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1999 SESSION
HB 2199 Coverage for individuals diagnosed with an inborn error of metabolism.
Introduced by: Robert F. McDonnell | all patrons ... notes | add to my profiles
SUMMARY AS INTRODUCED:
Coverage for certain medical formulas for individuals diagnosed with an inborn error of metabolism. Requires each (i) insurer issuing individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs on an outpatient basis, to offer and make available coverage for medical formulas prescribed for the treatment of inborn errors of metabolism, including phenylketonuria, maple syrup urine disease or homocystinuria, and approved by the United States Food and Drug Administration for such treatment. The term “prescription drug” shall include metabolic or medical formulas classified by the United States Food and Drug Administration as a medical food and defined as foods which are formulated to be consumed or administered entirely under the supervision of a physician and which are 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. Medical formulas shall not include commercial products which may be low in protein but have not been developed for the treatment of an inborn error of metabolism. This new section will not require coverage for experimental drugs for the treatment of an inborn error of metabolism which are not approved by the United States Food and Drug Administration, or for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage. This provision notes that closed formularies are not precluded so long as such formularies include medical formulas. This section will not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months’ duration. The bill’s provisions will apply to policies, contracts, and plans delivered, issued for delivery or renewed in Virginia on and after July 1, 1999. Diseases classified as inborn errors of metabolism include phenylketonuria, maple syrup urine disease and homocystinuria—all of which can be diagnosed at birth or soon after and will cause severe mental retardation in the absence of treatment.
FULL TEXT
HISTORY
- 01/20/99 House: Presented & ordered printed 999048350
- 01/20/99 House: Referred to Committee on Corporations, Insurance and Banking
- 01/26/99 House: Assigned to C. I. B. sub-committee: 3
- 02/01/99 House: No action taken by Corporations, Insurance and Banking by voice vote