NY State Assembly Bill A490A

assembly Bill A490A

Signed By Governor

2013-2014 Legislative Session

Enacts "Hannah's law"; requires certain insurance policies to include coverage for the cost of enteral formulas

download bill text pdf

Archive: Last Bill Status Via S2287 - Signed by Governor

Introduced
In Committee
On Floor Calendar
- Passed Senate
- Passed Assembly
Delivered to Governor
Signed by Governor

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Actions

view actions (15)

	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Oct 21, 2013	signed chap.388
Oct 09, 2013	delivered to governor
Jun 18, 2013	returned to senate passed assembly ordered to third reading rules cal.290 substituted for a490a
Jun 18, 2013	substituted by s2287a
Jun 17, 2013	ordered to third reading rules cal.290 rules report cal.290 reported
Jun 12, 2013	reported referred to rules reported referred to ways and means
Jun 07, 2013	print number 490a
Jun 07, 2013	amend (t) and recommit to insurance
Jan 09, 2013	referred to insurance

Votes

Bill Amendments

Original

A (Active)

Original

A (Active)

Co-Sponsors

Multi-Sponsors

A490 - Details

See Senate Version of this Bill:: S2287
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A2188, S628
2011-2012: A8413, S5034

A490 - Summary

Enacts "Hannah's law"; requires that every health insurance policy or contract which provides coverage for prescription drugs include coverage for the cost of enteral formulas administered orally or via feeding tube.

A490 - Bill Text download pdf

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

                                   490

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by M. of A. PAULIN, GUNTHER, MAISEL, ZEBROWSKI, KATZ, ROSEN-
  THAL, HOOPER -- Multi-Sponsored by -- M. of A.  CERETTO,  DINOWITZ  --
  read once and referred to the Committee on Insurance

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
gastrointestinal motility such as chronic intestinal pseudo-obstruction;
and multiple, severe food allergies which if left untreated  will  cause

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD05057-01-3

A. 490                              2

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;
gastroesophageal reflux with failure to thrive; disorders  of  gastroin-
testinal  motility  such  as  chronic intestinal pseudo-obstruction; and

A. 490                              3

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.

Co-Sponsors

Multi-Sponsors

A490A (ACTIVE) - Details

See Senate Version of this Bill:: S2287
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: A2188, S628
2011-2012: A8413, S5034

A490A (ACTIVE) - Summary

A490A (ACTIVE) - Bill Text download pdf

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

                                 490--A

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by M. of A. PAULIN, GUNTHER, MAISEL, ZEBROWSKI, KATZ, ROSEN-
  THAL, HOOPER -- Multi-Sponsored by -- M. of A.  CERETTO,  DINOWITZ  --
  read  once  and  referred  to  the Committee on Insurance -- 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 whether administered orally or via tube feeding

  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; gastroesophageal reflux with failure to thrive;  disor-
ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
struction; and multiple, severe food allergies which if  left  untreated

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.

                                                           LBD05057-02-3

A. 490--A                           2

will  cause malnourishment, chronic physical disability, mental retarda-
tion 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 elec-
tively. Coverage for certain inherited diseases of amino acid and organ-
ic  acid  metabolism shall include modified solid food products that are
low protein or which contain modified protein which are medically neces-
sary, 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 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; gastroesophageal reflux with failure to thrive;  disor-
ders  of gastrointestinal motility such as chronic intestinal pseudo-ob-
struction; and multiple, severe food allergies which if  left  untreated
will  cause malnourishment, chronic physical disability, mental retarda-
tion 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 elec-
tively. Coverage for certain inherited diseases of amino acid and organ-
ic acid metabolism shall include modified solid food products  that  are
low protein or which contain modified protein which are medically neces-
sary,  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  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;  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

A. 490--A                           3

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 neces-
sary, 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 and homocystinuria, obtained at a partic-
ipating 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  formu-
lary;  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.

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The New York State Senate

assembly Bill A490A

Sponsored By

Archive: Last Bill Status Via S2287 - Signed by Governor

Your Voice

Actions

Votes

Jun 13, 2013 - floor Vote

Floor Vote: Jun 13, 2013

May 29, 2013 - floor Vote

Floor Vote: May 29, 2013

May 1, 2013 - floor Vote

Floor Vote: May 1, 2013

Apr 23, 2013 - Finance committee Vote

Committee Vote: Apr 23, 2013

Mar 18, 2013 - Insurance committee Vote

Committee Vote: Mar 18, 2013

Bill Amendments

Co-Sponsors

Multi-Sponsors

A490 - Details

A490 - Summary

A490 - Bill Text download pdf

Co-Sponsors

Multi-Sponsors

A490A (ACTIVE) - Details

A490A (ACTIVE) - Summary

A490A (ACTIVE) - Bill Text download pdf

Comments

assembly Bill A490A

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Sponsored By

PAULIN

Archive: Last Bill Status Via S2287 - Signed by Governor

Your Voice

Actions

Votes

Jun 13, 2013 - floor Vote

Floor Vote: Jun 13, 2013

May 29, 2013 - floor Vote

Floor Vote: May 29, 2013

May 1, 2013 - floor Vote

Floor Vote: May 1, 2013

Apr 23, 2013 - Finance committee Vote

Committee Vote: Apr 23, 2013

Mar 18, 2013 - Insurance committee Vote

Committee Vote: Mar 18, 2013

Bill Amendments

Co-Sponsors

Aileen Gunther

Alan Maisel

Kenneth Zebrowski

Steve Katz

Linda Rosenthal

Earlene Hooper

Multi-Sponsors

John Ceretto

Jeffrey Dinowitz

A490 - Details

A490 - Summary

A490 - Bill Text download pdf

Co-Sponsors

Aileen Gunther

Kenneth Zebrowski

Steve Katz

Linda Rosenthal

Earlene Hooper

Multi-Sponsors

John Ceretto

Jeffrey Dinowitz

A490A (ACTIVE) - Details

A490A (ACTIVE) - Summary

A490A (ACTIVE) - Bill Text download pdf

Comments