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PA Bulletin, Doc. No. 01-1933



Mandated Benefits

[31 Pa.B. 6005]

   Section 9 of Act 34 of 1993 requires that the Health Care Cost Containment Council (Council) review proposed mandated health benefits on request of the executive and legislative branches of government. The Council has been requested by Senator Edwin G. Holl, Chairperson of the Senate Banking and Insurance Committee, to review Senate Bill 636, Printer's Number 674 (Schwartz), the Colorectal Cancer Early Detection Act. Senate Bill 636 would require health insurance policies to provide coverage for colorectal cancer screening examinations and laboratory tests for cancer for eligible nonsymptomatic individuals in accordance with the most recently published American Cancer Society guidelines for colorectal cancer screenings. Eligible individuals include: (1) individuals 50 years of age or older; and (2) individuals under 50 years of age who are at high risk for colorectal cancer according to the most recently published colorectal cancer screening guidelines of the American Cancer Society. Covered screenings include: 1) fecal-occult blood test; (2) flexible sigmoidoscopy; (3) colonoscopy; (4) barium enema; and (5) other procedures as the Department of Health deems appropriate.

   The Council is requesting that anyone supporting or opposing these mandated insurance benefits provide six copies of the documentation to the Council no later than 5 p.m. on December 27, 2001. The documentation should be mailed to Flossie Wolf, 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 this Commonwealth.

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

Executive Director

[Pa.B. Doc. No. 01-1933. Filed for public inspection October 26, 2001, 9:00 a.m.]

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