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State Legislative Update

March 20- March 24, 2000

		Government Affairs Newsletters Washington Updates Hey, Wait A Minute State Legislative Updates Through the Grapevine

Antitrust

Action was taken on antitrust legislation in California, New Hampshire, New Jersey and Tennessee.

Senator Jackie Spier of California introduced S.B. 2007 on February 25, 2000. This measure presumes that all third-party payers in the state have significant market power, and would allow physician coalitions to collectively bargain all patient care, clinical and reimbursement issues. Furthermore, California S.B. 2007 would require carriers to finance any costs the state incurs due to the institution of physician collective bargaining through an assessment mechanism. This legislation was assigned to the Senate Judiciary Committee on March 16, 2000.

In New Hampshire, H.B 1135, sponsored by Representative Quandt, would establish a committee to determine if the Governor should mediate negotiations between healthcare providers and health insurance carriers. This legislation was defeated in the House Commerce Committee on March 9, 2000.

Assembly Member Asselta, of New Jersey, introduced A.B. 2241 on March 20, 2000. This bill, which is known as the "Health Care Provider Joint Negotiation Act," would permit independent physicians and other health care providers to engage in joint negotiations over certain terms and conditions of their contracts with health insurance carriers.

Representative Curtiss’ bill in Tennessee, H.B. 2936, passed the House Committee on Health and Human Resources on March 14, 2000 as amended and was assigned to the House Committee on Finance and Ways and Means. This bill, which is known as the Health Care Provider Joint Negotiations Act, would allow physicians to enter into joint negotiations with health plans concerning certain contractual provisions.

Children’s Health Insurance Program (CHIP)

Action was taken on CHIP bills in three states- Connecticut, Utah and West Virginia. In Connecticut, S.B. 266 was introduced by Senator Harp on February 15, 2000 and failed to meet a joint favorable deadline. This bill would have provided health insurance coverage under the HUSKY plan, Part B and the HUSKY Plus program for children that either have a disability or a family income that exceeds 300 percent of the federal poverty level.

Also in Connecticut, S.B. 346 was introduced by the Senate Committee on Human Services on February 16, 2000. The bill was then sent to the Joint Committee on Human Services. This measure would expand enrollment in the HUSKY Plan by implementing a system of presumptive eligibility. This measure would also provide for the dissemination of information about the HUSKY program.

In Utah, Senator Poulton’s bill, S.B. 15 is currently awaiting action by the Governor. This bill would appropriate funds from the state’s share of the master tobacco settlement of 1998 for CHIP, among other purposes.

In West Virginia, Representative Prezioso introduced S.B. 565 on February 21, 2000. This bill passed the House and on March 7, 2000 went to the Senate for concurrence. The Senate refused to concur to the House amendments on March 8, 2000. This bill would transfer authority for the CHIP program to the state Department of Administration.

Confidentiality

In Minnesota, S.F. 3658 sponsored by Senator Knutson passed the Senate Committee on Judiciary and was referred to the Senate Committee on Rules and Administration on March 14, 2000. This bill states that health maintenance organizations (HMOs) may not disclose individually identifiable data that is held by the HMO to anyone except in special circumstances. An enrollee could give consent to HMO to disclose information, or information could be disclosed if it is subject to a court order. Personal information is defined as any individually identifiable data that is collected from which judgements can be made about an individual’s character, habit, finances, occupation, general reputation and others.

Consolidated Omnibus Budget Reconciliation Act of 1983 (COBRA)

Action was taken on COBRA matters in Connecticut. S.B. 532 was introduced in the Committee on Public Health on February 29, 2000. From the Committee on Public Health, it was reported with a substitute and filed with the Legislative Commissioner’s Office. This bill would extend the period of health insurance portability and provide extended health insurance coverage to individuals that have exhausted their benefits under COBRA.

Genetic Discrimination

Legislators in California, Idaho and Michigan addressed relevant legislation concerning genetic discrimination. California S.B. 1364, sponsored by Senator Johnston, was withdrawn from the Senate Rules Committee on March 16, 2000 and re-assigned to the Senate Committee on Appropriations. This bill would amend the state’s existing Confidentiality of Medical Information Act by specifying that the definition of the term “genetic characteristic” is the same as the definition contained in existing provisions that apply to health care service plans.

