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PA Bulletin, Doc. No. 98-428

NOTICES

HEALTH CARE COST CONTAINMENT COUNCIL

Mandated Benefits

[28 Pa.B. 1360]

   Section 9 of Act 34 of 1993 requires that the Health Care Cost Containment Council (Council) review existing or proposed mandated health benefits on request of the executive and legislative branches of government. The Council has been requested by Senator F. Joseph Loeper, Chairperson of the Senate Rules Committee to review Senate Bill 39, the proposed Cancer Prevention and Early Detection Services Act which would require insurance coverage of certain cancer-related services, as well as a proposed amendment that would exclude the following from affected health insurance policies: ''accident only, fixed indemnity, limited benefit, credit, dental, vision, specified disease, Medicare supplement, Civilian Health and Medical Program of the Uniform Service (CHAMPUS) supplement, long-term care or disability income, workers' compensation or automobile medical payment insurance.'' The amendment would also add coverage of annual digital rectal exams and PSA tests for men 40-years old and older with certain prostate cancer risk factors and would specify that the benefits be subject to the same copayment and coinsurance provisions of an insurance policy as other medical services, but shall be exempt from any deductible or dollar limit provisions.

   The Council is requesting that anyone supporting or opposing these mandated insurance benefits provide six copies of documentation to the Council no later than May 29, 1998. The documentation should be mailed to Lynne A. Edris, PA Health Care Cost Containment Council, 225 Market Street, Suite 400, Harrisburg, PA 17101.

   Documentation submitted should be in accordance with any or all of the following information categories described in Section 9 of Act 34:

   (i)  The extent to which the proposed benefit and the services it would provide are needed by, available to and utilized by the population of the Commonwealth.

   (ii)  The extent to which insurance coverage for the proposed benefit already exists, or if no such coverage exists, the extent to which this lack of coverage results in inadequate health care or financial hardship for the population of the Commonwealth.

   (iii)  The demand for the proposed benefit from the public and the source and extent of opposition to mandating the benefit.

   (iv)  All relevant findings bearing on the social impact of the lack of the proposed benefit.

   (v)  Where the proposed benefit would mandate coverage of a particular therapy, the results of at least one professionally accepted, controlled trial comparing the medical consequences of the proposed therapy, alternative therapies and no therapy.

   (vi)  Where the proposed benefit would mandate coverage of an additional class of practitioners, the result of at least one professionally accepted, controlled trial comparing the medical results achieved by the additional class of practitioners and those practitioners already covered by benefits.

   (vii)  The results of any other relevant research.

   (viii)  Evidence of the financial impact of the proposed legislation, including at least:

   (A)  The extent to which the proposed benefit would increase or decrease cost for treatment or service.

   (B)  The extent to which similar mandated benefits in other states have affected charges, costs and payments for services.

   (C)  The extent to which the proposed benefit would increase the appropriate use of the treatment or service.

   (D)  The impact of the proposed benefit on administrative expenses of health care insurers.

   (E)  The impact of the proposed benefits on benefits costs of purchasers.

   (F)  The impact of the proposed benefits on the total cost of health care within this Commonwealth.

CLIFFORD L. JONES,   
Executive Director

[Pa.B. Doc. No. 98-428. Filed for public inspection March 13, 1998, 9:00 a.m.]


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