Bill Text: NY A09826 | 2023-2024 | General Assembly | Introduced

---

Bill Title: Relates to coverage for the treatment of asthma.

Spectrum: Partisan Bill (Democrat 14-0)

Status: (Introduced) 2024-04-09 - referred to insurance [A09826 Detail]

Download: New_York-2023-A09826-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          9826

                   IN ASSEMBLY

                                      April 9, 2024
                                       ___________

        Introduced  by  M.  of  A.  REYES,  LUPARDO,  SEAWRIGHT, SIMON, FORREST,
          DARLING, DICKENS,  DINOWITZ,  GALLAGHER,  ZINERMAN,  SILLITTI,  MEEKS,
          JACKSON,  DAVILA  -- read once and referred to the Committee on Insur-
          ance

        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:

     1    Section 1. Paragraph (r) of subdivision 2  of  section  365-a  of  the
     2  social  services  law, as added by section 32 of part C of chapter 58 of
     3  the laws of 2008, is amended to read as follows:
     4    (r) asthma self-management training services for persons or parents of
     5  persons diagnosed with asthma including information  on  proper  use  of
     6  devices such as spacers, valved holding chambers and masks, and triggers
     7  in  the  environment  which  should  be  avoided  or  managed, when such
     8  services are ordered by a physician, registered  physician's  assistant,
     9  registered  nurse  practitioner,  or  licensed midwife and provided by a
    10  licensed, registered, or certified health care professional,  as  deter-
    11  mined  by  the  commissioner  of  health,  who is certified as an asthma
    12  educator by the National  Asthma  Educator  Certification  Board,  or  a
    13  successor  national  certification  board;  provided,  however, that the
    14  provisions of this paragraph shall not take effect unless all  necessary
    15  approvals under federal law and regulation have been obtained to receive
    16  federal  financial  participation  in  the costs of health care services
    17  provided pursuant to this paragraph.  Nothing in this paragraph shall be
    18  construed to modify any licensure, certification or  scope  of  practice
    19  provision under title eight of the education law.
    20    § 2. Subsection (i) of section 3216 of the insurance law is amended by
    21  adding a new paragraph 15-b to read as follows:
    22    (15-b)  (A) Every policy which provides medical coverage that includes
    23  coverage for physician services in a physician's office and every policy
    24  which provides major  medical  or  similar  comprehensive-type  coverage
    25  shall  include coverage for the following equipment and supplies for the
    26  treatment of asthma, and for children under nineteen years of age  addi-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02413-01-3
        A. 9826                             2

     1  tional  equipment  and  supplies  for  use  in school, if recommended or
     2  prescribed by a physician or other licensed health care provider legally
     3  authorized to prescribe under title eight of the education law:   rescue
     4  inhaler  treatments  and  nebulizers;  spacers, valved holding chambers,
     5  masks and/or other such devices used to  assist  in  getting  medication
     6  into  the  lungs.  In  addition,  the  commissioner of the department of
     7  health shall provide and periodically update by  rule  or  regulation  a
     8  list  of  additional  asthma  equipment and related supplies such as are
     9  medically necessary for the treatment of asthma, for which  there  shall
    10  also  be  coverage. Such policies shall also include coverage for asthma
    11  self-management education to ensure that persons with asthma, or persons
    12  who have a child or children with asthma, are educated as to the  proper
    13  self-management  and treatment of their condition, including information
    14  on proper use of devices and triggers in the environment which should be
    15  avoided or managed. Such  coverage  for  self-management  education  and
    16  education  relating  to  devices  shall  be  limited to visits medically
    17  necessary upon the diagnosis of asthma, where a  physician  diagnoses  a
    18  significant  change in the patient's symptoms or conditions which neces-
    19  sitate changes in a patient's self-management, or where  reeducation  or
    20  refresher  education is necessary. Such education may be provided by the
    21  physician or other licensed health care provider legally  authorized  to
    22  prescribe  under  title  eight  of the education law, or their staff, as
    23  part of an office visit for asthma  diagnosis  or  treatment,  or  by  a
    24  certified  asthma  nurse  educator,  upon the referral of a physician or
    25  other licensed health care  provider  legally  authorized  to  prescribe
    26  under title eight of the education law. Education provided by the certi-
    27  fied  asthma  nurse  educator, may be limited to group settings wherever
    28  practicable. Coverage for self-management education and education relat-
    29  ing to devices shall also include home visits when medically necessary.
    30    (B) Such coverage may be subject to annual deductibles and coinsurance
    31  as may be deemed appropriate by the superintendent and as are consistent
    32  with those established for other benefits within a given policy.
    33    § 3. Subsection (k) of section 3221 of the insurance law is amended by
    34  adding a new paragraph 23 to read as follows:
    35    (23) (A) Every policy which provides medical  coverage  that  includes
    36  coverage for physician services in a physician's office and every policy
    37  which  provides  major  medical  or  similar comprehensive-type coverage
    38  shall include coverage for the following equipment and supplies for  the
    39  treatment  of asthma, and for children under nineteen years of age addi-
    40  tional equipment and supplies for  use  in  school,  if  recommended  or
    41  prescribed by a physician or other licensed health care provider legally
    42  authorized  to  prescribe under title eight of the education law: rescue
    43  inhaler treatments and nebulizers;  spacers,  valved  holding  chambers,
    44  masks  and/or  other  such  devices used to assist in getting medication
    45  into the lungs. In addition,  the  commissioner  of  the  department  of
    46  health  shall  provide  and  periodically update by rule or regulation a
    47  list of additional asthma equipment and related  supplies  such  as  are
    48  medically  necessary  for the treatment of asthma, for which there shall
    49  also be coverage. Such policies shall also include coverage  for  asthma
    50  self-management education to ensure that persons with asthma, or persons
    51  who  have a child or children with asthma, are educated as to the proper
    52  self-management and treatment of their condition, including  information
    53  on proper use of devices and triggers in the environment which should be
    54  avoided  or  managed.  Such  coverage  for self-management education and
    55  education relating to devices  shall  be  limited  to  visits  medically
    56  necessary  upon  the  diagnosis of asthma, where a physician diagnoses a
        A. 9826                             3

     1  significant change in the patient's symptoms or conditions which  neces-
     2  sitate  changes  in a patient's self-management, or where reeducation or
     3  refresher education is necessary. Such education may be provided by  the
     4  physician  or  other licensed health care provider legally authorized to
     5  prescribe under title eight of the education law,  or  their  staff,  as
     6  part  of  an  office  visit  for  asthma diagnosis or treatment, or by a
     7  certified asthma nurse educator, upon the referral  of  a  physician  or
     8  other  licensed  health  care  provider  legally authorized to prescribe
     9  under title eight of the education law. Education provided by the certi-
    10  fied asthma nurse educator, may be limited to  group  settings  wherever
    11  practicable. Coverage for self-management education and education relat-
    12  ing to devices shall also include home visits when medically necessary.
    13    (B) Such coverage may be subject to annual deductibles and coinsurance
    14  as may be deemed appropriate by the superintendent and as are consistent
    15  with those established for other benefits within a given policy.
    16    §  4. This act shall take effect on the first of January next succeed-
    17  ing the date on which it shall have become a law and shall apply to  all
    18  policies issued, renewed, altered or modified on or after such date.