The Idaho Senate Committee on State Affairs introduced a bill, H.B. 1567, on March 13, 2000 that would prohibit specified health insurers, as well as employers, from discriminating against individuals on the basis of genetic testing. This measure was assigned to the Senate Committee on State Affairs on March 14, 2000.

On March 14, 2000, Michigan S.B. 589, S.B. 590, and S.B. 591 were signed by the Governor and enacted into law. These measures, sponsored by Senators Shugars, Hammerstrom, and Schwartz respectively, would amend existing law to prohibit Blue Cross and Blue Shield of Michigan, other private insurers and HMOs from requiring applicants or enrollees to submit to genetic testing or disclose genetic information. Certain private insurers and HMOs could still require applicants to answer questions about their family medical histories.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Action was taken on HIPAA measures in Hawaii, Representative Hiraki and Senator Taniguchi introduced H.B. 2707 and S.B. 2292 on January 27, 2000 and January 21, 2000 respectively. H.B. 2797passed the House and was sent to the Senate Committee on Commerce and Consumer Protection. S.B. 2292 was sent to the Senate Committee on Commerce and Consumer Protection and the Senate Committee on Health and Human Services where it passed and then passed the Senate with a Committee amendment. Both of these measures would require group and individual health insurers to comply with the federal HIPAA requirements.

Health Insurance Tax Incentive

The House Committee on Taxation and Revenue sponsored H.B. 707 in Idaho, and on March 20, 2000 it passed the Senate Committee on Local Government and Taxation as amended. This bill would create a tax deduction for taxpayers that are self-employed. The deduction would be equal to the amount the taxpayer paid for insurance premiums to cover the taxpayer, his/her spouse and/or dependents. The deduction may not be greater than three percent of the taxpayer’s total investments.

In New York, on March 20, 2000, Senator Seward introduced S.B. 7057, which was then assigned to the Senate Committee on Insurance. A tax credit would be provided to small employers that provide health insurance benefits for their employees. The tax credit would be equal to twenty percent the premium paid by the employer for each employee.

Wisconsin A.B. 456 was sponsored by Assembly Member Hahn and on March 14, 2000 it passed the Assembly then was referred to the Senate Committee on Economic Development, Housing and Government Operations. This measure would change the existing individual income tax deduction from 50 percent to 100 percent of the costs paid by an individual for health insurance coverage for the individual, his or her spouse and/or the individual’s dependents. To qualify, an individual must be employed and pay for his/her own health insurance.

Health Plan Liability

The Connecticut Senate Committee on the Judiciary sponsored S.B. 511, and on March 20, 2000 it failed to meet the joint favorable deadline. A managed care organization would have been required to exercise ordinary care when making a health care treatment decision for an enrollee. The enrollee would have been able to file civil actions against the organization to recover damages for personal injury or harm caused when the HMO failed to exercise ordinary care. The internal review and appeals process would have to had been exhausted before any civil action could go forward and civil action could not be brought against the enrollee’s employer unless the employer made the health care treatment decision that resulted in the enrollee’s injury or death.

On March 21, 2000 in Maryland, S.B. 9, which was sponsored by Senator Green, was withdrawn from further consideration. This bill would have established that if a health plan enrollee suffered harm, then the insurance carriers or managed care plan would be liable. Insurers would have been required to exercise ordinary care when making health care treatment decisions. An enrollee would not have been able to file a claim unless he/she had exhausted the review appeal process, an internal grievance process and had given a written notice to the health plan. Employers who purchase the health plan could not be held liable.

Two similar bills relating to health plan liability in Rhode Island have been introduced. H.B. 8057 was introduced by Representative Henseler and referred to the House Committee on Corporations on March 16, 2000. S.B. 2847 was introduced by Senator Irons and referred to the Senate Committee on Corporations on March 15, 2000. Both bills would provide new standards for health care entities when making health care treatment decisions and provide enrollees with an option of an external review when appealing treatment decisions. A health care entity would be liable for any health treatment decision made by employees or representatives who are acting on behalf of the entity that do not exercise ordinary care.

