Bill Text: GA HB132 | 2011-2012 | Regular Session | Introduced

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Bill Title: Medical Food Equity Act; enact

Spectrum: Slight Partisan Bill (Republican 2-1)

Status: (Introduced - Dead) 2011-02-03 - House Second Readers [HB132 Detail]

Download: Georgia-2011-HB132-Introduced.html

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11 LC 37 1133

House Bill 132

By: Representatives Watson of the 163rd, Lindsey of the 54th, and Benfield of the 85th

A BILL TO BE ENTITLED
AN ACT

To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, so as to require certain insurance coverage for physician prescribed special dietary foods or formulas for specific chronic medical conditions; to provide a short title; to provide for definitions; to provide for related matters; to provide for applicability; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

This Act shall be known and may be cited as the "Medical Food Equity Act."

SECTION 2.

Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance generally, is amended by adding a new Code section to read as follows:

"33-24-59.14.

(a) As used in this Code section, the term:

(1) 'Food tolerance and absorption disorders' means eosinophilic gastrointestinal disorders, including post-transplant; Immunoglobulin E and non-Immunoglobulin E mediated allergies to multiple food proteins; food protein-induced enterocolitis syndrome; and impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract.

(2) 'Health benefit plan' means any hospital or medical insurance policy or certificate, health care plan contract or certificate, qualified higher deductible health plan, health maintenance organization subscriber contract, any health benefit plan established pursuant to Article 1 of Chapter 18 of Title 45, or managed care plan; but health benefit plan does not include policies issued in accordance with Chapter 31 of this title; disability income policies; or Chapter 9 of Title 34, relating to workers' compensation.

(3) 'Inherited metabolic and genetic disorders' means medical conditions that interfere with the metabolism or absorption of specific nutrients for which the Department of Community Health screens newborns pursuant to Code Section 31-12-6, et seq.

(4) 'Insurer' means any accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation, health care corporation, health maintenance organization, provider sponsored health care corporation, or any similar entity and any self-insured health benefit plan not subject to the exclusive jurisdiction of the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq., which entity provides for the financing or delivery of health care services through a health benefit plan, or the plan administrator of any health benefit plan established pursuant to Article 1 of Chapter 18 of Title 45.

(5) 'Medical food' means food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation. For purposes of this Code section, medical food includes the following:

(A) Nutritionally modified counterparts of traditional foods, including foods modified to be low protein, and other forms of foods, such as formulas, pills, capsules, and bars, used in the treatment of inherited metabolic and genetic disorders;

(B) Any amino acid-based elemental formula which is medically necessary, in the opinion of the attending physician, for the diagnosis and treatment of food tolerance and absorption disorders and which is recognized as a special formula by the Georgia Women, Infants, and Children program; and

(C) Any medical equipment, supplies, and services required to administer medical food.

(b) Each insurer providing a prescription drug benefit or reimbursement for health care costs as part of a health benefit plan delivered, issued for delivery, or renewed in this state shall provide coverage and reimbursement for medical foods used in the diagnosis and treatment of inherited metabolic and genetic disorders and food tolerance and absorption disorders, regardless of delivery method, where the attending physician has issued a written order stating that the medical food is medically necessary.

(c) An insurer shall provide the coverage described in subsection (b) of this Code Section on a basis no less favorable than the basis on which prescription drugs and other medications and related services are covered by the health benefit plan, and to the same extent that the health benefit plan provides coverage for drugs that are available only on the orders of a physician."

SECTION 3.

This Act shall be applicable to policies issued on or renewed after July 1, 2011.

SECTION 4.

All laws and parts of laws in conflict with this Act are repealed.