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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