STATE OF NEW YORK ________________________________________________________________________ 8584 IN ASSEMBLY January 12, 2024 ___________ Introduced by M. of A. LUNSFORD -- read once and referred to the Commit- tee on Insurance AN ACT to amend the insurance law, in relation to medical assistance coverage for medically tailored meals and medical nutrition therapy for the purpose of disease management The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subsection (i) of section 3216 of the insurance law is 2 amended by adding a new paragraph 21-a to read as follows: 3 (21-a) (A) For purposes of this paragraph: 4 (i) "Medically tailored meals" and "medical nutrition therapy" means a 5 nutritional assessment, nutritional therapy, and nutritional counseling 6 provided by a certified dietician, certified nutritionist, or a medical 7 doctor, including the provision of any food indicated by a nutritional 8 assessment and the delivery of such food, ordered by a health care 9 professional acting within his or her lawful scope of practice pursuant 10 to title eight of the education law, for the purpose of treating one or 11 more chronic conditions that an individual is diagnosed with. 12 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 13 and other dementias. 14 (iii) "Managed care product" means a policy which requires that 15 medical or other health care services covered under the policy, other 16 than emergency care services, be provided by, or pursuant to a referral 17 from, a primary care provider, and that services provided pursuant to 18 such a referral be rendered by a health care provider participating in 19 the insurer's managed care provider network. In addition, a managed care 20 product shall also mean the in-network portion of a contract which 21 requires that medical or other health care services covered under the 22 contract, other than emergency care services, be provided by, or pursu- 23 ant to a referral from, a primary care provider, and that services 24 provided pursuant to such a referral be rendered by a health care 25 provider participating in the insurer's managed care provider network, 26 in order for the insured to be entitled to the maximum reimbursement 27 under the contract. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03736-02-3
A. 8584 2 1 (iv) "Medically tailored meal vendor" is a vendor that provides 2 medically tailored meals according to the specifications in a 3 prescription from a certified dietician, certified nutritionist, or a 4 medical doctor. 5 (B) Every policy which is a managed care product as defined in clause 6 (iii) of subparagraph (A) of this paragraph that provides coverage for 7 physician services in a physician's office, and every policy which is a 8 managed care product that provides major medical or similar comprehen- 9 sive-type coverage, shall include coverage for medically tailored meals 10 and medical nutrition therapy as defined in clause (i) of subparagraph 11 (A) of this paragraph, provided by a certified dietician or certified 12 nutritionist licensed pursuant to section eight thousand four of the 13 education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a medical 14 doctor, in connection with the management or treatment of one or more 15 chronic conditions. 16 (C) Individual coverage is limited per medical diagnosis of one chron- 17 ic condition. Covered individuals may receive coverage of a maximum of 18 ten meals per week for a maximum duration of three months from the date 19 the individual receives its first meal prescription per a diagnosis of a 20 chronic condition. An individual may renew medically tailored meal 21 coverage with an assessment and renewed prescription from a certified 22 dietician, certified nutritionist or medical doctor. The managed care 23 product shall provide coverage for meals that comply with the medically 24 tailored meal prescription from a pre-approved medically tailored meal 25 vendor. The medically tailored meal vendor shall have a certified dieti- 26 cian, certified nutritionist or medical doctor review and approve the 27 menus provided in response to a prescription for medically tailored 28 meals. All medically tailored meal vendors shall be pre-approved by the 29 managed care plan. 30 (D) Medically tailored meals and medical nutrition therapy services 31 may be subject to reasonable deductible, co-payment and co-insurance 32 amounts, reasonable fee or benefit limits, and reasonable utilization 33 review, provided that any such amounts, limits and review: (i) shall not 34 function to direct treatment in a manner discriminative against 35 medically tailored meals and medical nutritional therapy care, and (ii) 36 individually and collectively shall be no more restrictive than those 37 applicable under the same policy to care or services provided by other 38 health professionals in the diagnosis, treatment and management of 39 chronic diseases. Nothing herein contained shall be construed as imped- 40 ing or preventing either the provision or coverage of medically tailored 41 meals and medical nutritional therapy care and services by a duly certi- 42 fied dietician, certified nutritionist or medical doctor, within the 43 lawful scope of their practice, in hospital facilities on a staff or 44 employee basis. 