BILL NUMBER:  S5774

 TITLE OF BILL :

An act to amend the social services law, in relation to excluding
outpatient blood clotting factor products and related services and
treatments from coverage by managed care provided to medical
assistance recipients

 PURPOSE :

To maintain the provision of blood clotting factor and related
treatment and services furnished in connection with the care of
hemophilia and other blood clotting disorders to Medicaid
beneficiaries outside of Medicaid managed care.

 SUMMARY OF PROVISIONS :

Section 1 amends section 364-j of the Social Services Law to maintain
the current exclusion of outpatient blood clotting factor products and
treatments and services furnished to care for persons with hemophilia
from the Medicaid managed care program

Section 2 of the bill provides that the legislation would take effect
immediately.

              

 JUSTIFICATION :

Hemophilia and other bleeding disorders are conditions in which the
blood does not clot properly due to a defective or missing protein.
Blood clotting factor replacement therapy prevents and controls
bleeding by temporarily replacing the missing or defective protein.
The administration, handling and dispensing of the product is a
complex exercise, which requires the expertise of Hemophilia Treatment
Centers and other expert providers, specialized pharmacy and unique
storage and refrigeration requirements.

Because of the relatively small (approximately 350) Medicaid
beneficiaries with hemophilia, the complex nature of the management of
the disease, and the expense associated with blood clotting factor
therapies, the Department of Health has not included clotting factor
within the Medicaid managed care benefit package but has paid for it
directly. Although the Department has previously considered "carving
in" blood clotting factor and associated services into the benefit
package, it has repeatedly been determined that access to the
comprehensive care and therapies required by persons with these
disorders warranted keeping clotting factor outside of the Medicaid
managed care program.

The Department has now proposed to carve in clotting factor and
related services into the Medicaid managed care program, effective
July 1, 2017. Consumers, advocacy organizations, Hemophilia Treatment
Centers, the New York Blood Center (which procures, prepares and
delivers the clotting factor) and Medicaid managed care plans support
the continued "carve-out" of clotting factor and related services from
the Medicaid managed care program.

 LEGISLATIVE HISTORY :

None.

 FISCAL IMPLICATIONS :

None. The Department of Health has repeatedly indicated that carving
in this benefit would not result in a savings to the Medicaid program.

 EFFECTIVE DATE :
Immediately.