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.