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9 LONG TITLE
10 General Description:
11 This bill amends the Accident and Health Insurance part of the Insurance Code to
12 provide coverage for eosinophilic gastrointestinal disorders and short bowel syndrome.
13 Highlighted Provisions:
14 This bill:
15 . defines terms;
16 . requires that a health benefit plan shall provide 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:
26 Other Special Clauses:
28 Utah Code Sections Affected:
30 31A-22-636, Utah Code Annotated 1953
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) A health benefit plan shall provide 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.
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