| |
|
| |
| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
| |
| HOUSE BILL |
|
| |
| |
| INTRODUCED BY BRADFORD, SONNEY, BRENNAN, BRIGGS, FABRIZIO, GOODMAN, HORNAMAN, KORTZ, MANN, McGEEHAN, PARKER, PYLE, SIPTROTH, STABACK, TRUE, VULAKOVICH AND WAGNER, MARCH 1, 2010 |
| |
| |
| REFERRED TO COMMITTEE ON INSURANCE, MARCH 1, 2010 |
| |
| |
| |
| AN ACT |
| |
1 | Amending the act of December 20, 1996 (P.L.1492, No.191), |
2 | entitled "An act providing for certain health insurance |
3 | policies to cover the cost of formulas necessary for the |
4 | treatment of phenylketonuria and related disorders," further |
5 | defining "health insurance policy"; and providing for |
6 | nonallergenic baby formula. |
7 | The General Assembly of the Commonwealth of Pennsylvania |
8 | hereby enacts as follows: |
9 | Section 1. Sections 2, 3, 4, 6 and 7 of the act of December |
10 | 20, 1996 (P.L.1492, No.191), known as the Medical Foods |
11 | Insurance Coverage Act, are amended to read: |
12 | Section 2. Declaration of policy. |
13 | The General Assembly finds and declares as follows: |
14 | (1) Phenylketonuria (PKU), branched-chain ketonuria, |
15 | galactosemia and homocystinuria are aminoacidopathies that |
16 | are rare hereditary genetic metabolic disorders. |
17 | (2) Lacking in these aminoacidopathies is the body's |
18 | ability to process or metabolize amino acids, and, if left |
19 | untreated or without proper therapeutic management, these |
|
1 | disorders cause severe mental retardation and chronic |
2 | physical disabilities. |
3 | (3) The only form of treatment is by restricting food |
4 | intake in order to remove the problem amino acids, which are |
5 | necessary in the diet, and then replenishing them in |
6 | carefully controlled measured amounts of a nutritional food |
7 | substitute. |
8 | (4) In an attempt to encourage the development of new |
9 | products, increase availability and reduce cost, formulas |
10 | were removed from the Federal prescription list and |
11 | reclassified as medical foods. An unfortunate side effect has |
12 | been the reluctance of many insurance companies to cover the |
13 | cost of these formulas. In instances where coverage is |
14 | provided, it is random and subject to inconsistent |
15 | interpretation. |
16 | (5) The intent of this legislation is not to require |
17 | insurance coverage for normal food products used in dietary |
18 | management of these disorders, but to provide for such |
19 | coverage of formulas that are equivalent to a prescription |
20 | drug and nonallergenic baby formula medically necessary for |
21 | the therapeutic treatment of such rare hereditary genetic |
22 | metabolic disorders and administered under the direction of a |
23 | physician. |
24 | (6) In recognition by the General Assembly that such |
25 | formulas and nonallergenic baby formula are medically |
26 | necessary and critical to the well-being of individuals |
27 | afflicted with rare hereditary genetic metabolic disorders, |
28 | it shall be required that health insurance policies issued in |
29 | this Commonwealth shall include such coverage. |
30 | Section 3. Definitions. |
|
1 | The following words and phrases when used in this act shall |
2 | have the meanings given to them in this section unless the |
3 | context clearly indicates otherwise: |
4 | "Health insurance policy." Except for specified disease and |
5 | accident-only policies, the term shall mean any group health |
6 | insurance policy, contract or plan or any individual policy, |
7 | contract or plan [with coverage for prescription drugs] which |
8 | provides medical coverage on an expense-incurred, service or |
9 | prepaid basis. The term includes the following: |
10 | (1) A health insurance policy or contract issued by a |
11 | nonprofit corporation subject to 40 Pa.C.S. Chs. 61 (relating |
12 | to hospital plan corporations) and 63 (relating to |
13 | professional health services plan corporations) and [the act |
14 | of December 14, 1992 (P.L.835, No.134), known as the |
15 | Fraternal Benefit Societies Code.] Article 24 of the act of |
16 | May 17, 1921 (P.L.582, No.284), known as The Insurance |
17 | Company Law of 1921. |
18 | (2) A health service plan operating under the act of |
19 | December 29, 1972 (P.L.1701, No.364), known as the Health |
20 | Maintenance Organization Act. |
21 | Section 4. Medical foods insurance coverage. |
22 | Except as provided in section 7, any health insurance policy |
23 | which is delivered, issued for delivery, renewed, extended or |
24 | modified in this Commonwealth by any health care insurer shall |
25 | provide that the health insurance benefits applicable under the |
26 | policy include coverage for the cost of nutritional supplements |
27 | (formulas) and nonallergenic baby formula as medically necessary |
28 | for the therapeutic treatment of phenylketonuria, branched-chain |
29 | ketonuria, galactosemia and homocystinuria as administered under |
30 | the direction of a physician. |
|
1 | Section 6. Cost-sharing provisions. |
2 | (a) Applicability.--Benefits for nutritional supplements |
3 | (formulas) and nonallergenic baby formula as medically necessary |
4 | for the therapeutic treatment of phenylketonuria, branched-chain |
5 | ketonuria, galactosemia and homocystinuria as administered under |
6 | the direction of a physician shall be subject to copayment and |
7 | coinsurance provisions of a health insurance policy to the |
8 | extent that other medical services covered by the policy are |
9 | subject to those provisions. |
10 | (b) Exemption.--Benefits for nutritional supplements |
11 | (formulas) and nonallergenic baby formula as medically necessary |
12 | for the therapeutic treatment of phenylketonuria, branched-chain |
13 | ketonuria, galactosemia and homocystinuria as administered under |
14 | the direction of a physician shall be exempt from deductible |
15 | provisions in a health insurance policy. This exemption must be |
16 | explicitly provided for in the policy. |
17 | Section 7. Exemption. |
18 | Notwithstanding sections 4 and 5, this act shall not be |
19 | construed to require a health insurance policy to include |
20 | coverage for nutritional supplements (formulas) and |
21 | nonallergenic baby formula as medically necessary for the |
22 | therapeutic treatment of phenylketonuria, branched-chain |
23 | ketonuria, galactosemia and homocystinuria as administered under |
24 | the direction of a physician for an individual who is a resident |
25 | of this Commonwealth if all of the following apply: |
26 | (1) The individual is employed outside this |
27 | Commonwealth. |
28 | (2) The individual's employer maintains a health |
29 | insurance policy for the individual as an employment benefit. |
30 | Section 2. This act shall take effect in 180 days. |
|