STATE OF NEW YORK ________________________________________________________________________ 3207 2025-2026 Regular Sessions IN ASSEMBLY January 23, 2025 ___________ 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 such health care professional's lawful scope 10 of practice pursuant to title eight of the education law, for the 11 purpose of treating one or more chronic conditions that an individual is 12 diagnosed with. 13 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 14 and other dementias. 15 (iii) "Managed care product" means a policy which requires that 16 medical or other health care services covered under the policy, other 17 than emergency care services, be provided by, or pursuant to a referral 18 from, a primary care provider, and that services provided pursuant to 19 such a referral be rendered by a health care provider participating in 20 the insurer's managed care provider network. In addition, a managed care 21 product shall also mean the in-network portion of a contract which 22 requires that medical or other health care services covered under the 23 contract, other than emergency care services, be provided by, or pursu- 24 ant to a referral from, a primary care provider, and that services EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD04408-01-5
A. 3207 2 1 provided pursuant to such a referral be rendered by a health care 2 provider participating in the insurer's managed care provider network, 3 in order for the insured to be entitled to the maximum reimbursement 4 under the contract. 5 (iv) "Medically tailored meal vendor" is a vendor that provides 6 medically tailored meals according to the specifications in a 7 prescription from a certified dietician, certified nutritionist, or a 8 medical doctor. 9 (B) Every policy which is a managed care product as defined in clause 10 (iii) of subparagraph (A) of this paragraph that provides coverage for 11 physician services in a physician's office, and every policy which is a 12 managed care product that provides major medical or similar comprehen- 13 sive-type coverage, shall include coverage for medically tailored meals 14 and medical nutrition therapy as defined in clause (i) of subparagraph 15 (A) of this paragraph, provided by a certified dietician or certified 16 nutritionist licensed pursuant to section eight thousand four of the 17 education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a medical 18 doctor, in connection with the management or treatment of one or more 19 chronic conditions. 20 (C) Individual coverage is limited per medical diagnosis of one chron- 21 ic condition. Covered individuals may receive coverage of a maximum of 22 ten meals per week for a maximum duration of three months from the date 23 the individual receives its first meal prescription per a diagnosis of a 24 chronic condition. An individual may renew medically tailored meal 25 coverage with an assessment and renewed prescription from a certified 26 dietician, certified nutritionist or medical doctor. The managed care 27 product shall provide coverage for meals that comply with the medically 28 tailored meal prescription from a pre-approved medically tailored meal 29 vendor. The medically tailored meal vendor shall have a certified dieti- 30 cian, certified nutritionist or medical doctor review and approve the 31 menus provided in response to a prescription for medically tailored 32 meals. All medically tailored meal vendors shall be pre-approved by the 33 managed care plan. 34 (D) Medically tailored meals and medical nutrition therapy services 35 may be subject to reasonable deductible, co-payment and co-insurance 36 amounts, reasonable fee or benefit limits, and reasonable utilization 37 review, provided that any such amounts, limits and review: (i) shall not 38 function to direct treatment in a manner discriminative against 39 medically tailored meals and medical nutritional therapy care, and (ii) 40 individually and collectively shall be no more restrictive than those 41 applicable under the same policy to care or services provided by other 42 health professionals in the diagnosis, treatment and management of 43 chronic diseases. Nothing herein contained shall be construed as imped- 44 ing or preventing either the provision or coverage of medically tailored 45 meals and medical nutritional therapy care and services by a duly certi- 46 fied dietician, certified nutritionist or medical doctor, within the 47 lawful scope of their practice, in hospital facilities on a staff or 48 employee basis. 49 (E) The coverage required by this paragraph shall not be abridged by 50 any regulation promulgated by the superintendent. 51 § 2. Subsection (k) of section 3221 of the insurance law is amended by 52 adding a new paragraph 11-a to read as follows: 53 (11-a) (A) For purposes of this paragraph: 54 (i) "Medically tailored meals" and "medical nutrition therapy" means a 55 nutritional assessment, nutritional therapy, and nutritional counseling 56 provided by a certified dietician, certified nutritionist, or a medical
