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State Legislative Update

April 3 - April 7, 2000

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

Children Health Insurance Program (CHIP)

Action was taken on CHIP bills in four states—California, Connecticut, Maryland, and New York. In California, S.B. 2020 was introduced on February 25, 2000. On March 30, 2000 it was read for a second time in the Senate and amended. Then it was re-referred to the Committee on Health and Human Services. This bill would require both public and private schools, as part of the process for updating parent and pupil information, to request evidence of health insurance coverage for new and returning pupils. S.B. 2020 would also require both public and private schools to have a designated person or persons trained to help the parents and legal guardians of uninsured pupils determine eligibility for available health insurance programs for children and assist with the application process.

In Connecticut, H.B. 5529 was introduced on February 16, 2000. On April 3, 2000 the bill was reported out of the Legislative Commissioner’s office with a committee substitute and reissued by the Legislative Commissioner’s office with File No. 372. This bill would improve the delivery of behavioral health services and support children with mental health service needs. It would also provide for the allocation of funds under the HUSKY plan for behavioral health services to children with serious emotional disturbances.

In Maryland, Senator Miller introduced S.B. 863 on February 24, 2000. On April 3, 2000 the bill passed the House Committee on Economic Matters and the Committee amendment was adopted on the House floor. S.B. 863 would alter the family income level eligibility requirement for CHIP participation and would repeal the requirement that individuals must pay a specified annual family contribution in order to participate in CHIP.

Senator Kelley introduced Maryland S.B. 395 on February 3, 2000. The bill, on March 31, 2000, was reported as amended out of the Committee on Environmental Matters and adopted on the House floor. This bill would establish guaranteed eligibility under the Maryland Medical Assistance Program for pregnant women and for children under a specified age for a specified amount of time. The bill would also establish presumptive eligibility for any individual who applies for CHIP.

Representative Taylor introduced Maryland H.B. 2 on January 12, 2000. On March 30, 2000 a committee substitute passed the Senate floor and was sent to the House for concurrence. H.B. 2 would expand eligibility for CHIP to those under a private-option plan. The bill would also require that those enrolled in CHIP receive health benefits through either an employer-sponsored health benefit plan or through a managed care organization. This measure would also establish standards for health benefit plans participating in the program.

In New York, A.B. 10346 was introduced on March 28, 2000 and was sent to the Assembly Committee on Health. This bill would direct the state Department of Health to contract with community-based organizations and not-for-profit corporations for the provision of outreach, information and educational services to immigrants on the availability of health care services, medical assistance, emergency medical assistance, the Family Health Plus Program and CHIP.

Confidentiality

Similar bills have been recently introduced in New York, relating to the confidentiality of medical records. A.B. 10324, sponsored by Assembly Member Flanagan, was introduced and referred to the Assembly Committee on Health on March 28, 2000. Senator Hannon sponsored S.B. 4873, which on April 2, 2000 was referred to the Senate Committee on Health. Both bills would amend an existing state law to include provisions concerning privacy of medical records. A health plan enrollee would be allowed to receive, inspect and amend a copy of his or her own medical records that are kept by a health plan. The health plan would be required to provide each enrollee with a copy of their rights and the plan’s responsibilities with regard to medical record privacy. If a health plan desires to disclose an enrollee’s medical information, the plan would be required to obtain written informed consent from the enrollee.

Consolidated Omnibus Budget Reconciliation Act of 1983 (COBRA)

In Connecticut, S.B. 532 was introduced to the Committee on Public Health on February 29, 2000. This bill was reported out of the Legislative Commissioner’s office with a committee substitute on April 4, 2000 and reissued by the Legislative Commissioner’s office with File No. 382. 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 and New Hampshire addressed relevant legislation concerning genetic discrimination. California S.B. 1364, sponsored by Senator Johnston, passed the Senate on April 4, 2000 and was sent to the Assembly. 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 healthcare service plans.

