NY State Senate Bill 2023-S1234

Senate Bill S1234

2023-2024 Legislative Session

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

download bill text pdf

Current 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 03, 2024	referred to insurance
Jan 10, 2023	referred to insurance

2023-S1234 (ACTIVE) - Details

See Assembly Version of this Bill:: A1500
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
2015-2016: S2043, A3732
2017-2018: S3345, A6206, A10576
2019-2020: S2305, A5053
2021-2022: S3386, A1831

2023-S1234 (ACTIVE) - Summary

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

2023-S1234 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S1234

SPONSOR: BAILEY
 
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 retarda-
tion 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-specif-

ic 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; abdo-
minal 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.  Espe-
cially 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:

2017-18: Referred to Insurance

2019-20: Referred to Insurance

2021-22: Referred to Insurance

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

2023-S1234 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1234
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 10, 2023
                                ___________
 
 Introduced  by  Sen.  BAILEY -- 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 section 6 of subpart B of part J of chapter
 57 of the laws of 2019, is amended to read as follows:
   (21) Every policy that 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. Specific diseases and disorders
 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;
 disorders  of gastrointestinal motility such as chronic intestinal pseu-
 do-obstruction; and multiple, severe food allergies including,  but  not
 limited  to  immunoglobulin E and nonimmunoglobulin E-mediated allergies
 to multiple food proteins; severe  food  protein  induced  enterocolitis
 syndrome;  eosinophilic  disorders; and impaired absorption of nutrients
 caused by disorders affecting the absorptive surface, function,  length,
 and  motility  of  the  gastrointestinal tract. Enteral, INFANT AND BABY
 formulas that are medically necessary and taken under written order from
 a physician for the treatment of  specific  diseases  shall  be  distin-
 guished  from  nutritional  supplements  taken  electively. Coverage for
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02931-01-3

 S. 1234                             2
 
 certain inherited diseases of amino acid and organic acid metabolism  as
 well  as severe protein allergic conditions shall include modified solid
 food products that are low protein, contain  modified  protein,  or  are
 amino  acid  based that are medically necessary. 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.
   § 2. Paragraph 11 of subsection (k) of section 3221 of  the  insurance
 law,  as  amended  by section 14 of subpart B of part J of chapter 57 of
 the laws of 2019, is amended to read as follows:
   (11) Every policy that 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. Specific diseases and disorders
 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;
 disorders  of gastrointestinal motility such as chronic intestinal pseu-
 do-obstruction; and multiple, severe food allergies including,  but  not
 limited  to  immunoglobulin E and nonimmunoglobulin E-mediated allergies
 to multiple food proteins; severe  food  protein  induced  enterocolitis
 syndrome;  eosinophilic  disorders  and impaired absorption of nutrients
 caused by disorders affecting the absorptive surface, function,  length,
 and  motility  of  the  gastrointestinal tract. Enteral, INFANT AND BABY
 formulas that are medically necessary and taken under written order from
 a physician for the treatment of  specific  diseases  shall  be  distin-
 guished  from  nutritional  supplements  taken  electively. Coverage for
 certain inherited diseases of amino acid and organic acid metabolism  as
 well  as severe protein allergic conditions shall include modified solid
 food products that are low protein, contain  modified  protein,  or  are
 amino  acid  based that are medically necessary. 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.
   § 3. Subsection (y) of section 4303 of the insurance law,  as  amended
 by  section 27 of subpart B of part J of chapter 57 of the laws of 2019,
 is amended to read as follows:
   (y) Every contract that 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. Specific  diseases  and  disorders
 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;
 disorders of gastrointestinal motility such as chronic intestinal  pseu-
 do-obstruction;  and  multiple, severe food allergies including, but not
 limited to immunoglobulin E and nonimmunoglobulin  E-mediated  allergies
 to  multiple  food  proteins;  severe food protein induced enterocolitis
 S. 1234                             3
 
 syndrome; eosinophilic disorders; and impaired absorption  of  nutrients
 caused  by disorders affecting the absorptive surface, function, length,
 and motility of the gastrointestinal tract.  Enteral,  INFANT  AND  BABY
 formulas that are medically necessary and taken under written order from
 a  physician  for  the  treatment  of specific diseases shall be distin-
 guished from nutritional  supplements  taken  electively.  Coverage  for
 certain  inherited diseases of amino acid and organic acid metabolism as
 well as severe protein allergic conditions shall include modified  solid
 food  products  that  are  low protein, contain modified protein, or are
 amino acid based that are medically necessary. 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.
   §  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.
   §  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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