S T A T E O F N E W Y O R K
________________________________________________________________________
2186--A
2013-2014 Regular Sessions
I N S E N A T E
January 14, 2013
___________
Introduced by Sens. ROBACH, ADAMS, BRESLIN, GRISANTI, MARCHIONE, NOZZO-
LIO, PARKER, VALESKY -- read twice and ordered printed, and when
printed to be committed to the Committee on Health -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
AN ACT to amend the public health law, in relation to providing that
persons with hemophilia and other clotting protein deficiencies who
are otherwise eligible for the Child Health Plus program shall have
access to reimbursement for outpatient blood clotting factor concen-
trates 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
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02168-05-3
S. 2186--A 2
clotting factor treatments similar to those used by individuals with
hemophilia.
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, 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 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 complications 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 program.
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
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
S. 2186--A 3
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. 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.
