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

                                  2188

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 15, 2009
                               ___________

Introduced  by M. of A. BALL, BURLING, KOLB, P. RIVERA, WALKER, MOLINARO
  -- Multi-Sponsored by -- M. of A. CALHOUN, CONTE,  CROUCH,  McDONOUGH,
  QUINN,  SEMINERIO -- read once and referred to the Committee on Insur-
  ance

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. 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 MEDICAL,  MAJOR  MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE  COVERAGE  OR  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.
                                                           LBD05214-01-9
              

A. 2188                             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  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 MEDICAL, MAJOR MEDICAL OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE OR 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  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 MEDICAL, MAJOR  MEDICAL  OR  SIMILAR
COMPREHENSIVE-TYPE  COVERAGE  OR  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 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. 2188                             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.