Reimbursement Legislation
Below please find information on various state laws on insurance reimbursement for amino acid-based formula like Neocate. If you are having difficulty getting reimbursed for your child’s Neocate despite legislation in your state, please contact psamuel@shsna.com.
Arizona
|
Bill Number/Name: | House Bill 2364 |
| Effective Date: | April 2006 |
Overview of Law
- Requires insurance reimbursement for individuals diagnosed with an eosinophilic gastrointestinal disorder.
- Requires insurance to reimburse 75 percent of the cost of the formula with an annual cap $20,000.
- Covers formula administered orally or via a feeding tube.
Click here for the bill.
Connecticut
|
Bill Number/Name: | | | Chapter 700c – Health Insurance |
| Effective Date: | | | October 1, 2001 |
Overview of Law
- Requires coverage of amino acid-based formula for children up to eight years of age.
- Covers formula administered orally or via a feeding tube.
Click here for the bill.
Illinois
|
Bill Number/Name: | | | Senate Bill 935 |
| Effective Date: | | | January 1, 2008 |
Overview of Law
- Requires insurance coverage of amino acid-based formula for the diagnosis and treatment of eosinophilic disorders and short bowel syndrome.
- Covers formula administered orally or via a feeding tube.
Click here for the bill.
Maine
|
Bill Number/Name: | | | An Act to Protect the Health of Infants |
| Effective Date: | | | January 1, 2008 |
Overview of Law
- Requires insurance reimbursement of amino acid-based formula for children diagnosed by a physician with following conditions:
- Symptomatic allergic colitis or proctitis;
- Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis;
- A history of anaphylaxis;
- Gastroesophageal reflux disease that is nonresponsive to standard medical therapies;
- Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider;
- Cystic fibrosis; or
- Malabsorption of cow milk-based or soy milk-based infant formula.
- Applies to children age 2 and under.
- Covers formula administered orally or via a feeding tube.
Click here for the bill.
Maryland
|
Bill Number/Name: | | | House Bill 578 |
| Effective Date: | | | October 1, 2008 |
Overview of Law
- Requires reimbursement of amino acid-based formula for the diagnosis and management of certain allergies, syndromes and conditions.
- Covers formula administered orally or via a feeding tube.
Click here for the bill.
Massachusetts
|
Bill Number/Name: | | | Coverage for nonprescription enteral formulas for home use. |
| Effective Date: | | | January 1, 1994 |
Overview of Law
- Requires reimbursement of enteral amino acid-based formula for the treatment of Crohn’s Disease, ulcerative colitis, gastroesophageal reflux, gastrointestinal motility, chronic intestinal pseudo-obstruction, and inherited diseases of amino acids and organic acids.
Click here for the bill.
Minnesota
|
Bill Number/Name: | | | No Law – Insurers Agreement |
| Effective Date: | | | May 2007 |
Overview of Law
- The insurers’ agreement to reimburse families for amino acid-based formula includes the state’s six largest insurance plans:
- BlueCross BlueShield of Minnesota/Blue Plus
- HealthPartners
- Medica
- PreferredOne
- Sanford Health Plan
- UCare Minnesota
- Metropolitan Health Plan
- Co-pays and other terms vary by the plan.
Click here for the agreement letter.
New Hampshire
|
Bill Number/Name: | | | House Bill 1431 |
| Effective Date: | | | 1996 |
Overview of Law
- Requires coverage for all non-prescription enteral formulas
Click here for the bill.
New Jersey
|
Bill Number/Name: | | | Chapter 361 |
| Effective Date: | | | March 2002 |
Overview of Law
- Requires reimbursement for amino acid based formula for children with multiple food protein intolerance.
- Covers formulaadministered orally or via a feeding tube.
Click here for the bill.
New York
|
Bill Number/Name: | | | Article 32 – Insurance Law |
| Effective Date: | | | 1994 |
Overview of Law
- Requires reimbursement for amino acid-based formula for the treatment of condition that include, but are not limited to, inherited diseases of amino-acid or organic acid metabolism, Crohn's Disease, gastroesophageal reflux with failure to thrive, disorders of gastrointestinal motility such as chronic intestinal pseudo-obstruction, and multiple severe food allergies.
Click here for the bill.
Rhode Island
|
Bill Number/Name: | | | An Act Relating to Insurance – Enteral Nutrition Products |
| Effective Date: | | | January 1, 2009 |
Click here for the bill.