NY State Senate Bill 2015-S2043

Senate Bill S2043

2015-2016 Legislative Session

Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas

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Archive: Last Bill Status - In Senate Committee Insurance Committee

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

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 06, 2016	referred to insurance
Jan 21, 2015	referred to insurance

co-Sponsors

2015-S2043 (ACTIVE) - Details

See Assembly Version of this Bill:: A3732
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4303 & 4322, Ins L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S8326, A10450
2011-2012: S3270, A4492
2013-2014: S3321, A5282
2017-2018: S3345, A6206, A10576
2019-2020: S2305, A5053
2021-2022: S3386, A1831
2023-2024: S1234, A1500

2015-S2043 (ACTIVE) - Summary

Requires certain health insurance policies to include coverage for the cost of certain infant and baby formulas.

2015-S2043 (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S2043

TITLE OF BILL:

An act to amend the insurance law, in relation to requiring certain
health insurance policies to include coverage for the cost of certain
infant and baby formulas

PURPOSE:

To allow parents to affordably provide medically necessary formulas
for infants who would become malnourished or suffer from disorders if
these particular formulas were made unavailable to them.  These
disorders, if left untreated, may cause chronic physical disability,
mental retardation or death.

SUMMARY OF SPECIFIC PROVISIONS:

This bill would require that coverage by any policy which provides
coverage for prescription drugs must provide coverage for the cost of
infant and baby formulas which are proven effective as a
disease-specific regimen. Such formulas must be prescribed by a
physician or other license health care professional.  Coverage for
certain infant and baby formulas for any twelve months shall not be
less than $3000.

JUSTIFICATION:

Many infants have been prescribed medically necessary formulas which
have been proven effective as a disease-specific treatment regimen for
infants who are, or will become, malnourished or suffer from
disorders, which, if left untreated, may cause chronic physical
disability, mental retardation or death. Specific diseases for which
infant formulas have been proven effective include:  inherited
diseases of amino acid; Crohn's disease; gastroesophageal reflux with
failure to thrive; and multiple, severe food allergies.  Symptoms of
such allergies may also include: loose stools, which may contain
blood; vomiting; hives; diarrhea; abdominal cramps; coughing or
wheezing; runny nose; watery eyes; itchy skin rash, often around the
mouth; and colic.

Infant and baby formulas, which must be purchased to prevent symptoms
from occurring, are often more expensive than regular formulas.
Especially during these difficult economic times, parents need help to
provide the food that is best and safest for their infants.
Currently, in New York State, insurance companies are not required to
cover these medically necessary formulas. However, other states, such
as Arizona, Colorado, Louisiana, and Massachusetts do have provisions
which require insurance companies to cover such infant formulas.

LEGISLATIVE HISTORY:

Senate: 2009-10: S.8326 - Referred to Rules
Assembly: 2009-10: A.10450 (Meng) - Passed Assembly

EFFECTIVE DATE:


First of January next succeeding the date it becomes a law.

2015-S2043 (ACTIVE) - Bill Text download pdf

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

                                  2043

                       2015-2016 Regular Sessions

                            I N  S E N A T E

                            January 21, 2015
                               ___________

Introduced  by  Sen. HASSELL-THOMPSON -- read twice and ordered printed,
  and when printed to be committed 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 certain
  infant and baby formulas

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  21  of  subsection  (i) of section 3216 of the
insurance law, as amended by chapter 388 of the laws of 2013, is amended
to read as follows:
  (21) Every policy which provides coverage for prescription drugs shall
include coverage for the cost of enteral, INFANT AND BABY  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, INFANT AND  BABY
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, INFANT AND BABY formulas
have been proven effective shall include, but are not limited to, inher-
ited diseases of amino acid or organic acid metabolism; Crohn's Disease;
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,  INFANT  AND  BABY  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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06715-01-5

S. 2043                             2

calendar year or for any continuous period  of  twelve  months  for  any
insured  individual  shall not exceed two thousand five hundred dollars.
COVERAGE FOR INFANT AND BABY FORMULAS  FOR  ANY  CALENDAR  YEAR  OR  ANY
CONTINUOUS  PERIOD  OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL SHALL BE
NO LESS THAN THREE THOUSAND DOLLARS.
  S 2. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
law,  as  amended by chapter 388 of the laws of 2013, is amended to read
as follows:
  (11) Every policy which provides coverage for prescription drugs shall
include coverage for the cost of enteral, INFANT AND BABY  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, INFANT AND  BABY
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, INFANT AND BABY formulas
have been proven effective shall include, but are not limited to, inher-
ited diseases of amino-acid or organic acid metabolism; Crohn's Disease;
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,  INFANT  AND  BABY  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.
COVERAGE FOR INFANT AND BABY FORMULAS  FOR  ANY  CALENDAR  YEAR  OR  ANY
CONTINUOUS  PERIOD  OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL SHALL BE
NO LESS THAN THREE THOUSAND DOLLARS.
  S 3. Subsection (y) of section 4303 of the insurance law,  as  amended
by chapter 388 of the laws of 2013, is amended to read as follows:
  (y)  Every  contract  which  provides  coverage for prescription drugs
shall include coverage for the cost of enteral, INFANT AND BABY 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, INFANT AND BABY
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  disability,  mental  retardation  or  death.
Specific diseases for which enteral, INFANT AND BABY 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 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.

S. 2043                             3

Enteral, INFANT AND BABY 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
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.
COVERAGE FOR INFANT AND BABY FORMULAS  FOR  ANY  CALENDAR  YEAR  OR  ANY
CONTINUOUS  PERIOD  OF TWELVE MONTHS FOR ANY INSURED INDIVIDUAL SHALL BE
NO LESS THAN THREE THOUSAND DOLLARS.
  S 4. The opening paragraph  of  paragraph  25  of  subsection  (b)  of
section 4322 of the insurance law, as amended by chapter 388 of the laws
of 2013, is amended to read as follows:
  Prescription  drugs,  OBTAINED  AT  A  PARTICIPATING  PHARMACY UNDER A
PRESCRIPTION WRITTEN BY AN IN-PLAN OR  OUT-OF-PLAN  PROVIDER,  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], nutritional 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   participating  pharmacy  under  a
prescription written by an in-plan or out-of-plan provider]  AND  INFANT
AND  BABY  FORMULAS FOR HOME USE 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 INFANT OR BABY FORMULA IS CLEARLY MEDICALLY  NECES-
SARY AND HAS BEEN PROVEN EFFECTIVE AS A DISEASE-SPECIFIC TREATMENT REGI-
MEN  FOR THOSE INDIVIDUALS WHO ARE OR WILL BECOME MALNOURISHED OR SUFFER
FROM DISORDERS, WHICH IF LEFT UNTREATED, CAUSE CHRONIC PHYSICAL DISABIL-
ITY, MENTAL RETARDATION OR DEATH. SPECIFIC DISEASES FOR WHICH INFANT AND
BABY 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.  INFANT AND BABY 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 INFANT AND BABY FORMULAS FOR ANY CALENDAR
YEAR OR ANY CONTINUOUS PERIOD OF TWELVE MONTHS FOR ANY INSURED  INDIVID-
UAL  SHALL  BE  NO LESS THAN THREE THOUSAND DOLLARS.  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 5. 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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Senate Bill S2043

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Sponsored By

Ruth Hassell-Thompson