S T A T E   O F   N E W   Y O R K
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                                  5918

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            February 23, 2009
                               ___________

Introduced  by M. of A. TOWNS, DenDEKKER, RAIA -- read once and referred
  to the Committee on Insurance

AN ACT to amend the insurance  law,  in  relation  to  requiring  health
  insurance  policies to cover the cost of equipment, supplies and tests
  for the diagnosis and treatment of thalassemia,  or  Cooley's  anemia,
  and  relating to the medicaid buy-in program for people with thalasse-
  mia

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

  Section  1. Legislative findings and intent. The legislature finds and
declares that the cost of medical care in the United States has steadily
risen in  the  last  five  years,  outpacing  both  employer  wages  and
inflation.  Chronic disease consumes approximately seventy-eight percent
of health expenditures. Patients with thalassemia,  an  inherited  blood
disorder,  require  frequent red blood cell transfusions and iron chela-
tion therapy for survival. Patients with  thalassemia  are  the  largest
chronic  consumers  of  blood in the United States. Patients surveyed in
New York state claim their out-of-pocket costs average $555  per  month.
Eighty-five  percent  of  patients  with  thalassemia pay between 3 to 5
co-pays per month, with co-pays ranging from $15 to $30 a visit.  Nearly
fifty percent of patients contributed  a  portion  to  their  employer's
payment  of  premiums  or paid their health insurance premiums outright.
Fifty percent of the patients  surveyed  had  deductibles  greater  than
$1,000  that  had  to be satisfied before coverage began.  Patients with
thalassemia require numerous prescription drugs, on average between 3 to
4 prescription drugs a month with the average cost to the patient, rang-
ing between $150 to $200 a month. The legislature therefore  finds  that
with new treatments being expensive and for those with 50 percent co-in-
surance  on  prescription  drugs,  with  the average cost being $1,500 a
month, it would benefit residents of the state to require health  insur-
ance policies to cover the cost of equipment, supplies and tests for the

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08607-01-9
              

A. 5918                             2

diagnosis  and  treatment of thalassemia and to create a medicaid buy-in
programs for people with thalassemia.
  S  2.  There  shall  be  a  medicaid  buy-in  program  for people with
thalassemia. The commissioner of the department of health shall  promul-
gate  rules  and regulations to determine the criteria for such program.
Such rules and regulations shall increase  the  medicaid  buy-in  salary
level  for  individuals  with  thalassemia  to account for the increased
out-of-pocket costs associated with the disease.
  S 3. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 15-b to read as follows:
  (15-B) (A) EVERY POLICY WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES
COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY
WHICH  PROVIDES  MAJOR  MEDICAL  OR  SIMILAR COMPREHENSIVE-TYPE COVERAGE
SHALL INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES  AND  TESTS  FOR  THE
DIAGNOSIS  AND TREATMENT OF THALASSEMIA, IF RECOMMENDED OR PRESCRIBED BY
A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
  (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL  MEAN  THE
MEDICAL  CONDITION  KNOWN  AS  THALASSEMIA  MAJOR/INTERMEDIA OR COOLEY'S
ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE  FAIL-
URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
  S 4. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 7-a to read as follows:
  (7-A)(A)  EVERY  GROUP OR BLANKET ACCIDENT AND HEALTH INSURANCE POLICY
ISSUED OR ISSUED FOR DELIVERY  IN  THIS  STATE  WHICH  PROVIDES  MEDICAL
COVERAGE  THAT INCLUDES COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S
OFFICE AND EVERY POLICY WHICH PROVIDES MAJOR MEDICAL OR SIMILAR  COMPRE-
HENSIVE-TYPE COVERAGE SHALL INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES
AND TESTS FOR THE DIAGNOSIS AND TREATMENT OF THALASSEMIA. IF RECOMMENDED
OR  PRESCRIBED  BY  A  PHYSICIAN  OR OTHER LICENSED HEALTH CARE PROVIDER
LEGALLY AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
  (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL  MEAN  THE
MEDICAL  CONDITION  KNOWN  AS  THALASSEMIA  MAJOR/INTERMEDIA OR COOLEY'S
ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE  FAIL-
URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
  S  5.  Section  4303  of  the insurance law is amended by adding a new
subsection (u-1) to read as follows:
  (U-1)(A) A MEDICAL EXPENSE INDEMNITY CORPORATION OR A  HEALTH  SERVICE
CORPORATION  WHICH  PROVIDES MEDICAL COVERAGE THAT INCLUDES COVERAGE FOR
PHYSICIAN SERVICES IN  A  PHYSICIAN'S  OFFICE  AND  EVERY  POLICY  WHICH
PROVIDES  MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE COVERAGE SHALL
INCLUDE COVERAGE FOR ALL EQUIPMENT, SUPPLIES AND TESTS FOR THE DIAGNOSIS
AND TREATMENT OF THALASSEMIA, IF RECOMMENDED OR PRESCRIBED BY  A  PHYSI-
CIAN  OR  OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO
PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW.
  (B) FOR THE PURPOSES OF THIS PARAGRAPH, "THALASSEMIA" SHALL  MEAN  THE
MEDICAL  CONDITION  KNOWN  AS  THALASSEMIA  MAJOR/INTERMEDIA OR COOLEY'S
ANEMIA WHICH IS A FATAL GENETIC BLOOD DISEASE THAT RESULTS IN THE  FAIL-
URE TO PRODUCE SUFFICIENT HEMOGLOBIN.
  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.