PRINTER'S NO. 2836
No. 1980 Session of 2007
INTRODUCED BY BOYD, MENSCH, ARGALL, BENNINGHOFF, BUXTON, CUTLER, DALLY, FAIRCHILD, GINGRICH, HARPER, HICKERNELL, HORNAMAN, KAUFFMAN, MANN, McILHATTAN, MICOZZIE, MILNE, MOUL, MUNDY, MUSTIO, NAILOR, NICKOL, RAPP, REED, REICHLEY, ROAE, SCHRODER, SONNEY, STEIL, TRUE AND VULAKOVICH, NOVEMBER 14, 2007
REFERRED TO COMMITTEE ON INSURANCE, NOVEMBER 14, 2007
AN ACT 1 Amending the act of July 8, 1986 (P.L.408, No.89), entitled, as 2 reenacted, "An act providing for the creation of the Health 3 Care Cost Containment Council, for its powers and duties, for 4 health care cost containment through the collection and 5 dissemination of data, for public accountability of health 6 care costs and for health care for the indigent; and making 7 an appropriation," further providing for mandated health 8 benefits. 9 The General Assembly of the Commonwealth of Pennsylvania 10 hereby enacts as follows: 11 Section 1. Section 9 of the act of July 8, 1986 (P.L.408, 12 No.89), known as the Health Care Cost Containment Act, reenacted 13 and amended July 17, 2003 (P.L.31, No.14), is repealed: 14 [Section 9. Mandated health benefits. 15 In relation to current law or proposed legislation, the 16 council shall, upon the request of the appropriate committee 17 chairman in the Senate and in the House of Representatives or 18 upon the request of the Secretary of Health, provide information 19 on the proposed mandated health benefit pursuant to the
1 following: 2 (1) The General Assembly hereby declares that proposals 3 for mandated health benefits or mandated health insurance 4 coverage should be accompanied by adequate, independently 5 certified documentation defining the social and financial 6 impact and medical efficacy of the proposal. To that end the 7 council, upon receipt of such requests, is hereby authorized 8 to conduct a preliminary review of the material submitted by 9 both proponents and opponents concerning the proposed 10 mandated benefit. If, after this preliminary review, the 11 council is satisfied that both proponents and opponents have 12 submitted sufficient documentation necessary for a review 13 pursuant to paragraphs (3) and (4), the council is directed 14 to contract with individuals, pursuant to the selection 15 procedures for vendors set forth in section 16, who will 16 constitute a Mandated Benefits Review Panel to review 17 mandated benefits proposals and provide independently 18 certified documentation, as provided for in this section. 19 (2) The panel shall consist of senior researchers, each 20 of whom shall be a recognized expert: 21 (i) one in health research; 22 (ii) one in biostatistics; 23 (iii) one in economic research; 24 (iv) one, a physician, in the appropriate specialty 25 with current knowledge of the subject being proposed as a 26 mandated benefit; and 27 (v) one with experience in insurance or actuarial 28 research. 29 (3) The Mandated Benefits Review Panel shall have the 30 following duties and responsibilities: 20070H1980B2836 - 2 -
1 (i) To review documentation submitted by persons 2 proposing or opposing mandated benefits within 90 days of 3 submission of said documentation to the panel. 4 (ii) To report to the council, pursuant to its 5 review in subparagraph (i), the following: 6 (A) Whether or not the documentation is complete 7 as defined in paragraph (4). 8 (B) Whether or not the research cited in the 9 documentation meets professional standards. 10 (C) Whether or not all relevant research 11 respecting the proposed mandated benefit has been 12 cited in the documentation. 13 (D) Whether or not the conclusions and 14 interpretations in the documentation are consistent 15 with the data submitted. 16 (4) To provide the Mandated Benefits Review Panel with 17 sufficient information to carry out its duties and 18 responsibilities pursuant to paragraph (3), persons proposing 19 or opposing legislation mandating benefits coverage should 20 submit documentation to the council, pursuant to the 21 procedure established in paragraph (5), which demonstrates 22 the following: 23 (i) The extent to which the proposed benefit and the 24 services it would provide are needed by, available to and 25 utilized by the population of the Commonwealth. 26 (ii) The extent to which insurance coverage for the 27 proposed benefit already exists, or if no such coverage 28 exists, the extent to which this lack of coverage results 29 in inadequate health care or financial hardship for the 30 population of the Commonwealth. 20070H1980B2836 - 3 -
