1.Mandated health benefits proposals.
For purposes of this section, a mandated health benefit proposal is one that mandates health insurance coverage for specific
health services, specific diseases or certain providers of health care services as part of individual or group health insurance
policies. A mandated option is not a mandated benefit for purposes of this section.
1991, c. 701, §8 (NEW)
2.Procedures before legislative committees.
Whenever a legislative measure containing a mandated health benefit is proposed, the joint standing committee of the Legislature
having jurisdiction over the proposal shall hold a public hearing and determine the level of support for the proposal among
the members of the committee. If there is support for the proposed mandate among a majority of the members of the committee,
the committee may refer the proposal to the Bureau of Insurance for review and evaluation pursuant to subsection 3. Once
a review and evaluation has been completed, the committee shall review the findings of the bureau. A proposed mandate may
not be enacted into law unless review and evaluation pursuant to subsection 3 has been completed.
1997, c. 616, §4 (AMD)
3.Review and evaluation.
Upon referral of a mandated health benefit proposal from the joint standing committee of the Legislature having jurisdiction
over the proposal, the Bureau of Insurance shall conduct a review and evaluation of the mandated health benefit proposal and
shall report to the committee in a timely manner. The report must include, at the minimum and to the extent that information
is available, the following:
A. The social impact of mandating the benefit, including:
(1) The extent to which the treatment or service is utilized by a significant portion of the population;
(2) The extent to which the treatment or service is available to the population;
(3) The extent to which insurance coverage for this treatment or service is already available;
(4) If coverage is not generally available, the extent to which the lack of coverage results in persons being unable to obtain
necessary health care treatment;
(5) If the coverage is not generally available, the extent to which the lack of coverage results in unreasonable financial
hardship on those persons needing treatment;
(6) The level of public demand and the level of demand from providers for the treatment or service;
(7) The level of public demand and the level of demand from the providers for individual or group insurance coverage of the
treatment or service;
(8) The level of interest in and the extent to which collective bargaining organizations are negotiating privately for inclusion
of this coverage in group contracts;
(9) The likelihood of achieving the objectives of meeting a consumer need as evidenced by the experience of other states;
(10) The relevant findings of the appropriate health system agency relating to the social impact of the mandated benefit;
(11) The alternatives to meeting the identified need;
(12) Whether the benefit is a medical or a broader social need and whether it is consistent with the role of health insurance
and the concept of managed care;
(13) The impact of any social stigma attached to the benefit upon the market;
(14) The impact of this benefit on the availability of other benefits currently being offered;
(15) The impact of the benefit as it relates to employers shifting to self-insured plans and the extent to which the benefit
is currently being offered by employers with self-insured plans; and
(16) The impact of making the benefit applicable to the state employee health insurance program; [2011, c. 90, Pt. J, §21 (AMD).]
B. The financial impact of mandating the benefit, including:
(1) The extent to which the proposed insurance coverage would increase or decrease the cost of the treatment or service
over the next 5 years;
(2) The extent to which the proposed coverage might increase the appropriate or inappropriate use of the treatment or service
over the next 5 years;
(3) The extent to which the mandated treatment or service might serve as an alternative for more expensive or less expensive
treatment or service;
(4) The methods that will be instituted to manage the utilization and costs of the proposed mandate;
(5) The extent to which the insurance coverage may affect the number and types of providers of the mandated treatment or
service over the next 5 years;
(6) The extent to which insurance coverage of the health care service or provider may be reasonably expected to increase
or decrease the insurance premium and administrative expenses of policyholders;
(7) The impact of indirect costs, which are costs other than premiums and administrative costs, on the question of the costs
and benefits of coverage;
(8) The impact of this coverage on the total cost of health care, including potential benefits and savings to insurers and
employers because the proposed mandated treatment or service prevents disease or illness or leads to the early detection and
treatment of disease or illness that is less costly than treatment or service for later stages of a disease or illness;
(9) The effects of mandating the benefit on the cost of health care, particularly the premium and administrative expenses
and indirect costs, to employers and employees, including the financial impact on small employers, medium-sized employers
and large employers; and
(10) The effect of the proposed mandate on cost-shifting between private and public payors of health care coverage and on
the overall cost of the health care delivery system in this State.
In order to enable the committee to assess the financial impact of the benefit, the report must include a comparison of the
rate of increase in the Consumer Price Index for medical care services to the rate of increase in the Consumer Price Index
for the previous year and the current year as reported by the United States Department of Labor, Bureau of Labor Statistics; [2005, c. 125, §1 (AMD).]
C. The medical efficacy of mandating the benefit, including:
(1) The contribution of the benefit to the quality of patient care and the health status of the population, including the
results of any research demonstrating the medical efficacy of the treatment or service compared to alternatives or not providing
the treatment or service; and
(2) If the legislation seeks to mandate coverage of an additional class of practitioners:
(a) The results of any professionally acceptable research demonstrating the medical results achieved by the additional class
of practitioners relative to those already covered; and
(b) The methods of the appropriate professional organization that assure clinical proficiency; and [1991, c. 701, §8 (NEW).]
D. The effects of balancing the social, economic and medical efficacy considerations, including:
(1) The extent to which the need for coverage outweighs the costs of mandating the benefit for all policyholders;
(2) The extent to which the problem of coverage may be solved by mandating the availability of the coverage as an option
for policyholders; and
(3) The cumulative impact of mandating this benefit in combination with existing mandates on the costs and availability
of coverage. [1997, c. 616, §5 (AMD).]
2011, c. 90, Pt. J, §21 (AMD)
1991, c. 701, §8 (NEW).
1997, c. 616, §§4,5 (AMD).
2001, c. 258, §I1 (AMD).
2005, c. 125, §1 (AMD).
2011, c. 90, Pt. J, §21 (AMD).
Data for this page extracted on 10/16/2012 08:29:52.
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