S T A T E O F N E W Y O R K
________________________________________________________________________
4889
2023-2024 Regular Sessions
I N S E N A T E
February 16, 2023
___________
Introduced by Sens. RIVERA, BAILEY, MAY, SEPULVEDA -- read twice and
ordered printed, and when printed to be committed to the Committee on
Health
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.
LBD02413-01-3
S. 4889 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 PERSONS
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 NECES-
SITATE CHANGES IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REEDUCATION 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 23 to read as follows:
(23) (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 PERSONS
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
S. 4889 3
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 NECES-
SITATE CHANGES IN A PATIENT'S SELF-MANAGEMENT, OR WHERE REEDUCATION 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.
