S T A T E O F N E W Y O R K
________________________________________________________________________
6039
2011-2012 Regular Sessions
I N A S S E M B L Y
March 4, 2011
___________
Introduced by M. of A. KELLNER -- read once and referred to the Commit-
tee on Insurance
AN ACT to amend the public health law, the social services law and the
insurance law, in relation to providing that persons with hemophilia
and other clotting protein deficiencies who are otherwise eligible for
the Child Health Plus, Family Health Plus, and Healthy New York
programs shall have access to reimbursement for outpatient blood clot-
ting 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.
LBD09788-01-1
A. 6039 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, Child Health Plus, Family Health Plus and Healthy New York
do not cover clotting factors prescribed for use at home. Moreover, 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, Family
Health Plus, and Healthy New York 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 compli-
cations 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, Family Health Plus,
and Healthy New York programs.
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
A. 6039 3
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
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. 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:
(13) blood and blood products furnished in connection with surgery or
inpatient hospital services OR OUTPATIENT SERVICES FOR HEMOPHILIA AND
OTHER BLOOD CLOTTING PROTEIN DEFICIENCIES; and
S 6. 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.