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PA Bulletin, Doc. No. 07-1415



Mandated Benefits

[37 Pa.B. 4409]
[Saturday, August 4, 2007]

   Section 9 of the act 14 of July 17, 2003 (P. L. 31, No. 14) (Act 14) requires that the Health Care Cost Containment Council (Council) review proposed mandated health benefits on request of the executive and legislative branches of government. Senator Donald White, Chairperson of the Senate Banking and Insurance Committee, has requested that the Council review Senate Bill 146, Printer's Number 191 (Tomlinson). Senate Bill 146 would require health insurance policies to provide coverage for colorectal cancer screening for individuals in accordance with the most recently published American Cancer Society guidelines and approved medical standards and practices.

   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 October 4, 2007. 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 the following information categories described in section 9 of Act 14:

   (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. 07-1415. Filed for public inspection August 3, 2007, 9:00 a.m.]

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