Assembly Bill A5255

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5255
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 12, 2025
                                ___________
 
 Introduced by M. of A. REYES, LUPARDO, SEAWRIGHT, SIMON, FORREST, DINOW-
   ITZ, ZINERMAN, MEEKS, JACKSON, DAVILA -- read once and referred to the
   Committee on Insurance
 
 AN  ACT  to  amend  the  social  services  law and the insurance law, in
   relation to coverage for the treatment of asthma

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (r)  of  subdivision 2 of section 365-a of the
 social services law, as added by section 32 of part C of chapter  58  of
 the laws of 2008, is amended to read as follows:
   (r) asthma self-management training services for persons OR PARENTS OF
 PERSONS  diagnosed  with  asthma  INCLUDING INFORMATION ON PROPER USE OF
 DEVICES SUCH AS SPACERS, VALVED HOLDING CHAMBERS AND MASKS, AND TRIGGERS
 IN THE ENVIRONMENT  WHICH  SHOULD  BE  AVOIDED  OR  MANAGED,  when  such
 services  are  ordered by a physician, registered physician's assistant,
 registered nurse practitioner, or licensed midwife  and  provided  by  a
 licensed,  registered,  or certified health care professional, as deter-
 mined by the commissioner of health,  who  is  certified  as  an  asthma
 educator  by  the  National  Asthma  Educator  Certification Board, or a
 successor national certification  board;  provided,  however,  that  the
 provisions  of this paragraph shall not take effect unless all necessary
 approvals under federal law and regulation have been obtained to receive
 federal financial participation in the costs  of  health  care  services
 provided pursuant to this paragraph.  Nothing in this paragraph shall be
 construed  to  modify  any licensure, certification or scope of practice
 provision under title eight of the education law.
   § 2. Subsection (i) of section 3216 of the insurance law is amended by
 adding a new paragraph 15-b to read as follows:
   (15-B) (A) EVERY POLICY WHICH PROVIDES MEDICAL COVERAGE THAT  INCLUDES
 COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY
 WHICH  PROVIDES  MAJOR  MEDICAL  OR  SIMILAR COMPREHENSIVE-TYPE COVERAGE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04803-01-5
              