Health Purchasing Cooperatives

In Minnesota, two similar bills relating to health purchasing cooperatives had recent legislative activity. S.F. 3161, sponsored by Senator Kiscaden, passed the Senate and then was substituted for H.F. 3375, which was sponsored by Representative Mulder. H.F. 3375, on March 16, 2000, was indefinitely postponed. Both bills would amend a Minnesota statute that relates to health care purchasing alliances and allow qualifying employers to participate in a health care alliance with other employers without it affecting the employer’s standing under the Employee Retirement Income Security Act of 1974 (ERISA).

High-Risk Health Insurance Pools

The Idaho House Committee on Ways and Means introduced H.B. 750 on March 13, 2000. This bill would create a high-risk reinsurance pool in the state for individual health insurance carriers. H.B. 750 would establish funding for the pool through premium tax revenues. This legislation was passed by members of the House on March 16, 2000 and sent to the Senate for consideration.

Long-Term Care

Lawmakers in Hawaii and West Virginia addressed long-term care legislation. In Hawaii, Representative Arakaki introduced H.C.R. 105 on March 15, 2000. This resolution requests that the state conduct an overview study of the long-term care systems in place in both Japan and Germany. This measure was assigned to both the House Committee on Human Services and Housing and the House Committee on Health.

West Virginia H.B. 4354 was sent to the Governor for signature on March 18, 2000. This bill would allow individuals to deduct their long-term care insurance premiums from their federal taxable income when determining state income tax liability.

Managed Care Reform/Patient Protection

In twelve states—Colorado, Connecticut, Delaware, Florida, Georgia, Iowa, Kentucky, Maryland, Mississippi, New Hampshire, Rhode Island, and Washington—action was taken on legislation relating to managed care reform/patient protection. In Colorado, Senator Wattenberg sponsored S.B. 95, which on March 16, 2000 was sent to the Governor to be signed into law. This bill would require a health plan that covers any eye care services to give an enrollee direct access to any eye care provider that is a participant in the health plan. A referral from the individual’s primary care physician would then not be required.

The Senate Committee on Insurance in Connecticut sponsored H.B. 48. On March 17, 2000 the Legislative Commissioner’s Office reissued this bill with File No. 105. This measure would require that managed care organizations not penalize a health care provider that specifies that there be no substitutions for a specific brand name prescription drug.

In Delaware, Senator Blevins introduced S.B. 299 on March 16, 2000 and that same day it was assigned to the Senate Committee on Health and Social Services. This measure would establish an independent health care appeals program within the state Department of Health and Social Services. This program would establish the final step for the appeal of treatment decisions. Those that will review the treatment decision must be physicians or other health care practitioners.

Representative Villalobos in Florida, introduced H.B. 149 and on March 16, 2000 it was reported favorably with amendments from the House Committee on Governmental Operations and the House Committee on Health Care Licensing and Regulations. This measure states that an HMO contract could not prohibit or restrict a physician’s ability to provide hospital services to enrollees of a health plan. The HMO would not be able to deny payment to the provider for hospital services when they are medically necessary.

Also in Florida, H.B. 1523 was introduced on March 7, 2000. This bill, sponsored by Representative Sublette, would not allow health insurance carriers and HMOs to be deceptive and unfair towards health care providers. A deceptive practice would be to require a provider as a condition of participation in the health plan to participate in the carrier’s affiliate plans that have different terms, conditions, or level of payments then the one for which the provider is applying. S.B. 432 in Georgia became eligible for the Governor’s desk on March 16, 2000. Senator Polak sponsored this act which would amend an existing state law relating to insurance.

S.B. 432 would require those individuals that make treatment decisions to posses either a bachelors or higher degree in any health related field that specified by the state Insurance Commissioner.

Senator Madden, also in Georgia, sponsored S.B. 334, which on March 15, 2000 passed the House and was sent back to the Senate for concurrence. This measure specifies that all rural health care providers that meet certain conditions of the health plan shall be given the opportunity to apply to become a participating provider in a health care plan. Health benefit plans would be required to include a sufficient and reasonable number of providers located in rural areas.

S.F. 2237, which was formerly Senate Study Bill 3026 in Iowa, was introduced and referred to the Senate Committee on Commerce on March 20, 2000. The Committee on Commerce sponsored this bill, which would establish that under an HMO contract, podiatrists would be compensated for any care and treatment sought by an HMO enrollee.

