1
2
3
4
5
6
7 LONG TITLE
8 General Description:
9 This bill amends the Insurance Code to require health insurance coverage for the use of
10 an amino acid-based elemental formula, regardless of the delivery method of the
11 formula, for the diagnosis or treatment of an eosinophilic gastrointestinal disorder.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines terms;
15 ▸ requires a health benefit plan effective or renewed on or after January 1, 2017, to
16 provide coverage for the use of an amino acid-based elemental formula, regardless
17 of the delivery method of the formula, for the diagnosis or treatment of an
18 eosinophilic gastrointestinal disorder;
19 ▸ grants administrative rulemaking authority to the insurance commissioner; and
20 ▸ provides that exemptions to insurance coverage mandates for health benefit plans do
21 not apply to the insurance coverage for the use of an amino acid-based formula for
22 the diagnosis or treatment of an eosinophilic gastrointestinal disorder.
23 Money Appropriated in this Bill:
24 None
25 Other Special Clauses:
26 None
27 Utah Code Sections Affected:
28 ENACTS:
29 31A-22-644, Utah Code Annotated 1953
30
31 Be it enacted by the Legislature of the state of Utah:
32 Section 1. Section 31A-22-644 is enacted to read:
33 31A-22-644. Insurance coverage for amino acid-based formula.
34 (1) As used in this section:
35 (a) "Amino acid-based elemental formula" means a nutrition formula:
36 (i) made from individual non-allergenic amino acids that are broken down to enhance
37 absorption and digestion; and
38 (ii) designed for individuals who have a dysfunctional gastrointestinal tract and are
39 unable to tolerate and absorb whole foods or formulas composed of whole proteins, fats, or
40 carbohydrates.
41 (b) (i) "Eosinophilic gastrointestinal disorder" means a disorder characterized by
42 having above normal amounts of eosinophils in one or more specific places anywhere in the
43 digestive system.
44 (ii) "Eosinophilic gastrointestinal disorder" includes:
45 (A) eosinophilic esophagitis;
46 (B) eosinophilic gastritis;
47 (C) eosinophilic gastroenteritis;
48 (D) eosinophilic enteritis; and
49 (E) eosinophilic colitis.
50 (2) Notwithstanding Subsection 31A-22-618.5(2)(b)(i)(D), a health benefit plan
51 effective or renewed on or after January 1, 2017, shall provide coverage for the use of an amino
52 acid-based elemental formula, regardless of the delivery method of the formula, for the
53 diagnosis or treatment of an eosinophilic gastrointestinal disorder if prescribed by a physician
54 licensed under Title 58, Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah
55 Osteopathic Medical Practice Act, and if dispensed by a pharmacy licensed under Title 58,
56 Chapter 17b, Utah Pharmacy Practice Act.
57 (3) The commissioner shall make rules, in accordance with Title 63G, Chapter 3, Utah
58 Administrative Rulemaking Act, that set minimum standards for the coverage described in
59 Subsection (2).