In New Hampshire, legislation introduced by Representative Kurk passed the House as amended on March 30, 2000 and was sent to the Senate. This bill would prohibit the use of genetic testing when underwriting specified types of long-term care and disability insurance policies.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

S.B 53 and H.B. 91 were introduced on January 12, 2000. On March 30, 2000, H.B. 91 passed the House and went to the Senate for concurrence. On March 31, 2000, S.B. 53 passed the House and went to the Senate for concurrence. Both bills are now eligible for the Governor’s desk. These measures relate to Maryland’s HIPAA and would require special enrollment periods for certain group health plans. The bills also address small employer health benefit plans and would alter when a carrier may cancel or refuse to renew a health benefit plan. Finally these bills relate to health coverage continuation and would require enrollee notification of certain coverage changes.

Health Insurance Tax Incentives

The House Committee on Taxation and Revenue sponsored H.B. 707 in Idaho, and on March 30, 2000, both the House and Senate Conference Committees rejected it. This bill would have created a tax deduction for taxpayers who are self-employed. The deduction would have been equal to the amount the taxpayer paid for insurance premiums to cover the taxpayer, his/her spouse and/or dependents. The deduction could not have been greater than three percent of the taxpayer’s total investments.

Also in Idaho, the House Committee on Revenue sponsored three similar bills. All of the bills were introduced and passed by the House on March 30, 2000, but H.B. 802 is the only one to have been referred to the Senate Committee on Local Government and Taxation. These bills would create an income tax deduction for an individual who is self–employed. The amount of the tax deduction would equal the amount the taxpayer paid for medical insurance to cover the taxpayer, his/her spouse and/or dependents.

On April 3, 2000, in Idaho, both legislative chambers adopted S.J.M. 108. This resolution memorializes the United States Congress and the President to enact federal legislation to provide a full deductibility from federal income tax for individuals who purchase individual and small group health insurance.

In New Mexico, S.B. 27 was made eligible for the Governor’s desk on April 3, 2000. Senator Jennings sponsored this bill, which would create a tax deduction for certain unreimbursed or uncompensated medical expenses paid by an individual. The amount of the deduction would depend on the individual’s tax filing status and the individual’s household income level.

Health Purchasing Cooperatives

In Minnesota, S.F. 3161, sponsored by Senator Kiscaden, passed the House and was signed by the Governor on March 28, 2000. This new law will amend a Minnesota statute that relates to healthcare purchasing alliances and allow qualifying employers to participate in a healthcare alliance with other employers without affecting the employer’s standing under the Employee Retirement Income Security Act of 1974 (ERISA).

Long-Term Care

Lawmakers in California, Hawaii, Maryland, Mississippi and Missouri addressed long-term care legislation. In California, Assembly Member Alquist introduced A.B. 2281 on February 24, 2000. This bill would allow taxpayers to deduct a percentage of the amount they spent during the taxable year for the cost of long-term care insurance for themselves, a spouse or a dependent from their state income tax liability. The measure passed the Assembly Committee on Revenue and Taxation with an amendment on March 30, 2000. The bill was then read on the Assembly floor for the second time and referred back to the Revenue and Taxation Committee.

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 held in both the House Committee on Human Services and Housing and the House Committee on Health on March 29, 2000.

In Maryland, Senator Hollinger’s bill, S.B. 171, passed the Senate on March 29, 2000 and was assigned to the House Committee on Ways and Means. This measure would allow individuals a state income tax credit equal to 100 percent of qualified long-term care insurance premiums paid during the year by the taxpayer to insure the individual or the individual’s spouse, parent, step-parent, child or step-child. The tax credit outlined in S.B. 171 could only be used for one taxable year. S.B. 171 would also require the state Comptroller to submit a report concerning the impact and cost-savings of this credit.

Representative Barnett of Mississippi introduced a measure on March 1, 2000 that would provide individuals with an income tax credit for the amount they pay for long-term care insurance premiums. H.B. 1568 was defeated in the House Ways and Means Committee on March 29, 2000.

