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State Legislative Update

April 10 - April 28, 2000

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

Antitrust

Action was taken on physician antitrust legislation in four states—Alaska, Connecticut, New Hampshire and New York. In Alaska, S.B. 256, sponsored by Senator Kelly, passed the Senate as amended on April 20, 2000 and was assigned to the House Committee on Health, Education and Social Services. This bill would allow doctors to enter into collective negotiations with managed care plans that have substantial market power.

Connecticut S.B. 581 was reported unfavorably from the Joint Committee on Public Health on April 4, 2000. This bill, which was authored by the Senate Committee on Insurance, would have established standards for contract negotiations between physicians and specified types of health benefit plans.

Representative Apslund, of New Hampshire introduced H.B. 1496. This legislation would authorize joint negotiations by physicians with health benefit plans, including fee-based contract provisions under certain circumstances. H.B. 1496 was referred for interim study on March 23, 2000.

Senator Hannon introduced a new antitrust bill in New York on April 17, 2000. S.B. 7541, which is known as the “New York State Managed Care Freedom of Choice Act of 2000,” would authorize healthcare providers to engage in collective negotiations with health benefit plans under specified conditions. Such negotiations could extend to fee-based contract provisions if certain conditions were met determining that the health benefit plan has significant market power.

Children’s Health Insurance Program (CHIP)

Action was taken on CHIP bills in eight states—Colorado, Connecticut, Hawaii, Idaho, Maryland, New York, Pennsylvania and West Virginia. In Colorado,S.B. 223 was introduced on April 12, 2000 and sent to the Senate Committee on Health, Environment, Welfare and Institutions. This bill would make changes to the non-Medicaid state-subsidized insurance program known as the “Children’s Basic Health Plan.”

In Connecticut, on April 16, 2000 H.B. 5529 was sent to the Joint Committee on Legislative Management. This bill would improve the delivery of behavioral health services to children with mental health needs. It would also provide for the allocation of funds under the HUSKY plan for behavioral health services to children with serious emotional disturbances.

The Committee on Human Services introduced Connecticut S.B. 346 on February 16, 2000. On April 12, 2000 the bill was reported out of the Legislative Commissioner’s Office and reissued by the Legislative Commissioner’s Office with File No. 548. S.B. 346 would expand enrollment in the HUSKY Plan, implement presumptive eligibility, disseminate information concerning the HUSKY Plan during the application process for the public school free lunch and breakfast programs and encourage the retention of participants enrolled in the HUSKY plan.

In Hawaii, Representative Arakaki introduced H.B. 540 January 22, 2000. On April 16, 2000, the bill was sent to a conference committee. This bill would expand the state CHIP to include coverage of uninsured children that are in households with incomes of up to 300 percent of the federal poverty level. CHIP coverage would also be provided to all permanent legal immigrant residents, permanent residents and persons from countries of the Compact of Fall Association.

The Committee on Appropriations in Idaho introduced H.B. 797 on March 30, 2000, and on April 14, 2000 the Governor signed the bill into law. This legislation provides intent regarding the CHIP program.

Representative Taylor introduced Maryland H.B. 2 on January 12, 2000. On April 6, 2000, the House refused to concur with the Senate’s amendments so the bill was assigned to a conference committee. On April 8, 2000, the House and Senate adopted the Conference Committee report. H.B. 2 would expand eligibility for CHIP to those under a private-option health plan. This bill would require that those children 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 CHIP.

In New York, S.B. 7523 was introduced on April 17, 2000 by Senator Hannon and sent to the Senate Committee on Health. This bill would include, within the coverage provided under CHIP, the provision of pre-hospital emergency medical services.

In Pennsylvania, Senator Hughes’ bill, S.B. 1400, was introduced on April 6, 2000 and was referred to the Senate Committee on Banking and Insurance. The bill would authorize an adult health insurance program for certain individuals and provide enhancements to certain children’s health insurance benefits. This measure also authorizes the use of funds for certain purposes related to the provision of health insurance and healthcare to certain individuals.

In West Virginia, Representative Prezioso introduced S.B. 565 on February 21, 2000, and on April 5, 2000 it was signed into law. This measure transfers authority of CHIP over to the state Department of Administration.

Confidentiality

Senator Hollinger sponsored S.B. 371 in Maryland. On April 10, 2000 it became eligible for the Governor’s desk. This bill would establish that any person may be held liable for punitive damages if they knowingly obtain another individual’s medical records under a false pretense through deception with an intent to sell, transfer or use the individual’s identifiable medical information. A state advisory council on medical privacy and confidentiality would also be established to conduct hearings, monitor federal laws and make recommendations to the General Assembly regarding privacy and confidentiality of medical records.

In Wisconsin, the Governor signed two bills into law on April 21, 2000 that were sponsored by the Committee on Joint Legislative Council. A.B. 427, a measure to protect the privacy of a patient’s medical record, defines “record” for purposes of a patient’s healthcare. A.B. 428 establishes that individuals who violate a patient’s confidentiality will be subject to fines and criminal prosecution.

