S T A T E O F N E W Y O R K
________________________________________________________________________
8413--A
2011-2012 Regular Sessions
I N A S S E M B L Y
June 15, 2011
___________
Introduced by M. of A. PAULIN, GUNTHER, MAISEL, REILLY, ZEBROWSKI,
CASTELLI, KATZ, BURLING, ROSENTHAL, HOOPER -- Multi-Sponsored by -- M.
of A. CERETTO, DINOWITZ -- read once and referred to the Committee on
Insurance -- recommitted to the Committee on Insurance in accordance
with Assembly Rule 3, sec. 2 -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to requiring certain
health insurance policies to include coverage for the cost of enteral
formulas for the treatment of eosinophilic esophagitis and related
eosinophilic disorders
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; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC
DISORDERS; gastroesophageal reflux with failure to thrive; disorders of
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD08040-03-2
A. 8413--A 2
gastrointestinal motility such as chronic intestinal pseudo-obstruction;
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 necessary,
and such coverage for such modified solid food products for any calendar
year or for any continuous period of twelve months for any insured indi-
vidual 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; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC
DISORDERS; gastroesophageal reflux with failure to thrive; disorders of
gastrointestinal motility such as chronic intestinal pseudo-obstruction;
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 necessary,
and such coverage for such modified solid food products for any calendar
year or for any continuous period of twelve months for any insured indi-
vidual 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; EOSINOPHILIC ESOPHAGITIS AND RELATED EOSINOPHILIC DISORDERS;
A. 8413--A 3
gastroesophageal reflux with failure to thrive; disorders of gastroin-
testinal motility such as chronic intestinal pseudo-obstruction; and
multiple, severe food allergies which if left untreated will cause maln-
ourishment, 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 necessary, 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, EOSINOPHILIC ESOPHAGITIS AND RELATED
EOSINOPHILIC DISORDERS, and homocystinuria, obtained at a participating
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 formulary; 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.