In Missouri, H.B. 1737 was assigned to the Senate Committee on Insurance and Housing on April 3, 2000. This bill, which was sponsored by Representative Monaco, would require long-term care insurance policies to include information identifying the policy as either tax-qualified or non-tax-qualified. The bill would also require the state Insurance Commissioner to include in its long-term care consumer guide information about the tax consequences associated with different types of insurance policies.

Managed Care Reform/ Patient Protection

The Governor of Arizona signed S.B. 1076, sponsored by Senator Cirillo, into law on March 30, 2000. This bill clarifies the definition of emergency services in an existing state law as it relates to emergency healthcare. An emergency is defined as the onset of a medical condition that involves severe pain, illness or injury where immediate medical care would be reasonably expected to prevent a serious health injury, impairment of bodily functions or serious dysfunction to organs.

In California, A.B. 2262 sponsored by Assembly Member Ackerman was referred to the Assembly Committee on Judiciary and Health on March 9, 2000. This bill would add a provision to existing law that relates to the recovery of exemplary damages in a civil action brought against a managed care entity that did not exercise ordinary care when making an enrollee’s healthcare treatment decision. The exemplary monetary damages would not be able to exceed three times the compensatory monetary damages that are awarded to the enrollee.

Representative Casey in Florida sponsored H.B. 913, which was withdrawn on March 29, 2000 from the House Committee on General Government Appropriations. This measure would not allow an HMO to deny payment to a healthcare provider for covered services unless certain conditions were met.

Also in Florida, Senator Laurent introduced S.B. 706. On April 3, 2000 it was reported favorably from the Senate Committee on Baking and Insurance. This measure would define a “clean claim,” as a completed claim filled out on the correct form and submitted by an enrollee’s physician for medical care or healthcare services that are provided under a health plan. This measure also specifies procedures that the health plan must follow in order to contest a claim.

Senator Madden, in Georgia, sponsored S.B. 334, which on March 22, 2000 became eligible for the Governor’s desk. This measure specifies that all rural healthcare providers that meet certain conditions shall be given the opportunity to apply to become a participating provider in a healthcare plan. Health benefit plans would be required to include a sufficient and reasonable number of providers located in rural areas.

In Maryland, H.B. 669 sponsored by Representative Goldwater passed the Senate and then was sent to the House for concurrence on March 30, 2000. This bill would amend an existing state law to allow a woman greater access to obstetrical or gynecological care. Health Maintenance Organizations (HMOs) would 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, Senator Dorman introduced S.B. 325, which passed the Senate and was referred to the House Committee on Environmental Matters on March 29, 2000. This measure would expand a patient’s choice of healthcare providers within an HMO. A nurse practitioner would have the same responsibilities and privileges as a physician within the health plan.

Senator Exum, of Maryland, sponsored S.B. 567. The House passed this measure on April 3, 2000, and it was then referred to the Senate for concurrence. S.B. 567, which would allow the classification of an obstetrician/gynecologist as a woman’s primary care provider under an HMO health plan. A woman could also choose to select an in-network certified mid-wife as her obstetric primary care provider.

In New Hampshire, H.B. 1377 sponsored by Representative Martel passed the House and was then referred to the Senate Committee on Public Institutions, Health and Human Services on March 23, 2000. This bill would prohibit managed care organizations from excluding healthcare providers that are not certified by the American Board of Medical Specialist from joining the organization’s network. A committee would also be established by this bill to study the methods managed care organizations use to contract with healthcare providers.

A.B. 6811, sponsored by Assembly Member Grannis, was amended in the Assembly Committee on Rules in New York on April 4, 2000. This bill would amend an existing law relating to managed care to increase an enrollee’s access to specialized medical care under a managed care health plan. H.B. 2072 was passed in Oklahoma as amended by the Senate Committee on Human Resources on March 28, 2000. This bill, which was sponsored by Representative Morgan, amends the Oklahoma Managed Care Act.

