S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2451
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 19, 2021
                                ___________
 
 Introduced by M. of A. REYES, LUPARDO, BARRON, DAVILA, SEAWRIGHT, SIMON,
   O'DONNELL,  DARLING  --  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.
              

                                                            LBD00128-01-1

 A. 2451                             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
 PERSON'S 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 NECESSITATE CHANGES IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REED-
 UCATION  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 22 to read as follows:
   (22) (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
 PERSON'S 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

 A. 2451                             3
 
 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 NECESSITATE CHANGES IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REED-
 UCATION  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.