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First Substitute H.B. 233

Representative Ronda Rudd Menlove proposes the following substitute bill:


             1     
INSURANCE COVERAGE FOR AMINO ACID-BASED

             2     
FORMULA

             3     
2011 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Carol Spackman Moss

             6     
Senate Sponsor: Peter C. Knudson

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill amends the Insurance Code to allow an option to provide coverage for the use
             11      of an amino acid-based elemental formula, regardless of the delivery method of the
             12      formula, for the diagnosis or treatment of an eosinophilic gastrointestinal disorder.
             13      Highlighted Provisions:
             14          This bill:
             15          .    defines terms;
             16          .    provides that a health benefit plan may provide coverage for the use of an amino
             17      acid-based elemental formula, regardless of the delivery method of the formula, for
             18      the diagnosis or treatment of an eosinophilic gastrointestinal disorder if a licensed
             19      physician issues a written order stating that the formula is medically necessary;
             20          .    grants rulemaking authority to the Insurance Commissioner;
             21          .    provides that the coverage described in this bill may be similar to, or identical to,
             22      the coverage provided for other illnesses or diseases; and
             23          .    makes technical changes.
             24      Money Appropriated in this Bill:
             25          None


             26      Other Special Clauses:
             27          None
             28      Utah Code Sections Affected:
             29      ENACTS:
             30          31A-22-640, Utah Code Annotated 1953
             31     
             32      Be it enacted by the Legislature of the state of Utah:
             33          Section 1. Section 31A-22-640 is enacted to read:
             34          31A-22-640. Insurance coverage for amino acid-based formula.
             35          (1) As used in this section:
             36          (a) "Amino acid-based elemental formula" means a nutrition formula:
             37          (i) made from individual non-allergenic amino acids that are broken down to enhance
             38      absorption and digestion; and
             39          (ii) designed for individuals who have a dysfunctional gastrointestinal tract and are
             40      unable to tolerate and absorb whole foods or formulas composed of whole proteins, fats, or
             41      carbohydrates.
             42          (b) (i) "Eosinophilic gastrointestinal disorder" means a disorder characterized by
             43      having above normal amounts of eosinophils in one or more specific places anywhere in the
             44      digestive system.
             45          (ii) "Eosinophilic gastrointestinal disorder" includes:
             46          (A) eosinophilic esophagitis;
             47          (B) eosinophilic gastritis;
             48          (C) eosinophilic gastroenteritis;
             49          (D) eosinophilic enteritis; and
             50          (E) eosinophilic colitis.
             51          (2) A health benefit plan may provide coverage for the use of an amino acid-based
             52      elemental formula, regardless of the delivery method of the formula, for the diagnosis or
             53      treatment of an eosinophilic gastrointestinal disorder if a licensed physician issues a written
             54      order stating that the use of an amino acid-based elemental formula is medically necessary.
             55          (3) The commissioner shall make rules, in accordance with Title 63G, Chapter 3, Utah
             56      Administrative Rulemaking Act, that set minimum standards for the optional coverage


             57      described in Subsection (2).
             58          (4) The rules described in Subsection (3) may require that all cost sharing provisions
             59      for the coverage described in Subsection (2), including deductibles, coinsurance, annual
             60      maximums, and lifetime maximums, are similar to, or identical to, the coverage provided for
             61      other illnesses or diseases.


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