A. 3207 3 1 doctor, including the provision of any food indicated by a nutritional 2 assessment and the delivery of such food, ordered by a health care 3 professional acting within such health care professional's lawful scope 4 of practice pursuant to title eight of the education law, for the 5 purpose of treating one or more chronic conditions that an individual is 6 diagnosed with. 7 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 8 and other dementias. 9 (iii) "Managed care product" means a policy which requires that 10 medical or other health care services covered under the policy, other 11 than emergency care services, be provided by, or pursuant to a referral 12 from, a primary care provider, and that services provided pursuant to 13 such a referral be rendered by a health care provider participating in 14 the insurer's managed care provider network. In addition, a managed care 15 product shall also mean the in-network portion of a contract which 16 requires that medical or other health care services covered under the 17 contract, other than emergency care services, be provided by, or pursu- 18 ant to a referral from, a primary care provider, and that services 19 provided pursuant to such a referral be rendered by a health care 20 provider participating in the insurer's managed care provider network, 21 in order for the insured to be entitled to the maximum reimbursement 22 under the contract. 23 (iv) "Medically tailored meal vendor" is a vendor that provides 24 medically tailored meals according to the specifications in a 25 prescription from a certified dietician, certified nutritionist, or a 26 medical doctor. 27 (B) Every policy which is a managed care product as defined in clause 28 (iii) of subparagraph (A) of this paragraph that provides coverage for 29 physician services in a physician's office, and every policy which is a 30 managed care product that provides major medical or similar comprehen- 31 sive-type coverage, shall include coverage for medically tailored meals 32 and medical nutrition therapy as defined in clause (i) of subparagraph 33 (A) of this paragraph, provided by a certified dietician or certified 34 nutritionist licensed pursuant to section eight thousand four of the 35 education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a medical 36 doctor, in connection with the management or treatment of one or more 37 chronic conditions. 38 (C) Individual coverage is limited per medical diagnosis of one chron- 39 ic condition. Covered individuals may receive coverage of a maximum of 40 ten meals per week for a maximum duration of three months from the date 41 the individual receives its first meal prescription per a diagnosis of a 42 chronic condition. An individual may renew medically tailored meal 43 coverage with an assessment and renewed prescription from a certified 44 dietician, certified nutritionist or medical doctor. The managed care 45 product shall provide coverage for meals that comply with the medically 46 tailored meal prescription from a pre-approved medically tailored meal 47 vendor. The medically tailored meal vendor shall have a certified dieti- 48 cian, certified nutritionist or medical doctor review and approve the 49 menus provided in response to a prescription for medically tailored 50 meals. All medically tailored meal vendors shall be pre-approved by the 51 managed care plan. 52 (D) Medically tailored meals and medical nutrition therapy services 53 may be subject to reasonable deductible, co-payment and co-insurance 54 amounts, reasonable fee or benefit limits, and reasonable utilization 55 review, provided that any such amounts, limits and review: (i) shall not 56 function to direct treatment in a manner discriminative against
A. 3207 4 1 medically tailored meals and medical nutritional therapy care, and (ii) 2 individually and collectively shall be no more restrictive than those 3 applicable under the same policy to care or services provided by other 4 health professionals in the diagnosis, treatment and management of 5 chronic diseases. Nothing herein contained shall be construed as imped- 6 ing or preventing either the provision or coverage of medically tailored 7 meals and medical nutritional therapy care and services by a duly certi- 8 fied dietician, certified nutritionist or medical doctor, within the 9 lawful scope of their practice, in hospital facilities on a staff or 10 employee basis. 11 (E) The coverage required by this paragraph shall not be abridged by 12 any regulation promulgated by the superintendent. 