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Introduced Version House Bill 2266 History

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Key: Green = existing Code. Red = new code to be enacted
H. B. 2266


(By Delegates Walters, Evans, Pulliam and Jenkins)
[Introduced January 14, 1998; referred to the
Committee on Banking and Insurance then Government Organization.]



A BILL to amend chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article fifteen-d, relating to requiring that all mandated health insurance benefits be reviewed; legislative findings; requirements for proposals or amendment of mandated health benefits proposals; and mandated health benefits renewal panel creation and duties.

Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article fifteen-d, to read as follows:
ARTICLE 15D. MANDATED HEALTH BENEFITS REVIEW ACT.
§33-15D-1. Legislative findings.
The Legislature finds that the need exists to provide for independent review of mandated health benefits, proposals or an amendment to a proposal for mandated health benefits, mandated health insurance coverage, and mandated offerings of health benefits with regard to social impact, financial impact and medical efficacy.
The Legislature finds that in order to further the goal of reviewing legislative proposals, a need exists for documentation of the social impact, financial impact and medical efficacy of health insurance benefits and coverage which are proposed to be changed by statute to be attached to all proposed legislation.
§33-15D-2. Certified documentation to accompany mandated health benefits proposals; definition of mandated benefits; report to legislative committee; referral to review panel.
Proposals or an amendment to a proposal for mandated health benefits or mandated health insurance coverage shall be accompanied by documentation defining the proposals' social impact, financial impact and medical efficacy.
Mandated health benefits include: Mandated coverage for specific services, treatments or practices; mandated direct reimbursement to specific health care practitioners; mandated offering for specific services, treatments or practices; and mandated reimbursement amounts to specific health care practitioners.
Every person or organization which promotes or seeks sponsorship of a legislative proposal or an amendment to a proposal which mandates a health coverage or offering of a health coverage by an insurance carrier, health care service contractor or health maintenance organization as a component of individual or group policies shall submit documentation in support of the proposal to the legislative committee which will consider the legislation. To facilitate its understanding of the proposal and the attached documentation, the legislative committee shall refer both for review to the mandated health benefits review panel.
§33-15D-3. Mandated health benefits review panel created.
There is created a mandated health benefits review panel. The panel shall consist of three senior researchers, two experts in health research or biostatistics chosen from universities within the state and the third a senior research associate. Panel members are appointed by the secretary of health and human resources. Terms of appointments are at the secretary's discretion.
The panel members may be reimbursed for all reasonable and necessary expenses actually incurred in the performance of their duties. In addition, the panel members shall be compensated a per diem amount commensurate with the per diem amount paid to legislative members in the performance of their interim duties. Funds for the expenses of the panel shall be appropriated by the Legislature from existing health insurance premium taxes and placed into a separate account set aside for that purpose.
§33-15D-4 Panel review of documentation; contents of panel report.
The panel will review the documentation submitted with the proposed legislation and will issue a written report to the requesting legislative committee within thirty days of the initial request. Each report will contain three main sections: social impact; financial impact; and medical efficacy. For each section, the panel will address the following general criteria: (1) Whether the information is complete;
(2) Whether the research cited meets professional standards;
(3) Whether all relevant research has been included;
(4) Whether the conclusions and interpretations drawn from the evidence are consistent with the data presented.
The panel shall address the following issues in determining the adequacy of each section of the documentation:
(a) Social impact.--
To what extent is the treatment or service:
(1) Needed by the citizens of the state;
(2) Available to the people of the state;
(3) Utilized by the population of this state; and
(4) If the insurance coverage is not generally in place, the extent to which the lack of this coverage results in inadequate health care and financial hardship.
(b) Financial impact.--
To what extent:
(1) Will the coverage increase or decrease the cost of treatment or service;
(2) Have similar mandates affected charges costs and payments in other states;
(3) Will the coverage increase the appropriate use of the treatment or service;
(4) Will the mandated treatment or service be a substitute for more expensive or less expensive treatments or services;
(5) Will the coverage increase or decrease the administrative expenses of insurance companies in the premium and administrative expenses of policyholders;
(6) Will the financial impact of this coverage affect small employers, medium-sized employers and large employers;
(7) Will this coverage affect the total cost of health care; and
(8) Do existing mandates meet the requirements of this article.
(c) Medical efficacy.--
(1) For proposed legislation which mandates coverage of a particular therapy:
(A) Comparison of the medical consequences of utilizing the therapy, not utilizing the therapy, and utilizing alternative therapy or therapies. This comparison shall be made using the results of at least one professionally acceptable, controlled trial; and
(B) Discussion and evaluation of any other relevant research.
(2) For proposed legislation which mandates coverage of an additional class of practitioners:
(A) Comparison of the medical results achieved by the additional class of practitioners with those practitioners already covered. This comparison shall be made using the results of at least one professionally acceptable, controlled trial; and
(B) Discussion and evaluation of any other relevant research.
33-15D-5. Review of existing mandated health benefits; report to the Legislature; expiration of existing health benefits unless reauthorized by the Legislature.
In addition to the duties set forth in section four of this article, the panel shall review all existing state mandated health benefits, mandated health insurance coverage, and mandated offerings of health benefits in the same manner as prescribed in section four of this article. The panel shall report its findings to the standing committees on banking and insurance of the West Virginia Senate and House of Delegates on or before the first day of January, one thousand nine hundred ninety-nine.



NOTE: The purpose of this bill is create a mandated health benefits review panel to review both proposed legislation and existing law with regard to mandated health benefits. The bill provides funding for the panel and requires that all mandated health insurance benefits and proposed benefits be reviewed with regard to social impact, financial impact and medical efficacy. The bill requires further that all proposed legislation which would affect mandated health benefits have documentation of the social impact, financial impact and medical efficacy of the proposed changes.
This article is new; therefore, strike-throughs and underscoring have been omitted.
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