S T A T E O F N E W Y O R K
________________________________________________________________________
5918
2009-2010 Regular Sessions
I N A S S E M B L Y
February 23, 2009
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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.