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H.B. 124

This document includes House Floor Amendments incorporated into the bill on Tue, Mar 10, 2009 at 11:14 AM by ddonat. -->              1     

INSURANCE COVERAGE FOR EOSINOPHILIC

             2     
GASTROINTESTINAL DISORDERS AND

             3     
SHORT BOWEL SYNDROME

             4     
2009 GENERAL SESSION

             5     
STATE OF UTAH

             6     
Chief Sponsor: Christine A. Johnson

             7     
Senate Sponsor: Gregory S. Bell

             8     
             9      LONG TITLE
             10      General Description:
             11          This bill amends the Accident and Health Insurance part of the Insurance Code to
             12      H. [ provide ] require an offer of .H coverage for eosinophilic gastrointestinal disorders and short
             12a      bowel syndrome.
             13      Highlighted Provisions:
             14          This bill:
             15          .    defines terms;
             16          .    requires that H. [ a ] an insurer that provides a .H health benefit plan shall
             16a      H. [ provide ] offer at least one plan that provides .H coverage for the use of an amino
             17      acid-based elemental formula, regardless of the delivery method of the formula, for
             18      the diagnoses or treatment of an eosinophilic gastrointestinal disorder or short
             19      bowel syndrome if a licensed physician issues a written order stating that the
             20      formula is medically necessary;
             21          .    grants rulemaking authority to the Insurance Commissioner; and
             22          .    requires the coverage described in this bill to be similar to, or identical to, the
             23      coverage provided for other illnesses or diseases.
             24      Monies Appropriated in this Bill:
             25          None
             26      Other Special Clauses:
             27          None



             28      Utah Code Sections Affected:
             29      ENACTS:
             30          31A-22-636, Utah Code Annotated 1953
             31     
             32      Be it enacted by the Legislature of the state of Utah:
             33          Section 1. Section 31A-22-636 is enacted to read:
             34          31A-22-636. Insurance coverage for eosinophilic gastrointestinal disorders and
             35      short bowel syndrome.
             36          (1) As used in this section:
             37          (a) "Amino acid-based elemental formula" means a nutrition formula:
             38          (i) made from individual non-allergenic amino acids that are broken down to enhance
             39      absorption and digestion; and
             40          (ii) designed for individuals who have a dysfunctional or shortened gastrointestinal
             41      tract and are unable to tolerate and absorb whole foods or formulas composed of whole
             42      proteins, fats, or carbohydrates.
             43          (b) (i) "Eosinophilic gastrointestinal disorder" means a disorder characterized by
             44      having above normal amounts of eosinophils in one or more specific places anywhere in the
             45      digestive system.
             46          (ii) "Eosinophilic gastrointestinal disorder" includes:
             47          (A) eosinophilic esophagitis;
             48          (B) eosinophilic gastritis;
             49          (C) eosinophilic gastroenteritis;
             50          (D) eosinophilic enteritis; and
             51          (E) eosinophilic colitis.
             52          (c) "Short bowel syndrome" means malabsorption of nutrients resulting from
             53      anatomical or functional loss of a significant length of the small intestine.
             54          (2) H. [ A ] (a) An insurer, other than an insurer described in Subsection (2)(b), that
             54a      provides a .H health benefit plan shall H. [ provide ] offer at least one plan that provides .H
             54b      coverage for the use of an amino acid-based
             55      elemental formula, regardless of the delivery method of the formula, for the diagnoses or
             56      treatment of an eosinophilic gastrointestinal disorder or short bowel syndrome if a licensed
             57      physician issues a written order stating that the use of an amino acid-based elemental formula
             58      is medically necessary.
             58a           H. (b) An insurer that is subject to Title 49, Chapter 20, Public


             58b      Employees' Benefit and Insurance Program Act, shall offer to a covered employer at least one
             58c      plan that provides coverage for the use of an amino acid-based elemental formula, regardless
             58d      of the delivery method of the formula, for the diagnoses or treatment of an eosinophilic
             58e      gastrointestinal disorder or short bowel syndrome if a licensed physician issues a written order
             58f      stating that the use of an amino acid-based elemental formula is medically necessary. .H


             59          (3) The commissioner shall make rules, in accordance with Title 63G, Chapter 3, Utah
             60      Administrative Rulemaking Act, that set minimum standards for the coverage described in
             61      Subsection (2).
             62          (4) The rules described in Subsection (3) shall require that all cost sharing provisions
             63      for the coverage described in Subsection (2), including deductibles, coinsurance, annual
             64      maximums, and lifetime maximums are similar to, or identical to, the coverage provided for
             65      other illnesses or diseases.




Legislative Review Note
    as of 1-20-09 6:41 AM


Office of Legislative Research and General Counsel


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