H.B. 2072 would establish that health benefit plans could not deny emergency care coverage due to a lack of prior notification. If a patient or layperson believes that a condition is serious and needs medical attention, then the patient’s screening, evaluation and examination to determine condition status will be covered. However, if a provider later determines that the patient’s condition is not an emergency, then all other care does not have to be covered by the plan.

In Tennessee, the Senate Committee on Commerce, Labor and Agriculture recommended S.B. 3039, sponsored by Senator Rochelle, for passage. This bill would require managed care plans to notify enrollees in writing of the process required to request an independent review when treatment coverage has been denied by the plan. The fee paid by an enrollee to conduct the independent review could be refunded to the enrollee if the plan is found to have denied coverage unfairly.

Also in Tennessee, Representative Eckles sponsored H.B. 2499 and on March 28, 2000 it was recommended to pass the House Committee on Commerce’s Subcommittee on Industrial Impact. This bill would add a new section to existing HMO laws to prohibit an HMO from denying or rescinding payments to a healthcare provider. The commissioner of the Department of Commerce and Insurance would be required to conduct examinations periodically to verify HMO compliance. If payment violations occur, an HMO could be penalized as ordered by the Commissioner.

Mandated Benefits

Cancer-Related Mandates: Illinois and Maryland lawmakers addressed legislation concerning mandating coverage for cancer screening or treatment services.In Illinois, Senator O’Malley proposed S.B. 1955 on March 30, 2000 and the measure was immediately assigned to the Senate Rules Committee. This legislation would amend the state’s existing law to establish that mastectomy coverage provided by certain health insurers and HMOs must also include coverage of the surgical reconstruction of the non-diseased breast in order to ensure a symmetrical appearance. Furthermore, coverage must be provided for any necessary prosthetic devices and for the treatment of any conditions resulting from the mastectomy, specifically lymphedemas.

Legislation introduced on January 12, 2000 in Maryland that would require certain health insurers and HMOs to provide coverage for hair prostheses to chemotherapy patients under certain circumstances passed the Senate with an amendment on April 4, 2000. H.B. 22 was referred back to the House for concurrence with the Senate amendment that same day.

Children’s Health Mandates: Four states—Florida, Maine, Maryland and New York—have considered bills concerning mandated children’s health benefits. In Florida, Representative Prieguez proposed legislation that would require specified health insurers to provide coverage for auditory screening tests in newborns and provide referrals for ongoing treatment services if necessary. H.B. 399 passed the House Committee on Governmental Rules and Regulations as amended on March 30, 2000.

Maine lawmakers also took action on a newborn hearing-screening bill. H.P. 1260, which was introduced by Representative Fuller, passed both the House and Senate on March 31, 2000 and became eligible for the Governor’s desk. This bill would require certain health benefit contracts and HMOs to include coverage for newborn hearing screening tests.

In Maryland, a measure authored by Delegate Hurson, H.B. 6, passed the Senate on March 30, 2000 and was sent back to the House for concurrence. This legislation would prevent specified health plans, carriers and HMOs from denying coverage for rehabilitation services for enrolled children under certain circumstances.

New York A.B. 10288 and S.B. 7225, sponsored by Assembly Member DiNapoli and Senator LaValle respectively, would require certain health insurance carriers to provide enrollees with coverage for the cost of infant formula if prescribed by a physician or other healthcare provider. This mandate would apply to formula used in either the home or in a hospital setting. Both of these bills were introduced on March 28, 2000 and assigned to the Insurance Committees of their respective chambers.

Infertility Mandates: Legislation concerning insurance coverage of infertility diagnosis and treatment services was addressed by the legislatures of California and Oklahoma recently. 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 read for the second time on the Senate floor on March 29, 2000 and amended. The measure was then re-referred to the Senate Committee on Insurance.

