Chief Patron: Barker
Defray Costs of Coverage for Formula and Enteral Nutrition Products

Item 493 #4s

Language
Page 516, line 1, strike "$29,141,339" and insert "$29,841,339".
Page 516, line 1, strike "$29,010,485" and insert "$29,710,485".

Explanation

(This amendment provides $700,000 each year from the general fund to defray the costs of a mandate for health insurance coverage of medically-necessary formula and enteral nutrition products. House Bill 840 and Senate Bill 605 of the 2020 General Assembly Session required health insurance coverage of medically necessary formula and enteral nutrition products for covered individuals requiring treatment for an inherited metabolic disorder. At the time, the State Corporation Commission and Bureau of Insurance interpreted the mandate to be an extension of an existing mandate as opposed to a new one, thus not requiring the state to defray costs under federal rules. Recent updates from the federal Centers for Medicare and Medicaid Services suggest that the state may now be required to defray costs in the range of $350,000 to $700,000 per year. Health plans are already providing this coverage, and if costs are not defrayed for the 2023 plan year the Bureau of Insurance will prohibit the plans from continuing the coverage of these medically-----necessary formulas. Senate Bill 449 in the 2022 Session will modify the Code to permit the mandate to remain in effect, and this budget amendment is necessary to meet the federal requirement of defraying the costs.)