13 § 3. Section 4303 of the insurance law is amended by adding a new 14 subsection (y-1) to read as follows: 15 (y-1) (A) For purposes of this subsection: 16 (i) "Medically tailored meals" and "medical nutrition therapy" means a 17 nutritional assessment, nutritional therapy, and nutritional counseling 18 provided by a certified dietician, certified nutritionist, or a medical 19 doctor, including the provision of any food indicated by a nutritional 20 assessment and the delivery of such food, ordered by a health care 21 professional acting within such health care professional's lawful scope 22 of practice pursuant to title eight of the education law, for the 23 purpose of treating one or more chronic conditions that an individual is 24 diagnosed with. 25 (ii) "Chronic condition" means cancer, diabetes, Alzheimer's disease 26 and other dementias. 27 (iii) "Managed care product" means a contract which requires that 28 medical or other health care services covered under the contract, other 29 than emergency care services, be provided by, or pursuant to a referral 30 from, a primary care provider, and that services provided pursuant to 31 such a referral be rendered by a health care provider participating in 32 the insurer's managed care provider network. In addition, a managed care 33 product shall also mean the in-network portion of a contract which 34 requires that medical or other health care services covered under the 35 contract, other than emergency care services, be provided by, or pursu- 36 ant to a referral from, a primary care provider, and that services 37 provided pursuant to such a referral be rendered by a health care 38 provider participating in the insurer's managed care provider network, 39 in order for the insured to be entitled to the maximum reimbursement 40 under the contract. 41 (iv) "Medically tailored meal vendor" is a vendor that provides 42 medically tailored meals according to the specifications in a 43 prescription from a certified dietician, certified nutritionist, or a 44 medical doctor. 45 (B) Every contract issued by a health service corporation or a medical 46 expense indemnity corporation which is a managed care product as defined 47 in subparagraph (iii) of paragraph (A) of this subsection that provides 48 coverage for physician services in a physician's office, and every 49 managed care product that provides major medical or similar comprehen- 50 sive-type coverage, shall include coverage for medically tailored meals 51 and medical nutrition therapy as defined in subparagraph (i) of para- 52 graph (A) of this subsection, provided by a certified dietician or 53 certified nutritionist licensed pursuant to section eight thousand four 54 of the education law and pursuant to 8 NYCCR 52.5 and 8 NYCRR 79-6 or a 55 medical doctor, in connection with the management or treatment of one or 56 more chronic conditions.
A. 3207 5 1 (C) Individual coverage is limited per medical diagnosis of one chron- 2 ic condition. Covered individuals may receive coverage of a maximum of 3 ten meals per week for a maximum duration of three months from the date 4 the individual receives its first meal prescription per a diagnosis of a 5 chronic condition. An individual may renew medically tailored meal 6 coverage with an assessment and renewed prescription from a certified 7 dietician, certified nutritionist or medical doctor. The managed care 8 product shall provide coverage for meals that comply with the medically 9 tailored meal prescription from a pre-approved medically tailored meal 10 vendor. The medically tailored meal vendor shall have a certified dieti- 11 cian, certified nutritionist or medical doctor review and approve the 12 menus provided in response to a prescription for medically tailored 13 meals. All medically tailored meal vendors shall be pre-approved by the 14 managed care plan. 15 (D) Medically tailored meals and medical nutrition therapy services 16 may be subject to reasonable deductible, co-payment and co-insurance 17 amounts, reasonable fee or benefit limits, and reasonable utilization 18 review, provided that any such amounts, limits and review: (i) shall not 19 function to direct treatment in a manner discriminative against 20 medically tailored meals and medical nutritional therapy care, and (ii) 21 individually and collectively shall be no more restrictive than those 22 applicable under the same contract to care or services provided by other 23 health professionals in the diagnosis, treatment and management of 24 chronic diseases. Nothing herein contained shall be construed as imped- 25 ing or preventing either the provision or coverage of medically tailored 26 meals and medical nutritional therapy care and services by a duly certi- 27 fied dietician, certified nutritionist or medical doctor, within the 28 lawful scope of their practice, in hospital facilities on a staff or 29 employee basis. 30 (E) The coverage required by this subsection shall not be abridged by 31 any regulation promulgated by the superintendent. 32 § 4. This act shall take effect on the one hundred eightieth day after 33 it shall have become a law. Effective immediately, the addition, amend- 34 ment and/or repeal of any rule or regulation necessary for the implemen- 35 tation of this act on its effective date are authorized to be made and 36 completed on or before such effective date.