Also in Wisconsin, Senator Moen introduced S.B. 249. This measure concerned patient privacy protections in the collection and dissemination of healthcare information by the Department of Health and Family Services (DHFS). If DHFS released a report for internal or public use, only zip codes from a patient’s personal information would have been able to be used to protect the identity of the patient. On April 6, 2000, S.B. 249 failed to pass pursuant to S. J. R. 1.

Genetic Discrimination

California A.B. 2797 passed the Assembly Committee on the Judiciary on April 25, 2000. This bill, which was introduced by Assembly Member Papan, would prohibit people who sell or underwrite insurance coverage from disclosing individually identifiable information concerning the health, medical, or genetic history of a customer.

Health Insurance Tax Incentives

In California, A.B. 2200, sponsored by Assembly Member Pacheco, was rereferred to the Assembly Committee on Revenue and Taxation on April 13, 2000. This measure would create an income tax deduction equal to 100 percent of medical expenses that cost more than $1000. To qualify, an individual must be 65 years of age or older and have an income less than $50,000, or $100,000 for a married couple.

Representative Faucheux in Louisiana introduced H.B. 63 on April 24, 2000 and it was then referred to the House Committee on Ways and Means. This measure would grant a tax credit to employers that provide health insurance to employees. The credit could equal up to 50 percent of the amount paid by the employer for the insurance premiums.

In New Mexico, the Governor signed into law S.B. 27 on April 12, 2000. Senator Jennings sponsored this bill, which creates a tax deduction for certain unreimbursed or uncompensated medical expenses paid by an individual. The amount of the deduction depends on the individual’s tax filing status and the individual’s household income level.

Representative Orie of Pennsylvania introduced H.B. 2447, and on April 10, 2000 it was sent to the Senate Committee on Finance. This measure would establish a tax credit for individuals who are 55 years of age or older and pay for a prescription drug insurance policy that covers the individual and/or spouse. The tax credit would equal 25 percent of the premium, but it could not exceed $250 per policy. If the tax credit exceeded the individuals tax liability, then the remaining amount would be refunded to the individual.

Wisconsin A.B. 456 was sponsored by Assembly Member Hahn and on April 6, 2000 it failed to pass pursuant to S. J. R. 1. This measure would have changed an existing individual income tax deduction from 50 percent to 100 percent of costs paid by an individual for health insurance coverage either for the individual, his or her spouse and/or the individual’s dependents. To qualify, an individual must have been employed and must have paid for his/her own health insurance.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Action was taken on HIPAA measures in Hawaii. Representative Hiraki and Senator Taniguchi introduced two similar bills, H.B. 2797 and S.B. 2292. H.B. 2797 passed the Senate as amended, but the House disagreed with the Senate amendments and on April 16, 2000 the bills were sent to a conference committee. Both of these measures require group and individual health insurance carriers to comply with the federal HIPAA requirements.

Health Plan Liability

In Alaska, H.B. 211, sponsored by Representative Rokeberg, passed the House and then the Senate Committee on Finance on April 19, 2000. H.B. 211 was then referred to the Senate Committee on Rules. This measure would establish the civil liability of managed care entities that do not exercise ordinary care when making treatment decisions. Also included in this measure is a requirement that a health plan contract would need to clearly identify all healthcare services that the plan provides and covers, as well as the plan’s utilization and external review process.

In Florida, Senator Silver sponsored S.B. 282, which was placed on the Senate’s table on April 25, 2000. This legislation would establish that specified health insurance carriers, Health Maintenance Organizations (HMOs) and managed care entities have the duty to exercise ordinary care when making health treatment decisions, and that they are liable for any harm or damages to an insured individual caused by the failure to exercise ordinary care. Furthermore, carriers, HMOs and other managed care organizations would be liable for damages for harm caused by the failure of their employees, agents or other representatives to exercise ordinary care when making health treatment decisions.

Representative Saxl in Maine sponsored H.P. 543, a patient’s bill of rights that is similar to federal legislation currently pending in Congress. The Maine legislation was recalled from the Governor’s desk on April 24, 2000. This bill would create an independent external review process, establish an enrollee’s right to sue health plans, grant broader access to specialists, prohibit financial incentives to providers and grant greater access to clinical trials.

In Tennessee, Senator Dixon sponsored S.B. 2833, and on April 11, 2000 it was referred to the Senate Committee on Commerce, Labor and Agriculture. The Patient’s Bill of Rights for Managed Care Act would be amended by this measure to establish that HMOs or health plan carriers must exercise ordinary care when making healthcare treatment decisions. The HMO or managed care carrier would be liable for damages if they fail to exercise ordinary care and the insured or enrollee is harmed.

Health Purchasing Cooperatives

In Florida, Senator King sponsored S.B. 2086 and on April 6, 2000 it was placed on the Senate calendar. This measure would insure small employers under health insurance policies, which would be issued to small employer health alliances that are organized as not-for-profit organizations. S.B. 2086 also authorizes health insurance carriers to issue group health insurance policies to small employer health alliances.