Representative Johns in Kentucky sponsored H.B. 390, which passed the House on March 14, 2000 and was referred to the Senate Committee on Health and Welfare. This measure would provide for an external review procedure. The State Insurance Commissioner would be required to report every six months to the Interim Joint Committee on Banking and Insurance and to the Governor the number of external reviews that are requested as well as a summary of the findings and recommendations of the external review entity.

In Maryland, the House passed H.B. 669, which was sponsored by Representative Goldwater on March 17, 2000. This bill would amend an existing state law to allow a woman greater access to obstetrical or gynecological care. HMOs would have to provide the same benefits and coverage to a woman receiving care from a certified nurse midwife or any other authorized provider of obstetric or gynecological services as they would to a certified obstetrician or gynecologist under the individual’s health plan.

Also in Maryland, the Senate adopted the Senate Committee on Finance amendments to S.B. 567 on March 21, 2000. Senator Exum sponsored this measure which would allow the classification of an obstetrician/gynecologist as a woman’s primary care provider under an HMO health plan. A woman may also choose to select an in-network certified mid-wife as her obstetric primary care provider.

Senator Huggins in Mississippi introduced S.B. 2846, and on March 14, 2000 it passed the Senate and was sent to the House Committee on Insurance. The responsibility of the Patient Protection Act would be transferred from the Mississippi Department of Insurance to the Mississippi State Department of Health under this measure. Preferred provider organizations (PPOs) would also be included in the definition of a managed care entity.

In New Hampshire, on March 9, 2000, the House Committee on Commerce defeated H.B. 1280. This measure would have provided that health care providers in emergency situations should follow the orders of the chief provider giving emergency services. If a health plan disputed any patient treatment action provided during an emergency, a third person would have been chosen by both parties for arbitration.

On February 3, 2000 in Rhode Island, H.B. 7468 was introduced by Representative Ginaitti and referred to the House Committee on Health, Education and Welfare. This measure would require an HMO to provide temporary credentials to a health care provider while the HMO reviews the provider’s application to participate in the HMO’s network.

In Washington, the Governor signed S.B. 6199, sponsored by Senator Wojahn, on March 15, 2000. This measure will ensure that patients who are covered by health plans receive quality health care. This act ensures that enrollees: (1) have access to information regarding their health plans; (2) have a broader choice among health care providers; (3) have access to a quick and impartial appeals process of a plan’s health related decision; (4) will be ensured the privacy of their medical information.

Mandated Benefits

Clinical Trial Mandates: Legislation concerning coverage of participation in clinical trials was considered in Minnesota and New Hampshire. In Minnesota, Senator Berglin’s bill, S.F. 3156, would also require certain health insurers to provide their enrollees with coverage of specified costs associated with participation in approved clinical trials. This bill passed the Senate Commerce Committee on March 6, 2000. Identical legislation, known as H.F. 3610, which was sponsored by Representative Goodno, passed the House Commerce Committee on March 15, 2000.

Senator Wheeler, of New Hampshire, introduced legislation that would require certain health benefit plans to provide coverage of participation in certain clinical trials. S.B. 409 passed the Senate on March 16, 2000 and was assigned to the House Commerce Committee on March 21, 2000.

Infertility Mandates: Three states—California, Florida, and Oklahoma—took action on legislation mandating coverage for the diagnosis and/or treatment of infertility. In California, Senator Hayden sponsored legislation on February 22, 2000. S.B. 1630 would require certain carriers of health and disability insurance to provide coverage for infertility treatment. Treatment must include at least four complete cycles of any one or a combination of any non-experimental reproductive assistance technologies. This bill was referred to the Senate Committees on Insurance and Business and Professions on March 16, 2000.

Florida H.B. 31, sponsored by Representative Wasserman, was temporarily deferred by the House Committee on Health Care Services on March 16, 2000. This bill would require a specified list of insurance carriers to provide coverage for the diagnosis and treatment of infertility. Certain types of procedures would be excluded from the mandated coverage requirement, and certain religious organizations would not be required to purchase plans that include that particular mandated benefit.

Finally in Oklahoma, Representative Davis’ bill, H.B. 1338, passed the Senate Judiciary Committee on March 20, 2000. This bill would require certain health insurance carriers to provide coverage for the diagnosis of infertility, as well as for specific infertility treatments.