45 (E) The coverage required by this paragraph shall not be abridged by 46 any regulation promulgated by the superintendent. 47 § 2. Subsection (k) of section 3221 of the insurance law is amended by 48 adding a new paragraph 11-a to read as follows: 49 (11-a) (A) For purposes of this paragraph: 50 (i) "Medically tailored meals" and "medical nutrition therapy" means a 51 nutritional assessment, nutritional therapy, and nutritional counseling 52 provided by a certified dietician, certified nutritionist, or a medical 53 doctor, including the provision of any food indicated by a nutritional 54 assessment and the delivery of such food, ordered by a health care 55 professional acting within his or her lawful scope of practice pursuant
A. 8584 3 1 to title eight of the education law, for the purpose of treating one or 2 more chronic conditions that an individual is diagnosed with. 3 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 4 and other dementias. 5 (iii) "Managed care product" means a policy which requires that 6 medical or other health care services covered under the policy, other 7 than emergency care services, be provided by, or pursuant to a referral 8 from, a primary care provider, and that services provided pursuant to 9 such a referral be rendered by a health care provider participating in 10 the insurer's managed care provider network. In addition, a managed care 11 product shall also mean the in-network portion of a contract which 12 requires that medical or other health care services covered under the 13 contract, other than emergency care services, be provided by, or pursu- 14 ant to a referral from, a primary care provider, and that services 15 provided pursuant to such a referral be rendered by a health care 16 provider participating in the insurer's managed care provider network, 17 in order for the insured to be entitled to the maximum reimbursement 18 under the contract. 19 (iv) "Medically tailored meal vendor" is a vendor that provides 20 medically tailored meals according to the specifications in a 21 prescription from a certified dietician, certified nutritionist, or a 22 medical doctor. 23 (B) Every policy which is a managed care product as defined in clause 24 (iii) of subparagraph (A) of this paragraph that provides coverage for 25 physician services in a physician's office, and every policy which is a 26 managed care product that provides major medical or similar comprehen- 27 sive-type coverage, shall include coverage for medically tailored meals 28 and medical nutrition therapy as defined in clause (i) of subparagraph 29 (A) of this paragraph, provided by a certified dietician or certified 30 nutritionist licensed pursuant to section eight thousand four of the 31 education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a medical 32 doctor, in connection with the management or treatment of one or more 33 chronic conditions. 34 (C) Individual coverage is limited per medical diagnosis of one chron- 35 ic condition. Covered individuals may receive coverage of a maximum of 36 ten meals per week for a maximum duration of three months from the date 37 the individual receives its first meal prescription per a diagnosis of a 38 chronic condition. An individual may renew medically tailored meal 39 coverage with an assessment and renewed prescription from a certified 40 dietician, certified nutritionist or medical doctor. The managed care 41 product shall provide coverage for meals that comply with the medically 42 tailored meal prescription from a pre-approved medically tailored meal 43 vendor. The medically tailored meal vendor shall have a certified dieti- 44 cian, certified nutritionist or medical doctor review and approve the 45 menus provided in response to a prescription for medically tailored 46 meals. All medically tailored meal vendors shall be pre-approved by the 47 managed care plan. 48 (D) Medically tailored meals and medical nutrition therapy services 49 may be subject to reasonable deductible, co-payment and co-insurance 50 amounts, reasonable fee or benefit limits, and reasonable utilization 51 review, provided that any such amounts, limits and review: (i) shall not 52 function to direct treatment in a manner discriminative against 53 medically tailored meals and medical nutritional therapy care, and (ii) 54 individually and collectively shall be no more restrictive than those 55 applicable under the same policy to care or services provided by other 56 health professionals in the diagnosis, treatment and management of
