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H.470
Introduced by Representatives Holmes of Bethel and Mazur of South
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Burlington
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Referred to Committee on
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Date:
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Subject: Insurance; health insurance; mandated health insurance benefits
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Statement of purpose: This bill proposes to require the commissioner of
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banking, insurance, securities, and health care administration to conduct
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evaluations of mandated health insurance benefits.
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AN ACT RELATING TO EVALUATIONS OF MANDATED HEALTH
INSURANCE BENEFITS
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It is hereby enacted by the General Assembly of the State of Vermont:
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Sec. 1. 8 V.S.A. § 4088b is added to read:
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§ 4088b. MANDATED HEALTH INSURANCE BENEFITS
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(a) The commissioner of banking, insurance, securities, and health care
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administration shall evaluate the medical efficacy and financial impact of any
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legislative bill or amendment to a bill proposing a new mandated health
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insurance benefit. The commissioner shall report to the committee with
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jurisdiction of the bill on the results of his or her evaluation on or before 30
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days following introduction of the bill, or following public release or other
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disclosure of the amendment.
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(b) The commissioner’s evaluation required by subsection (a) of this
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section shall be an independent, actuarially-based review. In conducting the
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evaluation, the commissioner shall:
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(1) review and summarize the relevant medical, actuarial and economic
research;
(2) if the coverage required by the mandate is not generally included in
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individual and group policies and contracts, determine to what extent lack of
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coverage of the proposed benefit results in financial hardship;
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(3) determine the demand for the proposed health care coverage from
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the public at large and in collective bargaining negotiations, and to what extent
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voluntary coverage of the proposed benefit is available;
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(4) evaluate the medical efficacy of the health care proposed to be
included as a mandated health insurance benefit, including:
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(A) in the case of a legislative proposal to mandate coverage of a
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particular therapy, the results of at least one clinical trial demonstrating the
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medical consequences of that therapy compared to no therapy and to
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alternative therapies, and the results of any other relevant clinical research;
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(B) in the case of a legislative proposal to mandate coverage of
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specific class of practitioner or medical specialty, the results of at least one
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professionally acceptable, controlled trial demonstrating the medical results
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achieved by the specific class of practitioners or medical specialty relative to
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those already covered, and the results of any other relevant clinical research;
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and
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(5) evaluate the financial impact of the proposed mandated health
insurance benefit, including an evaluation of:
(A) the extent to which coverage will increase or decrease the cost of
treatment or service;
(B) the extent to which the same or similar mandates have affected
charges, costs, utilization and payments in other states;
(C) the extent to which the coverage will increase the appropriate use
of the treatment or service;
(D) the extent to which the mandated treatment or service will be a
substitute for more expensive or less expensive treatments or services;
(E) the extent to which the coverage will increase or decrease the
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administrative expenses of third party payers and the premium and
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administrative expenses of policyholders;
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(F) the financial impact of the mandated coverage on small
employers, medium-sized employers and large employers; and
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(G) the impact of the mandated coverage on the total cost of health
care.
(c) The commissioner shall report to the general assembly on or before
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January 1 of the first year of each session of the general assembly with an
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evaluation, pursuant to the provisions of this section, of ten or more mandated
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health insurance benefits provided for under the law until all mandated health
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insurance benefits have been evaluated.
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(d) As used in this section:
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“Mandated health insurance benefit” means a law applicable to any
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health insurer including any mandated coverage for specific medical or health-
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related services, treatments, medications, or practices; any mandated coverage
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of services specific to health care practitioners; any mandate requiring an
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offering of specific services, treatments, practices, or an expansion of existing
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coverage; and any mandated reimbursement amount to specific health care
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practitioners.