1 (iii) The demand for the proposed benefit from the 2 public and the source and extent of opposition to 3 mandating the benefit. 4 (iv) All relevant findings bearing on the social 5 impact of the lack of the proposed benefit. 6 (v) Where the proposed benefit would mandate 7 coverage of a particular therapy, the results of at least 8 one professionally accepted, controlled trial comparing 9 the medical consequences of the proposed therapy, 10 alternative therapies and no therapy. 11 (vi) Where the proposed benefit would mandate 12 coverage of an additional class of practitioners, the 13 results of at least one professionally accepted, 14 controlled trial comparing the medical results achieved 15 by the additional class of practitioners and those 16 practitioners already covered by benefits. 17 (vii) The results of any other relevant research. 18 (viii) Evidence of the financial impact of the 19 proposed legislation, including at least: 20 (A) The extent to which the proposed benefit 21 would increase or decrease cost for treatment or 22 service. 23 (B) The extent to which similar mandated 24 benefits in other states have affected charges, costs 25 and payments for services. 26 (C) The extent to which the proposed benefit 27 would increase the appropriate use of the treatment 28 or service. 29 (D) The impact of the proposed benefit on 30 administrative expenses of health care insurers. 20070H1980B2836 - 4 -
1 (E) The impact of the proposed benefits on 2 benefits costs of purchasers. 3 (F) The impact of the proposed benefits on the 4 total cost of health care within the Commonwealth. 5 (5) The procedure for review of documentation is as 6 follows: 7 (i) Any person wishing to submit information on 8 proposed legislation mandating insurance benefits for 9 review by the panel should submit the documentation 10 specified in paragraph (4) to the council. 11 (ii) The council shall, within 30 days of receipt of 12 the documentation: 13 (A) Publish in the Pennsylvania Bulletin notice 14 of receipt of the documentation, a description of the 15 proposed legislation, provision for a period of 60 16 days for public comment and the time and place at 17 which any person may examine the documentation. 18 (B) Submit copies of the documentation to the 19 Secretary of Health and the Insurance Commissioner, 20 who shall review and submit comments to the council 21 on the proposed legislation within 30 days. 22 (C) Submit copies of the documentation to the 23 panel, which shall review the documentation and issue 24 their findings, pursuant to paragraph (3), within 90 25 days. 26 (iii) Upon receipt of the comments of the Secretary 27 of Health and the Insurance Commissioner and of the 28 findings of the panel, pursuant to subparagraph (ii), but 29 no later than 120 days following the publication required 30 in subparagraph (ii), the council shall submit said 20070H1980B2836 - 5 -
1 comments and findings, together with its recommendations 2 respecting the proposed legislation, to the Governor, the 3 President pro tempore of the Senate, the Speaker of the 4 House of Representatives, the Secretary of Health, the 5 Insurance Commissioner and the person who submitted the 6 information pursuant to subparagraph (i).] 7 Section 2. The act is amended by adding a section to read: 8 Section 9.1. Mandated health benefits. 9 (a) Purpose.--The General Assembly hereby declares that 10 proposals for mandated health insurance benefits should be 11 accompanied by adequate, independently certified documentation 12 defining the social and financial impact and medical efficacy of 13 the proposal. 14 (b) Mandated benefit review report required.--A mandated 15 benefit review report is required as follows: 16 (1) No bill proposing a mandated health insurance 17 benefit shall be given second consideration in either the 18 Senate or the House of Representatives until the council has 19 submitted, pursuant to this section, a mandated benefits 20 review report. 21 (2) No amendment, which concerns a mandated health 22 insurance benefit, to a bill shall be considered by either 23 the Senate or the House of Representatives until the council 24 has submitted, pursuant to this section, a mandated benefits 25 review report. 26 (3) Requests for a mandated benefits review report for a 27 specific bill or amendment may be made by the President pro 28 tempore, the majority or minority leader, or a majority or 29 minority chairman of the Senate or the Speaker, the majority 30 or minority leader, or a majority or minority chairman of the 20070H1980B2836 - 6 -
