Bill: 16 RS SB 193/GA
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- > Mandates that health benefit plans with prescription drug coverage provide coverage for amino acid-based elemental formulas for insureds with a medical diagnosis of an eosinophilic disorder. Further, mandates that insurance policies for state employees and their dependents provide coverage for amino acid-based formulas for insureds with eosinophilic disorders. In addition, the bill requires that the state provide payment for amino acid-based formulas where the affected person has a medical diagnosis of an eosinophilic disorder and does not have coverage under any public or private health benefit plan for amino acid-based formulas.
Pertinent Language of Bill 16 RS SB 193/GA:
Section 1. KRS 205.560 is amended to read as follows:
The scope of medical care for which the Cabinet for Health and Family Services undertakes to pay shall be designated and limited by regulations promulgated by the cabinet, pursuant to the provisions in this section. . . . . The selection of another class or other classes of medical care shall be recommended by the council to the secretary for health and family services after taking into consideration, among other things, the amount of federal and state funds available, the most essential needs of recipients, and the meeting of such need on a basis insuring the greatest amount of medical care as defined in KRS 205.510 consonant with the funds available, including but not limited to the following categories, except where the aid is for the purpose of obtaining an abortion:
(c) Drugs, nursing care, medical supplies, and services during the time when a recipient is not in a hospital but is under treatment and on the prescription of a physician, dentist, or podiatrist. For purposes of this paragraph, drugs shall include products for the treatment of inborn errors of metabolism or genetic, gastrointestinal, and food allergic conditions, consisting of therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified food products that are medically indicated for therapeutic treatment and are administered under the direction of a physician, and include but are not limited to the following conditions:
24. Food protein allergies;
25. Food protein-induced enterocolitis syndrome;
26. Eosinophilic disorders; and
27. Short-bowel syndrome;
Section 2. KRS 213.141 is amended to read as follows:
The cabinet shall prescribe by administrative regulation pursuant to KRS Chapter 13A a fee not to exceed ten dollars ($10) to be paid for a certified copy of a record of a birth:
(b) One dollar ($1) of which shall be used by the Division of Maternal and Child Health to pay for therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified foods for all inborn errors of metabolism and genetic conditions if:
1. The therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein modified food products are medically indicated for the therapeutic treatment of inborn errors of metabolism or genetic conditions and are administered under the direction of a physician; and
2. The affected person’s therapeutic food, formulas, supplements, amino acid-based elemental formula, or low-protein foods are not covered under any public or private health benefit plan.
Section 3. KRS 304.17A-258 is amended to read as follows:
(1) For purposes of this section:
(a) “Therapeutic food, formulas, and supplements” means products intended for the dietary treatment of inborn errors of metabolism or genetic conditions, including eosinophilic disorders, food protein allergies, food protein-induced enterocolitis syndrome, and short bowel disorders, under the direction of a physician and includes amino acid-based elemental formula; [and]
(b) “Low-protein modified food” means a product formulated to have less than one (1) gram of protein per serving and intended for the dietary treatment of inborn errors of metabolism or genetic conditions under the direction of a physician; and
(c) “Amino acid-based elemental formula” means a product intended for the diagnosis and dietary treatment of eosinophilic disorders, food protein allergies, food protein-induced enterocolitis, and short-bowel syndrome under the direction of a physician.
(2) A health benefit plan that provides prescription drug coverage shall include in that coverage therapeutic food, formulas, supplements, and low-protein modified food products for the treatment of inborn errors of metabolism or genetic conditions if the therapeutic food, formulas, supplements, and low-protein modified food products are obtained for the therapeutic treatment of inborn errors of metabolism or genetic conditions under the direction of a physician. Coverage under this subsection may be subject, for each plan year, to a cap of twenty-five thousand dollars ($25,000) for therapeutic food, formulas, and supplements and a separate cap for each plan year of four thousand dollars ($4,000) on low-protein modified foods. Each cap shall be subject to annual inflation adjustments based on the consumer price index.
Section 4. KRS 18A.225 is amended as follows:
(16) Any policy provided to state employees or their dependents pursuant to this section shall provide coverage for obtaining amino acid-based elemental formula pursuant to Section 3 of this Act.
