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.