S691 — An Act ensuring access to healthcare and medically necessary food for children

Summary

An Act ensuring access to healthcare and medically necessary food for children

Bill Text

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The bill adds definitions for 'covered disease or condition' and 'medically necessary food', and imposes requirements on insurance carriers related to specialty care, prescription coverage, and cost-sharing for medically necessary food.

• Section 1 of chapter 176O

  “covered disease or condition”, Immunoglobulin E and non-Immunoglobulin E-mediated allergies to food proteins, including the following: (i) food protein-induced enterocolitis syndrome. (ii) Immunoglobulin E and non-Immunoglobulin E-mediated allergies to food proteins; and (iii) Eosinophilic disorders, including eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic colitis, and post-transplant eosinophilic disorders.

  This defines specific allergies and eosinophilic disorders as covered diseases or conditions under the law.

• Section 1 of chapter 176O

  “Medically necessary food”, food, including a low protein modified food product, an amino acid preparation product, a modified fat preparation product, or a nutritional formula, including such a formula that does not require a prescription, that is: (i) furnished pursuant to the prescription, order, or recommendation, as applicable, of a physician or other health care professional qualified to make such prescription, order, or recommendation, for the dietary management of a covered disease or condition; (ii) a specially formulated and processed product (as opposed to a naturally occurring food stuff used in its natural state) for the partial or exclusive feeding of an individual by means of oral intake or enteral feeding by tube; (iii) intended for the dietary management of an individual who, because of therapeutic or chronic medical needs, has limited or impaired capacity to ingest, digest, absorb, or metabolize ordinary food stuffs or certain nutrients, or who has other special medically determined nutrient requirements, the dietary management of which cannot be achieved by the modification of the normal diet alone; (iv) intended to be used under medical supervision, which may include in a home setting; and (v) intended only for an individual receiving active and ongoing medical supervision wherein the individual requires medical care on a recurring basis for, among other things, instructions on the use of the food. Unless otherwise noted, the term “Medically necessary food” shall not include (i) foods taken as part of an overall diet designed to reduce the risk of a disease or medical condition or as weight loss products, even if they are recommended by a physician or other health professional; (ii) foods marketed as gluten-free for the management of celiac disease or non-celiac gluten sensitivity; and (iii) foods marketed for the management of diabetes.

  This establishes a definition for medically necessary food and specifies what is included and excluded.

• Section 15 of chapter 176O

  (l) No carrier shall require an insured to obtain a referral or prior authorization from a primary care provider for specialty care provided by an immunologist or family practitioner participating in such carrier's health care provider network; no carrier shall categorize prescription coverage as “durable medical equipment”; no carrier shall apply prescription co-pay and deductible for medically necessary food.

  This prohibits insurance carriers from imposing certain restrictions on access to specialty care and coverage for medically necessary food.

Sponsors

• Brendan P. Crighton · Primary

Subjects