Insurance-coverage of phenylketonuria.

WORKING DRAFT
2010
STATE OF
WYOMING
10LSO-0341

HOUSE BILL
NO.
HB0116

Insurance-coverage of phenylketonuria.

Sponsored by:
Representative(s) Zwonitzer, Dn. and Millin

A BILL

for

AN ACT relating to insurance; requiring coverage of inherited enzymatic disorders; providing a definition; and providing for an effective date.

Be It Enacted by the Legislature of the State of
Wyoming
:

Section 1.

W.S. 26
‑
20
‑
401 is created to read:

ARTICLE 4
INHERITED ENZYMATIC DISORDER COVERAGE

26
‑
20
‑
401.

Inherited enzymatic disorder coverage required.

(a)

All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service or indemnity type contracts issued by any insurer including any nonprofit corporation and individual and group service contracts issued by a health maintenance organization
issued or delivered on or after July 1, 2010
, shall provide coverage for the equipment, supplies and outpatient self-management training and education, including medical nutrition therapy for the treatment of inherited enzymatic disorders caused by single gene defects involved in the metabolism of amino, organic and fatty acids if prescribed by a health care professional legally authorized to prescribe such items under law. Covered inherited enzymatic disorder outpatient self-management training and education shall be provided by a certified, registered or licensed health care professional with expertise in inherited enzymatic disorders. For purposes of this section, required covered outpatient self-management training and education shall be limited to:

(i)

A one (1) time evaluation and training program when medically necessary, within one (1) year of diagnosis;

(ii)

Additional medically necessary self-management training shall be provided upon a significant change in symptoms, condition or treatment.

(b)

For purposes of this section, "inherited enzymatic disorders" includes, but is not limited to phenylketonuria, maternal phenylketonuria, maple syrup urine disease, tyrosinemia, homocystinuria, histidinemia, urea cycle disorders, hyperlysinemia, glutaric acidemias, methylmalonic acidemia and propionic acidemia.

(c)

The benefits provided under this section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy. Private third party payors may not refuse, reduce or eliminate coverage due to the requirements of this section. Enforcement of this section shall be performed by the commissioner or his designee.

Section
2
.

T
his act is effective July 1, 2010
.

(END)

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HB0116