Smoking Cessation Mandates: Lawmakers in Maryland took action on two bills concerning the issue of mandatory insurance benefits for smoking cessation treatments. Senator Van Hollen introduced S.B. 518 on February 4, 2000. This legislation would require certain insurers to provide enrollees with coverage of certain types for treatment and assistance associated with participation in a smoking cessation program. This measure was assigned to the House Committee on Economic Matters on March 13, 2000.

Another Maryland bill addressing coverage for smoking cessation treatment, H.B. 1125 by Delegate Barve, was withdrawn from consideration on March 14, 2000.

Social Anxiety Disorder Mandates: Two states, Minnesota and New York, are considering bills concerning mandatory insurance coverage for social anxiety disorder treatment. In Minnesota, Senator Dillee proposed S.F. 3789 on March 15, 2000. The bill, which would require specified health insurance carriers to provide coverage for the treatment of social anxiety disorder, was assigned to the Senate Commerce Committee that same day.

Also, in New York, Senator Skelos introduced legislation on March 20, 2000 that would establish that certain health insurance policies and HMO plans that provide coverage for mental health treatment also must provide coverage for the treatment of social anxiety disorder. S.B. 7041 was referred to the Senate Committee on Insurance.

Other Mandates: State lawmakers have also been considering mandate bills that address coverage of a wide variety of other health services. Some of the mandate bills that have been acted upon recently include the following:

In Arizona, Representative Leff introduced a measure that would require certain specified health insurers to provide coverage for drugs used to treat cancer. The measure also mandates coverage of chiropractic services. On March 20, 2000, H.B. 2600 was recalled from the House.

A substitute version of Florida H.B. 399, sponsored by Representative Prieguez, passed the House Committee on Health Care Services on March 16, 2000. This bill would require specified health insurers to provide coverage for auditory screening tests in newborns

Also in Florida, S.B. 164, introduced by Senator Scott, would require certain health insurance carriers and HMOs to provide coverage for the diagnosis and treatment of autism spectrum disorder. This legislation passed the Senate Committee on Banking and Insurance on March 20, 2000.

Legislation sponsored by Representative Kawakami in Hawaii, which is known as H.B. 2392, would require specified types of health insurance plans to include coverage of diabetes self-management training and education, as well as diabetes equipment and medical supplies. This bill was assigned to the Senate Committee on Commerce and Consumer Affairs on March 17, 2000.

Indiana H.B. 1293, sponsored by Representative Ruppel, was signed by the Governor on March 15, 2000. This legislation will require managed care organizations that provide coverage to state public employees to cover all colorectal cancer screening services and related laboratory tests.

Also in Indiana, another piece of legislation introduced by Senator Wheeler, which concerns mandating insurance coverage for morbid obesity, was signed into law on March 15, 2000. S.B. 212 would apply to specified HMOs and insurers that issue accident and sickness policies.

Finally, in Iowa, a bill sponsored by Senator Johnson concerning mandatory insurance coverage of contraceptive drugs, devices and services was assigned to the House Committee on Commerce and Regulation on March 15, 2000. The members of this committee passed S.F. 2126 that same day.

Medical Savings Account

On March 17, 2000 in Colorado, the Governor signed H.B. 1037, which was sponsored by Representative Hoppe. This bill creates a catastrophic health plan that must be purchased by an individual who has a medical savings account. The health plan will have a deductible of at least $1500 but no more than $2200 for individuals and at least $3000 but no more than $4500 for families.

In New Hampshire, H.B. 1510 sponsored by Representative Wendleboe passed the House, and on March 9, 2000 it was assigned to the Senate Committee on Insurance. This measure would establish a medical savings account program for state employees. Funds contributed to the medical savings account must be used exclusively for qualifying medical or surgical care. This program would be contingent on the passage of federal legislation that authorizes the expansion of access to medical savings accounts.

Mental Health and Substance Abuse Parity

Parity legislation was addressed recently in six states—California, Hawaii, Maine, New York, South Carolina and Utah. In California, Senator Chesbro introduced a bill on February 23, 2000 that was assigned to the Senate Insurance and Health and Human Services Committee on March 15, 2000. S.B. 1764 would require that after January 1, 2001, specified health insurance plans must provide coverage for the treatment of drug and alcohol dependency.