 A. 5255                             2
 
 SHALL INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES FOR  THE
 TREATMENT  OF ASTHMA, AND FOR CHILDREN UNDER NINETEEN YEARS OF AGE ADDI-
 TIONAL EQUIPMENT AND SUPPLIES FOR  USE  IN  SCHOOL,  IF  RECOMMENDED  OR
 PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY
 AUTHORIZED  TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW:  RESCUE
 INHALER TREATMENTS AND NEBULIZERS;  SPACERS,  VALVED  HOLDING  CHAMBERS,
 MASKS  AND/OR  OTHER  SUCH  DEVICES USED TO ASSIST IN GETTING MEDICATION
 INTO THE LUNGS. IN ADDITION,  THE  COMMISSIONER  OF  THE  DEPARTMENT  OF
 HEALTH  SHALL  PROVIDE  AND  PERIODICALLY UPDATE BY RULE OR REGULATION A
 LIST OF ADDITIONAL ASTHMA EQUIPMENT AND RELATED  SUPPLIES  SUCH  AS  ARE
 MEDICALLY  NECESSARY  FOR THE TREATMENT OF ASTHMA, FOR WHICH THERE SHALL
 ALSO BE COVERAGE. SUCH POLICIES SHALL ALSO INCLUDE COVERAGE  FOR  ASTHMA
 SELF-MANAGEMENT EDUCATION TO ENSURE THAT PERSONS WITH ASTHMA, OR PERSONS
 WHO  HAVE A CHILD OR CHILDREN WITH ASTHMA, ARE EDUCATED AS TO THE PROPER
 SELF-MANAGEMENT AND TREATMENT OF THEIR CONDITION, INCLUDING  INFORMATION
 ON PROPER USE OF DEVICES AND TRIGGERS IN THE ENVIRONMENT WHICH SHOULD BE
 AVOIDED  OR  MANAGED.  SUCH  COVERAGE  FOR SELF-MANAGEMENT EDUCATION AND
 EDUCATION RELATING TO DEVICES  SHALL  BE  LIMITED  TO  VISITS  MEDICALLY
 NECESSARY  UPON  THE  DIAGNOSIS OF ASTHMA, WHERE A PHYSICIAN DIAGNOSES A
 SIGNIFICANT CHANGE IN THE PATIENT'S SYMPTOMS OR CONDITIONS WHICH  NECES-
 SITATE  CHANGES  IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REEDUCATION OR
 REFRESHER EDUCATION IS NECESSARY. SUCH EDUCATION MAY BE PROVIDED BY  THE
 PHYSICIAN  OR  OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW,  OR  THEIR  STAFF,  AS
 PART  OF  AN  OFFICE  VISIT  FOR  ASTHMA DIAGNOSIS OR TREATMENT, OR BY A
 CERTIFIED ASTHMA NURSE EDUCATOR, UPON THE REFERRAL  OF  A  PHYSICIAN  OR
 OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO PRESCRIBE
 UNDER TITLE EIGHT OF THE EDUCATION LAW. EDUCATION PROVIDED BY THE CERTI-
 FIED ASTHMA NURSE EDUCATOR, MAY BE LIMITED TO  GROUP  SETTINGS  WHEREVER
 PRACTICABLE. COVERAGE FOR SELF-MANAGEMENT EDUCATION AND EDUCATION RELAT-
 ING TO DEVICES SHALL ALSO INCLUDE HOME VISITS WHEN MEDICALLY NECESSARY.
   (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   § 3. Subsection (k) of section 3221 of the insurance law is amended by
 adding a new paragraph 24 to read as follows:
   (24)  (A)  EVERY  POLICY WHICH PROVIDES MEDICAL COVERAGE THAT INCLUDES
 COVERAGE FOR PHYSICIAN SERVICES IN A PHYSICIAN'S OFFICE AND EVERY POLICY
 WHICH PROVIDES MAJOR  MEDICAL  OR  SIMILAR  COMPREHENSIVE-TYPE  COVERAGE
 SHALL  INCLUDE COVERAGE FOR THE FOLLOWING EQUIPMENT AND SUPPLIES FOR THE
 TREATMENT OF ASTHMA, AND FOR CHILDREN UNDER NINETEEN YEARS OF AGE  ADDI-
 TIONAL  EQUIPMENT  AND  SUPPLIES  FOR  USE  IN SCHOOL, IF RECOMMENDED OR
 PRESCRIBED BY A PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER LEGALLY
 AUTHORIZED TO PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION  LAW:  RESCUE
 INHALER  TREATMENTS  AND  NEBULIZERS;  SPACERS, VALVED HOLDING CHAMBERS,
 MASKS AND/OR OTHER SUCH DEVICES USED TO  ASSIST  IN  GETTING  MEDICATION
 INTO  THE  LUNGS.  IN  ADDITION,  THE  COMMISSIONER OF THE DEPARTMENT OF
 HEALTH SHALL PROVIDE AND PERIODICALLY UPDATE BY  RULE  OR  REGULATION  A
 LIST  OF  ADDITIONAL  ASTHMA  EQUIPMENT AND RELATED SUPPLIES SUCH AS ARE
 MEDICALLY NECESSARY FOR THE TREATMENT OF ASTHMA, FOR WHICH  THERE  SHALL
 ALSO  BE  COVERAGE. SUCH POLICIES SHALL ALSO INCLUDE COVERAGE FOR ASTHMA
 SELF-MANAGEMENT EDUCATION TO ENSURE THAT PERSONS WITH ASTHMA, OR PERSONS
 WHO HAVE A CHILD OR CHILDREN WITH ASTHMA, ARE EDUCATED AS TO THE  PROPER
 SELF-MANAGEMENT  AND TREATMENT OF THEIR CONDITION, INCLUDING INFORMATION
 ON PROPER USE OF DEVICES AND TRIGGERS IN THE ENVIRONMENT WHICH SHOULD BE
 AVOIDED OR MANAGED. SUCH  COVERAGE  FOR  SELF-MANAGEMENT  EDUCATION  AND
 A. 5255                             3
 
 EDUCATION  RELATING  TO  DEVICES  SHALL  BE  LIMITED TO VISITS MEDICALLY
 NECESSARY UPON THE DIAGNOSIS OF ASTHMA, WHERE A  PHYSICIAN  DIAGNOSES  A
 SIGNIFICANT  CHANGE IN THE PATIENT'S SYMPTOMS OR CONDITIONS WHICH NECES-
 SITATE  CHANGES  IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REEDUCATION OR
 REFRESHER EDUCATION IS NECESSARY. SUCH EDUCATION MAY BE PROVIDED BY  THE
 PHYSICIAN  OR  OTHER LICENSED HEALTH CARE PROVIDER LEGALLY AUTHORIZED TO
 PRESCRIBE UNDER TITLE EIGHT OF THE EDUCATION LAW,  OR  THEIR  STAFF,  AS
 PART  OF  AN  OFFICE  VISIT  FOR  ASTHMA DIAGNOSIS OR TREATMENT, OR BY A
 CERTIFIED ASTHMA NURSE EDUCATOR, UPON THE REFERRAL  OF  A  PHYSICIAN  OR
 OTHER  LICENSED  HEALTH  CARE  PROVIDER  LEGALLY AUTHORIZED TO PRESCRIBE
 UNDER TITLE EIGHT OF THE EDUCATION LAW. EDUCATION PROVIDED BY THE CERTI-
 FIED ASTHMA NURSE EDUCATOR, MAY BE LIMITED TO  GROUP  SETTINGS  WHEREVER
 PRACTICABLE. COVERAGE FOR SELF-MANAGEMENT EDUCATION AND EDUCATION RELAT-
 ING TO DEVICES SHALL ALSO INCLUDE HOME VISITS WHEN MEDICALLY NECESSARY.
   (B) SUCH COVERAGE MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE
 AS MAY BE DEEMED APPROPRIATE BY THE SUPERINTENDENT AND AS ARE CONSISTENT
 WITH THOSE ESTABLISHED FOR OTHER BENEFITS WITHIN A GIVEN POLICY.
   §  4. 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 issued, renewed, altered or modified on or after such date.