  • 01 / May / 2013
    • DELIVERED TO ASSEMBLY
  • 01 / May / 2013
    • REFERRED TO INSURANCE
  • 10 / Jun / 2013
    • RECALLED FROM ASSEMBLY
  • 10 / Jun / 2013
    • RETURNED TO SENATE
  • 10 / Jun / 2013
    • VOTE RECONSIDERED - RESTORED TO THIRD READING
  • 10 / Jun / 2013
    • AMENDED ON THIRD READING (T) 2287A
  • 13 / Jun / 2013
    • REPASSED SENATE
  • 13 / Jun / 2013
    • RETURNED TO ASSEMBLY
  • 13 / Jun / 2013
    • REFERRED TO WAYS AND MEANS
  • 18 / Jun / 2013
    • SUBSTITUTED FOR A490A
  • 18 / Jun / 2013
    • ORDERED TO THIRD READING RULES CAL.290
  • 18 / Jun / 2013
    • PASSED ASSEMBLY
  • 18 / Jun / 2013
    • RETURNED TO SENATE
  • 09 / Oct / 2013
    • DELIVERED TO GOVERNOR
  • 21 / Oct / 2013
    • SIGNED CHAP.388

Summary

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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Bill Details

See Assembly Version of this Bill:
A490A
Versions:
S2287
S2287A
Legislative Cycle:
2013-2014
Law Section:
Insurance Law
Laws Affected:
Amd ยงยง3216, 3221, 4303 & 4322, Ins L
Versions Introduced in Previous Legislative Cycles:
2011-2012: S5034A, A8413A
2009-2010: S628, A2188, S628
2007-2008: A11215

Sponsor Memo

BILL NUMBER:S2287A

TITLE OF BILL: 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

PURPOSE: To update and modify existing laws requiring the coverage of
enteral formulas.

Section 1: The short title Hannah's Law.

Sections 2-4: Respectively, the sections amend the following sections
of the insurance law: Paragraph 21 of subsection (I) of section 3216,
paragraph 11 of subsection (k) of section 3221, and subsection (y) of
section 4303. Each section is amended to require that any insurance
policy which covers medical, major medical, or comprehensive-type
insurance also covers both oral and facing-tube administered enteral
formulas.

Section 5: Makes a conforming amendment to Insurance law section
4322(b) (25), applicable to standardized individual enrollee direct
payment contracts offered by health maintenance organizations.

Section 6: Provides the effective date.

JUSTIFICATION: Eosinophilic esophagitis is a life-threatening illness
that makes it impossible to eat most foods. In such cases, patients
can only receive nourishment from enteral formulas which may be
administered orally or via a feeding tube. Most insurance companies,
however, only cover the cost of administration via feeding tubes.
This bill requires that both methods of administration be covered.

This bill was written in response to the case of Hannah De Vane, a six
year-old girl with eosinophilic esophagitis. In Hannah's case, oral
feeding is possible. Unfortunately, her family's insurance policy only
covers the use of feeding tubes. As a result, her family must choose
between feeding Hannah with a feeding tube or paying out-of-pocket for
the more than $14,000 a year it costs to purchase and administer the
prescription formula orally.

This bill will ensure adequate coverage for patients living with
conditions such as eosinophilic esophagitis and other rare
eosinoptilic disorders.

LEGISLATIVE HISTORY:

A.8413-A, 2011 and 2012 referred to insurance. Same as S.5034-A, 2011
referred to insurance and 2012 passed senate. A.2188, 2010 held for
consideration in insurance; 2009, referred to insurance. Same as S.
628, 2010 and 2009 referred to insurance. A. 11219, 2008 referred to
insurance.

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: The bill shall be effective on the first of January
following enactment and shall be applicable to all policies and


contracts issued, renewed, modified, altered or amended on or after
such date.

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

                                 2287--A
    Cal. No. 414

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            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:

  Section  1.  Short title.  This act shall be known and may be cited as
"Hannah's law".
  S 2. Paragraph 21 of subsection (i) of section 3216 of  the  insurance
law,  as added by chapter 177 of the laws of 1997, is amended to read as
follows:
  (21) Every policy which provides coverage for prescription drugs shall
include coverage for the cost of enteral formulas for home use,  WHETHER
ADMINISTERED  ORALLY OR VIA TUBE FEEDING, for which a physician or other
licensed health care provider  legally  authorized  to  prescribe  under
title  eight of the education law has issued a written order. Such writ-
ten order shall state that the  enteral  formula  is  clearly  medically
necessary  and has been proven effective as a disease-specific treatment
regimen for those individuals who are or  will  become  malnourished  or
suffer  from  disorders, which if left untreated, cause chronic physical
disability, mental retardation or death.  Specific  diseases  for  which
enteral  formulas  have been proven effective shall include, but are not
limited to, inherited diseases of amino acid or organic acid metabolism;
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

ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
struction; and multiple, severe food allergies which if  left  untreated
will  cause malnourishment, chronic physical disability, mental retarda-
tion  or death. Enteral formulas which are medically necessary and taken
under written order from a  physician  for  the  treatment  of  specific
diseases shall be distinguished from nutritional supplements taken elec-
tively. Coverage for certain inherited diseases of amino acid and organ-
ic  acid  metabolism shall include modified solid food products that are
low protein or which contain modified protein which are medically neces-
sary, and such coverage for such modified solid food  products  for  any
calendar  year  or  for  any  continuous period of twelve months for any
insured individual shall not exceed two thousand five hundred dollars.
  S 3. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
law,  as added by chapter 177 of the laws of 1997, is amended to read as
follows:
  (11) Every policy which provides coverage for prescription drugs shall
include coverage for the cost of enteral formulas for home use,  WHETHER
ADMINISTERED  ORALLY OR VIA TUBE FEEDING, for which a physician or other
licensed health care provider  legally  authorized  to  prescribe  under
title  eight of the education law has issued a written order. Such writ-
ten order shall state that the  enteral  formula  is  clearly  medically
necessary  and has been proven effective as a disease-specific treatment
regimen for those individuals who are or  will  become  malnourished  or
suffer  from  disorders, which if left untreated, cause chronic physical
disability, mental retardation or death.  Specific  diseases  for  which
enteral  formulas  have been proven effective shall include, but are not
limited to, inherited diseases of amino-acid or organic acid metabolism;
Crohn's Disease; gastroesophageal reflux with failure to thrive;  disor-
ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
struction; and multiple, severe food allergies which if  left  untreated
will  cause malnourishment, chronic physical disability, mental retarda-
tion or death. Enteral formulas which are medically necessary and  taken
under  written  order  from  a  physician  for the treatment of specific
diseases shall be distinguished from nutritional supplements taken elec-
tively. Coverage for certain inherited diseases of amino acid and organ-
ic acid metabolism shall include modified solid food products  that  are
low protein or which contain modified protein which are medically neces-
sary,  and  such  coverage for such modified solid food products for any
calendar year or for any continuous period  of  twelve  months  for  any
insured individual shall not exceed two thousand five hundred dollars.
  S  4. Subsection (y) of section 4303 of the insurance law, as added by
chapter 177 of the laws of 1997, is amended to read as follows:
  (y) Every contract which  provides  coverage  for  prescription  drugs
shall  include  coverage  for the cost of enteral formulas for home use,
WHETHER ADMINISTERED ORALLY OR VIA TUBE FEEDING, for which  a  physician
or  other  licensed health care provider legally authorized to prescribe
under title eight of the education law has issued a written order.  Such
written  order shall state that the enteral formula is clearly medically
necessary and has been proven effective as a disease-specific  treatment
regimen  for  those  individuals  who are or will become malnourished or
suffer from disorders, which if left untreated, cause chronic  disabili-
ty,  mental  retardation  or  death. Specific diseases for which enteral
formulas have been proven effective shall include, but are  not  limited
to, inherited diseases of amino-acid or organic acid metabolism; Crohn's
Disease;  gastroesophageal  reflux  with failure to thrive; disorders of
gastrointestinal motility such as chronic intestinal pseudo-obstruction;

S. 2287--A                          3

and multiple, severe food allergies which if left untreated  will  cause
malnourishment,  chronic  physical  disability,  mental  retardation  or
death. Enteral formulas which are medically necessary  and  taken  under
written  order  from  a physician for the treatment of specific diseases
shall be distinguished from nutritional  supplements  taken  electively.
Coverage  for  certain inherited diseases of amino acid and organic acid
metabolism shall include modified  solid  food  products  that  are  low
protein,  or  which  contain modified protein which are medically neces-
sary, and such coverage for such modified solid food  products  for  any
calendar  year  or  for  any  continuous period of twelve months for any
insured individual shall not exceed two thousand five hundred dollars.
  S 5. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
section 4322 of the insurance law, as amended by chapter 554 of the laws
of 2002, is amended to read as follows:
  Prescription  drugs, including contraceptive drugs or devices approved
by the federal food  and  drug  administration  or  generic  equivalents
approved  as substitutes by such food and drug administration and nutri-
tional supplements (formulas), WHETHER  ADMINISTERED  ORALLY  OR  VIA  A
FEEDING TUBE for the therapeutic treatment of phenylketonuria, branched-
chain  ketonuria, galactosemia and homocystinuria, obtained at a partic-
ipating pharmacy under a prescription written by an in-plan  or  out-of-
plan   provider.   Health  maintenance  organizations,  in  addition  to
providing coverage for prescription drugs at a  participating  pharmacy,
may  utilize  a mail order prescription drug program. Health maintenance
organizations may provide prescription drugs pursuant to a  drug  formu-
lary;  however,  health  maintenance  organizations  must  implement  an
appeals process so that the use of non-formulary prescription drugs  may
be requested by a physician or other provider.
  S  6. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law and shall apply to  all
policies and contracts issued, renewed, modified, altered, or amended on
or after such date.

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