Substitute House Bill No. 7040
          Substitute House Bill No. 7040

              PUBLIC ACT NO. 97-167


AN ACT CONCERNING  HEALTH  INSURANCE  COVERAGE FOR
PRESCRIPTION FOODS.


    Be  it  enacted  by  the  Senate  and House of
Representatives in General Assembly convened:
    Section  1.  (NEW)  (a)  For  purposes of this
section:
    (1)  "Inherited  metabolic  disease"  means  a
disease for which  newborn  screening  is required
under section 19a-55 of the general statutes.
    (2)  "Low protein modified food product" means
a product formulated to have less than one gram of
protein  per  serving and intended for the dietary
treatment of an inherited metabolic disease  under
the  direction of a physician.
    (3) "Amino acid  modified preparation" means a
product intended for  the  dietary treatment of an
inherited metabolic disease under the direction of
a physician.
    (b) Each individual  health  insurance  policy
providing  coverage  of   the  type  specified  in
subdivisions (1), (2),  (4), (6), (11) and (12) of
section 38a-469 of the general statutes delivered,
issued for delivery or renewed in this state on or
after October 1,  1997, shall provide coverage for
amino acid modified  preparations  and low protein
modified  food  products   for  the  treatment  of
inherited metabolic diseases  if  the  amino  acid
modified preparations or low protein modified food
products  are  prescribed   for   the  therapeutic
treatment of inherited  metabolic diseases and are
administered under the direction of a physician.
    Sec.   2.  (NEW)  (a)  For  purposes  of  this
section:
    (1)  "Inherited  metabolic  disease"  means  a
disease for which  newborn  screening  is required
under section 19a-55 of the general statutes.
    (2) "Low protein  modified food product" means
a product formulated to have less than one gram of
protein per serving  and  intended for the dietary
treatment of an  inherited metabolic disease under
the direction of a physician.
    (3) "Amino acid  modified preparation" means a
product intended for  the  dietary treatment of an
inherited metabolic disease under the direction of
a physician.
    (b)  Each  group   health   insurance   policy
providing  coverage  of   the  type  specified  in
subdivisions (1), (2),  (4), (6), (11) and (12) of
section 38a-469 of the general statutes delivered,
issued for delivery or renewed in this state on or
after October 1,  1997, shall provide coverage for
amino acid modified  preparations  and low protein
modified  food  products   for  the  treatment  of
inherited metabolic diseases  if  the  amino  acid
modified preparations or low protein modified food
products  are  prescribed   for   the  therapeutic
treatment of inherited  metabolic diseases and are
administered under the direction of a physician.
    Sec.   3.   Section  19a-59a  of  the  general
statutes  is  repealed  and   the   following   is
substituted in lieu thereof:
    (a) FOR PURPOSES OF THIS SECTION:
    (1)  "INHERITED  METABOLIC  DISEASE"  MEANS  A
DISEASE FOR WHICH  NEWBORN  SCREENING  IS REQUIRED
UNDER SECTION 19a-55.
    (2)  "LOW PROTEIN MODIFIED FOOD PRODUCT" MEANS
A PRODUCT FORMULATED TO HAVE LESS THAN ONE GRAM OF
PROTEIN  PER  SERVING AND INTENDED FOR THE DIETARY
TREATMENT OF AN INHERITED METABOLIC DISEASE  UNDER
THE  DIRECTION OF A PHYSICIAN.
    (3) "AMINO ACID  MODIFIED PREPARATION" MEANS A
PRODUCT INTENDED FOR  THE  DIETARY TREATMENT OF AN
INHERITED METABOLIC DISEASE UNDER THE DIRECTION OF
A PHYSICIAN.
    [(a)] (b) Amino acid MODIFIED preparations and
[protein modified food]  LOW PROTEIN MODIFIED FOOD
PRODUCTS for the  treatment  of  [inborn errors of
metabolism,  for  use   by  infants,  children  or
pregnant women,] INHERITED METABOLIC DISEASE shall
be dispensed only  upon  the  prescription  of  an
individual authorized to  prescribe  drugs  within
this  state.  [For   purposes   of  this  section,
"protein  modified  food"   means  food  specially
formulated to reduce  the protein content to under
one gram of  protein  per  serving  and  does  not
include food naturally low in protein.]
    [(b)] (c) Notwithstanding  any other provision
of the general  statutes, the Department of Public
Health, in carrying  out  its  powers  and  duties
under   this  section,   may,   within   available
appropriations, purchase prescribed special infant
formula, [and medical  foods]  AMINO ACID MODIFIED
PREPARATIONS  AND  LOW   PROTEIN   MODIFIED   FOOD
PRODUCTS directly and  without  the  issuance of a
purchase order.

Approved June 24, 1997