Hawaii H.C.R. 168, sponsored by Representative Santiago on March 15, 2000, asks that the state Auditor study the social and financial impact of legislation that would require parity in insurance coverage for substance abuse treatment services and other mental health treatment services. This resolution was assigned to the House Committees on Health and Consumer Protection and Commerce on March 17, 2000.

Also in Hawaii, Senator Chun-Oakland introduced S.B. 2974 on January 26, 2000. This measure was referred to the House Committee on Consumer Protection and Commerce on March 17, 2000. This bill would require certain insurance carriers to provide coverage for substance abuse treatment services.

Two parity measures introduced in Maine last session were defeated on March 14, 2000. Representative Brooks sponsored H.P. 835, and Senator Daggett introduced S.P. 346. H.P. 835 would have required certain insurers to provide parity in insurance coverage of the treatment of mental illnesses and would have classified eating disorders as a mental illness. S.P. 346 would have required specified group and individual health insurance plans to provide equal coverage for substance abuse treatment services.

In New York, legislation sponsored by Senator McGee last session was amended by the Senate Committee on Alcoholism and Drug Abuse on March 17, 2000. S.B. 3946 would establish that individuals with certain types of family insurance coverage could not be denied coverage of alcoholism or substance abuse treatment unless the treatment is deemed to be unnecessary. Assembly Member Weisenberg introduced similar legislation, known as A.B. 9528, on February 10, 2000 and the Assembly Committee on Alcoholism and Drug Abuse amended it on March 16, 2000.

In South Carolina, Senator McConnell introduced legislation on January 18, 2000 that would require certain health insurers to provide coverage for mental health and substance abuse treatment. Insurers would be prohibited from placing any access restrictions or cost-sharing requirements on mental health and/or substance abuse treatment that are greater than those imposed on the treatment of other physical illnesses. S.B. 1041 passed the Senate on March 15, 2000 and was referred to the House Committee on Ways and Means for consideration on March 17, 2000.

H.B. 35, sponsored by Representative Buffmire of Utah, would require certain health insurers to provide equal coverage for mental health conditions, including cost-sharing and payment limits, as provided for other physical health conditions. The Governor signed this measure on March 16, 2000.

Ombudsman

Senator Madden sponsored S.B. 479 in Georgia. This measure passed both the Senate and the House, and on March 16, 2000 it was sent to the Senate for concurrence with House amendments. This measure would create a state mental health, mental retardation and substance abuse ombudsman. The position would be for a full-time employee that would work for the consumers’ insurance advocate in the Governor’s office. The ombudsman would advocate the rights of those with disabilities, and promote their well being and quality of life. One duty of the ombudsman would be to set a program up to investigate, report and resolve complaints against insurance carriers by those suffering from mental health conditions, mental retardation or substance abuse.

In Virginia, Representative Rust sponsored H.B. 726, which became eligible for the Governor’s desk on March 1, 2000. This bill amends the 1999 Omnibus Health Insurance Act and specifies that if an individual has a condition where a specialist is needed, the individual no longer needs to get a referral from the primary care physician to seek treatment from the specialist. This act also states that health plan grievances should be directed to the state Office of the Managed Care Ombudsman.

Single-Payer Health Plans

In Maine, Representative Saxl’s measure, H.P. 1702, was defeated on March 14, 2000. This measure would have established a commission to study the creation of a statewide public/private purchasing alliance for health insurance in order to ensure that all Maine citizens have access to health care.

The Uninsured

Action was taken on legislation in Arizona sponsored by Representative Knaperak. The bill would establish the Premium Sharing Program in the state to help subsidize health insurance coverage for uninsured state residents. H.B. 2262 would fund the program through revenues from the state’s share of the master tobacco settlement of 1998. This measure passed the Senate Rules Committee on March 20, 2000.

In Connecticut, Senator Harp proposed legislation on February 15, 2000 that failed to meet the joint favorable deadline on March 9, 2000. S.B. 268 would have established a mechanism to provide publicly funded health coverage to all uninsured state residents.

Senator Hargrove’s measure, S.B. 5848, was assigned to the Washington Senate Rules Committee on March 9, 2000. Since state residents in rural and under-served areas are experiencing access barriers to the state’s Basic Health Plan, this legislation would authorize an administrator to develop alternate purchasing strategies to increase access for those segments of the state’s population.