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

                                  3865

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                              March 8, 2011
                               ___________

Introduced  by  Sen.  ROBACH -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

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
              

S. 3865                             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

S. 3865                             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.