AB 1926 requires healthcare service plans to provide coverage for the testing and treatment of digestive and inherited metabolic disorders
SACRAMENTO, CA – Today, Assemblymember Damon Connolly (D-San Rafael) introduced Assembly Bill (AB) 1926, which expands healthcare coverage for metabolic disorders to include enteral nutrition treatment options for patients with digestive and inherited metabolic disorders.
“Providing coverage for the testing and treatment of digestive and inherited metabolic disorders is a common sense measure to ensure that Californians are getting the best care possible, and simultaneously saving money statewide,” said Assemblymember Damon Connolly (D-San Rafael). “Including an effective and cost-saving treatment option for metabolic disorders serves to benefit patients, insurance companies, and residents across the state.”
Inflammatory Bowel Disease (IBD), which includes Crohn’s Disease and Ulcerative Colitis, affects an estimated 3 million Americans. IBD causes chronic inflammation in the gastrointestinal (GI) tract, the area of the body where digestion and absorption of nutrients take place. Enteral nutrition (EN) is a liquid dietary treatment for IBD, typically administered in conjunction with biological therapies or corticosteroids. EN can be administered as the primary treatment of IBD, called exclusive enteral nutrition (EEN). Exclusive Enteral Nutrition can provide the full amount of necessary calories without solid food. EEN can be the main therapy for mild to moderate cases of Crohn’s Disease in children and adolescents, serving as an alternative to the use of corticosteroids for treatment, which mitigates the risk of tolerance and growth impairment associated with steroid use. Further, EEN is a cheaper alternative to steroids, and would save money for insurance companies, patients, and all of California. Despite studies showing the benefits of medical enteral nutrition for IBD patients, particularly pediatric patients, health plans are not required to cover their enteral nutrition, including over the counter.
AB 1926 would require healthcare service plan contracts and disability insurance policies that provide coverage for hospital, medical, or surgical expenses to also provide coverage for the enteral nutrition products, such as nutrition drinks, used for the treatment of chronic digestive diseases including Crohn’s disease and inherited metabolic disorders. Coverage for these enteral nutrition products must include the formulas that are part of a diet prescribed by a licensed physician and managed by a healthcare professional.
AB 1926 is currently waiting to be assigned to a policy committee.
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Assembymember Connolly represents the entirety of Marin County and Southern Sonoma County