In Oklahoma, Representative Davis’ bill, H.B. 1338, passed the Senate Judiciary Committee on March 30, 2000 as amended. This bill would require certain health insurance carriers to provide coverage for the diagnosis of infertility, as well as for specific infertility treatments.

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:

Legislation sponsored by Senator Chun-Oakland in Hawaii, which is known as S.B. 2657, 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 passed the House Committee on Finance on March 30, 2000.

Lawmakers in Maryland took action on Senator Van Hollen’s bill, S.B. 518. 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. On April 3, 2000 this legislation was reported unfavorably from the House Committee on Economic Matters.

The Senate Committee on Ways and Means in Massachusetts introduced S.B. 2155 on March 29, 2000 as a substitute for S.B. 733. Rules were suspended for this new bill and it passed the Senate on March 30, 2000. On April 3, 2000 this legislation was assigned to the House Ways and Means Committee. S.B. 2155 would require all health benefit plans that provide coverage for prescription drugs to also include coverage for certain gynecological services including FDA-approved contraceptives and hormone replacement therapy. Employers that are affiliated with a church or church-controlled organizations would not be required to offer these benefits in plans they provide to employees.

Senator Hart of Michigan introduced S.B. 1190 on March 30, 2000, which would require HMOs to provide coverage for independent second medical opinions under certain circumstances. This bill was assigned to the Senate Committee on Health Policy.

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 on March 27, 2000 and was substitute for H.F. 3610 on March 29, 2000. H.F. 3610, sponsored by Representative Goodno, was indefinitely postponed the same day.

Virginia H.B. 165 was enacted into law on March 24, 2000. This measure will require certain health insurers and HMOs to provide coverage for general anesthesia and related hospitalization and facilities charges when a licensed dentist and treating physician determine that such services are necessary for patient treatment.

Mental Health and Substance Abuse Parity

California S.B. 1764, introduced by Senator Chesbro on February 23, 2000, would require specified health insurance contracts, disability policies and self-insured employee welfare benefit plans to provide enrollees with coverage for certain types of alcohol and/or drug abuse treatment services. This legislation was re-referred to the Senate Committee on Insurance on April 4, 2000.

Kansas S.B. 547 is currently pending before the Senate Committee on Financial Institutions and Insurance. This bill, which was sponsored by the members of that committee, would require certain types of health insurance to include coverage for specified types of mental health conditions.

In Missouri, Representative Schilling introduced H.B. 2115 concerning coverage of mental illnesses and substance abuse treatment. This legislation would require certain specified individual and group insurers and managed care entities that provide coverage for mental illnesses and chemical dependency services to use the same cost-sharing and benefit limitation mechanisms for inpatient and outpatient mental health and chemical dependency services as are used for other inpatient and outpatient medical treatment services. On March 30, 2000, this bill was assigned to the House Committee on Critical Issues.

Representative Crosby of New Hampshire introduced H.B. 1134 in January of 2000, and on March 31, 2000, the measure was ordered enrolled. This bill would establish a state committee to investigate mental health treatment services provided by managed care plans in the state.

In New York, Assembly Member Weisenberg introduced legislation, known as A.B. 9528, on February 10, 2000. This bill would establish that individuals with certain types of family insurance coverage could not be denied coverage of alcoholism or substance abuse treatment due to family history of the disease unless the treatment is deemed to be unnecessary. This bill passed the Assembly on April 3, 3000 and was assigned to the Senate Committee on Alcoholism and Drug Abuse.

Ombudsman

In Florida, Senator Saunders introduced S.B. 336 on March 7, 2000, then on March 29, 2000 it was withdrawn from further consideration. This measure would have created a statewide managed care ombudsman office that would have been within the Agency for Health Care Administration. The ombudsman office would have assisted consumers in resolving complaints against managed care plans. The office would have been part of a two-year pilot program that was funded by an assessment on health care premiums.

Senator Madden sponsored S.B. 479 in Georgia. This measure passed both the Senate and the House, and on March 22, 2000 it became eligible for the Governor’s desk. 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.