A. 8584 4 1 chronic diseases. Nothing herein contained shall be construed as imped- 2 ing or preventing either the provision or coverage of medically tailored 3 meals and medical nutritional therapy care and services by a duly certi- 4 fied dietician, certified nutritionist or medical doctor, within the 5 lawful scope of their practice, in hospital facilities on a staff or 6 employee basis. 7 (E) The coverage required by this paragraph shall not be abridged by 8 any regulation promulgated by the superintendent. 9 § 3. Section 4303 of the insurance law is amended by adding a new 10 subsection (y-1) to read as follows: 11 (y-1) (A) For purposes of this subsection: 12 (i) "Medically tailored meals" and "medical nutrition therapy" means a 13 nutritional assessment, nutritional therapy, and nutritional counseling 14 provided by a certified dietician, certified nutritionist, or a medical 15 doctor, including the provision of any food indicated by a nutritional 16 assessment and the delivery of such food, ordered by a health care 17 professional acting within his or her lawful scope of practice pursuant 18 to title eight of the education law, for the purpose of treating one or 19 more chronic conditions that an individual is diagnosed with. 20 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 21 and other dementias. 22 (iii) "Managed care product" means a contract which requires that 23 medical or other health care services covered under the contract, other 24 than emergency care services, be provided by, or pursuant to a referral 25 from, a primary care provider, and that services provided pursuant to 26 such a referral be rendered by a health care provider participating in 27 the insurer's managed care provider network. In addition, a managed care 28 product shall also mean the in-network portion of a contract which 29 requires that medical or other health care services covered under the 30 contract, other than emergency care services, be provided by, or pursu- 31 ant to a referral from, a primary care provider, and that services 32 provided pursuant to such a referral be rendered by a health care 33 provider participating in the insurer's managed care provider network, 34 in order for the insured to be entitled to the maximum reimbursement 35 under the contract. 36 (iv) "Medically tailored meal vendor" is a vendor that provides 37 medically tailored meals according to the specifications in a 38 prescription from a certified dietician, certified nutritionist, or a 39 medical doctor. 40 (B) Every contract issued by a health service corporation or a medical 41 expense indemnity corporation which is a managed care product as defined 42 in subparagraph (iii) of paragraph (A) of this subsection that provides 43 coverage for physician services in a physician's office, and every 44 managed care product that provides major medical or similar comprehen- 45 sive-type coverage, shall include coverage for medically tailored meals 46 and medical nutrition therapy as defined in subparagraph (i) of para- 47 graph (A) of this subsection, provided by a certified dietician or 48 certified nutritionist licensed pursuant to section eight thousand four 49 of the education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a 50 medical doctor, in connection with the management or treatment of one or 51 more chronic conditions. 52 (C) Individual coverage is limited per medical diagnosis of one chron- 53 ic condition. Covered individuals may receive coverage of a maximum of 54 ten meals per week for a maximum duration of three months from the date 55 the individual receives its first meal prescription per a diagnosis of a 56 chronic condition. An individual may renew medically tailored meal
A. 8584 5 1 coverage with an assessment and renewed prescription from a certified 2 dietician, certified nutritionist or medical doctor. The managed care 3 product shall provide coverage for meals that comply with the medically 4 tailored meal prescription from a pre-approved medically tailored meal 5 vendor. The medically tailored meal vendor shall have a certified dieti- 6 cian, certified nutritionist or medical doctor review and approve the 7 menus provided in response to a prescription for medically tailored 8 meals. All medically tailored meal vendors shall be pre-approved by the 9 managed care plan. 10 (D) Medically tailored meals and medical nutrition therapy services 11 may be subject to reasonable deductible, co-payment and co-insurance 12 amounts, reasonable fee or benefit limits, and reasonable utilization 13 review, provided that any such amounts, limits and review: (i) shall not 14 function to direct treatment in a manner discriminative against 15 medically tailored meals and medical nutritional therapy care, and (ii) 16 individually and collectively shall be no more restrictive than those 17 applicable under the same contract to care or services provided by other 18 health professionals in the diagnosis, treatment and management of 19 chronic diseases. Nothing herein contained shall be construed as imped- 20 ing or preventing either the provision or coverage of medically tailored 21 meals and medical nutritional therapy care and services by a duly certi- 22 fied dietician, certified nutritionist or medical doctor, within the 23 lawful scope of their practice, in hospital facilities on a staff or 24 employee basis. 25 (E) The coverage required by this subsection shall not be abridged by 26 any regulation promulgated by the superintendent. 27 § 4. This act shall take effect on the one hundred eightieth day after 28 it shall have become a law. Effective immediately, the addition, amend- 29 ment and/or repeal of any rule or regulation necessary for the implemen- 30 tation of this act on its effective date are authorized to be made and 31 completed on or before such effective date.