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NO. 128. AN ACT RELATING TO HEALTH INSURANCE COVERAGE FOR NUTRITIONAL TREATMENT FOR INHERITED METABOLIC DISEASES.

(S.253)

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1. 8 V.S.A. § 4089d is added to read:

§ 4089d. TREATMENT OF INHERITED METABOLIC DISEASES

(a) For the purposes of this section,

(1) "Inherited metabolic disease" means a disease caused by an inherited abnormality of body chemistry for which the state screens newborn infants.

(2) "Insurer" means any health insurance company, nonprofit hospital and medical service corporation, managed care organization and health maintenance organization. The term does not apply to coverage for specified disease or other limited benefit coverage.

(3) "Low protein modified food product" means a food product that is specifically formulated to have less than one gram of protein per serving and is intended to be used under the direction of a physician for the dietary treatment of a metabolic disease.

(4) "Medical food" means an amino acid modified preparation that is intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.

(b) An insurer shall provide coverage for medical foods prescribed for medically necessary treatment for an inherited metabolic disease.

(c) Coverage for low protein modified food products prescribed for medically necessary treatment of an inherited metabolic disease shall be at least $2,500.00 during any continuous period of twelve months for any insured individual.

Sec. 2. MEDICAL FOOD; GOVERNMENTAL BULK PURCHASE: OUTREACH

The Health Department and the Department of Social Welfare in consultation with health insurance carriers shall create a system by which:

(1) Purchases of medical food are made at reduced prices and the medical food is provided to individuals and insureds at a price that reflects only the price paid for the formula and any related storage and handling costs incurred.

(2) Outreach and education is provided to the public.

Sec. 3. EFFECTIVE DATE

This act shall take effect on passage and shall apply to all health insurance policies issued or offered on and after October 1, 1998, and to other health insurance policies on their renewal date on or after October 1, 1998.

Approved: April 27, 1998