1 House of Representatives. 2 (4) The council shall submit to the General Assembly a 3 mandated benefits review report within 120 days after a 4 request for a report has been made to the council. Extensions 5 may be granted, upon the request of the council, by the 6 President pro tempore of the Senate or the Speaker of the 7 House of Representatives, as appropriate. 8 (c) Council duties.-- 9 (1) The council shall biannually contract with vendors 10 qualified to review mandated health insurance benefit 11 proposals pursuant to the selection procedures for vendors 12 set forth in section 16. Contracted vendors shall be 13 available for mandated benefit review requests for the 14 duration of their contract and shall be paid on a per report 15 basis. 16 (i) Qualified vendors shall demonstrate a capacity 17 for health research, biostatistics, economic research and 18 experience in insurance or actuarial research. 19 Additionally, a qualified vendor shall have access to 20 physicians or other experts with current medical 21 knowledge of the subject being proposed as a mandated 22 health insurance benefit. 23 (ii) Selected venders shall, when called upon by the 24 council, research and analyze the impact of a proposed 25 mandated health insurance benefit. The vendor's analysis 26 shall be factual, and shall, if possible, provide a 27 reliable estimate of both the short-range and long-range 28 costs and/or savings and effects of the proposed mandated 29 health insurance benefit on the individual and group 30 insurance markets in this Commonwealth. Additionally, 20070H1980B2836 - 7 -
1 vendors shall analyze the proposed mandated health 2 insurance benefit in terms of its impact on short-range 3 and long-term quality of life indicators, such as 4 predicted health outcomes, sustainable independent living 5 and ability to enter or remain in the work force. 6 (2) The council shall receive mandated benefits review 7 report requests from the Senate and the House of 8 Representatives. 9 (i) Except as otherwise provided in subsection (b), 10 upon receipt of such a request, the council shall contact 11 a selected vendor to review the proposed mandated health 12 insurance benefit. 13 (ii) If the proposed mandated health insurance 14 benefit is substantially similar to a proposal for which 15 a mandated benefits review report request was previously 16 received by the council within the same legislative 17 session, a separate report may not be required and the 18 council may so inform the requester. 19 (3) The council shall, within 30 days of receipt of the 20 request for a mandated benefits review report, published in 21 the Pennsylvania Bulletin notice of receipt of a request for 22 a mandated benefits review report, a description of the 23 proposed legislation and a provision for a period of 60 days 24 for public comment. Upon closing of the public comment 25 period, the council shall: 26 (i) Submit copies of the documentation to the 27 Secretary of Health and the Insurance Commissioner, who 28 shall review and submit comments to the council on the 29 proposed legislation within 30 days. 30 (ii) Submit copies of the documentation to the 20070H1980B2836 - 8 -
1 selected vendor for their use in reviewing the proposed 2 mandated health insurance benefit. 3 (4) Upon completion of the review by the selected vendor 4 and expiration of the public comment period, the council 5 shall formulate recommendations regarding the proposed 6 mandated health insurance benefit based on the selected 7 vendor's review and comments received from the Secretary of 8 Health, the Insurance Commissioner and the public. 9 (5) The council shall submit a report to the General 10 Assembly to contain their recommendations, the selected 11 vendor's review and comments received from the Secretary of 12 Health, the Insurance Commissioner and the public. 13 (d) Definitions.--As used in this section, the following 14 words and phrases shall have the meanings given to them in this 15 subsection: 16 "Mandated health insurance benefit." A statute that required 17 a health care insurer and/or a health maintenance organization 18 to provide health insurance coverage for any specified service 19 or procedure or any specified health care provider or that 20 requires a health care insurer or health maintenance 21 organization to provide health insurance coverage in a specified 22 manner or that prohibits a health insurer from providing health 23 insurance coverage in a specified manner. 24 "Mandated health insurance report." A report that is issued 25 by the council pursuant to subsection (c)(5). 26 Section 3. This act shall take effect January 1, 2009. I21L35JS/20070H1980B2836 - 9 -