Representative Farkas in Florida sponsored H.B. 1571, a similar measure to S.B. 2086, which was placed on the House calendar as of April 20, 2000.

High-Risk Health Insurance Pools

In Idaho, the Governor signed both pending risk-pool bills on April 17, 2000. H.B. 750 creates a high-risk reinsurance pool in the state for individual health insurance carriers. Funding for the pool will be through premium tax revenues. S.B. 780 would amend Section 20 of H.B. 750 by establishing that carriers would be required to provide the state Department of Insurance with information necessary for the implementation of the act, and the Department would then be required to maintain the confidentiality of any trade secrets or proprietary information.

Long-Term Care

Lawmakers in California, Illinois, Louisiana, Maine, New York and Virginia addressed long-term care legislation. In California, S.B. 2111 was read for a second time, amended and sent back to the Committee on Insurance. This measure would require that the premium section of the long-term care insurance consumer worksheet include a reference to the state’s consumer rate guide and indicate where the guide could be obtained.

Illinois S.B. 1325 passed the Senate Rules Committee on April 15, 2000 and was assigned to the Senate Revenue and Executive Committees. This bill, which was sponsored by Senator Peterson, would authorize a 15 percent income tax credit for qualified long-term care premium expenses for the individual, spouse, parent or dependent. The credit may not exceed $200 or the taxpayer’s liability, whichever is less, and may not be carried over to succeeding years.

In Louisiana, Senator Schedler introduced S.B. 47 on April 24, 2000. This measure would create a long-term care income tax credit for Louisiana citizens.

Legislation in Maine, known as H.P. 33, which was sponsored by the Commission on Rate Setting, passed the House on April 7, 2000 and was placed on the special appropriations table on April 8, 2000. This measure would improve the dissemination of information to the public concerning long-term care and would require the state Bureau of Insurance to report on long-term care tax credits.

New York A.B. 2684, which was introduced by Assembly Member Cook, passed the Senate on April 17, 2000 and was assigned to the Senate Committee on Insurance. This legislation would establish that long-term care policies be renewable annually at the option of the insured unless there is a non-payment of premiums.

Also in New York, A.B. 4009 passed the Assembly on April 17, 2000 and was assigned to the Senate Finance Committee. This legislation would authorize voluntary deductions from state employees’ salaries for long-term care insurance premiums.

Finally, New York Assembly Member Morelle introduced legislation on a long-term care tax credits on March 28, 2000. This bill was assigned to the Assembly Committee on Ways and Means on March 28, 2000.

In Virginia, the Governor signed four long-term care bills. H.B. 923 will require long-term care carriers to return unearned premiums on a pro-rata basis in the event of a policy cancellation. H.B. 1458 and S.B. 517, introduced by Representative Morgan and Senator Forbes, allow local government and school board employees to participate in a voluntary long-term care insurance program made available to them by the state Department of Personnel and Training. Finally, H.B. 1511, which was also sponsored by Representative Morgan, establishes limits on the contestability periods for long-term care insurance.

Managed Care Reform/Patient Protection

Legislation relating to managed care reform/patient protection was addressed in Alaska, Florida, Georgia, Hawaii, Kentucky, Maryland, Michigan, New York, Oklahoma, Tennessee and Wisconsin. On April 21, 2000 in Alaska, the House concurred with the Senate’s amendments to H.B. 121, which was sponsored by Representative Bunde. This bill relates to a patient’s right to dental care. A health plan would not be able to restrict in any way a patient’s access to a dentist when the plan contract covers dental care. The enrollee would be able to bring civil action against the health insurer if his/her right to a dentist was impeded.

Representative Villalobos in Florida introduced H.B. 149, and on March 29, 2000 it was placed on the House calendar. 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.

Representative Casey in Florida sponsored H.B. 913, which was placed on the House calendar on March 29, 2000. This measure would prohibit an HMO from denying payment to a healthcare provider for covered services unless certain conditions were met.

H.B. 1523, sponsored in Florida by Representative Sublette, was reported favorably from the House Committee on Healthcare services on April 13, 2000. This measure would not allow health insurance carriers and HMOs to be deceptive and unfair towards healthcare 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.

Senator Brown-Waite sponsored S.B. 1900 in Florida, which was placed on the Senate’s table on April 25, 2000. This measure would create the managed care organization’s patient bill of rights to provide quality healthcare and benefits to all residents of Florida. Health plan enrollees would have to be provided a copy of their rights and given the opportunity to file a civil suit against a health plan that does not exercise ordinary care when making treatment decisions. Damages against a healthcare plan can be sought in the amount of $500 or the actual cost of damages.

In Florida, another measure relating to managed care reform is S.B. 1534. This bill was sponsored by Senator Geller and reported favorably from the Senate Committee on Banking and Insurance on April 24, 2000. This bill would modify the grievance procedure for managed care organizations. A health plan subscriber would be held accountable for costs and attorney fees for court proceedings if the subscriber had filed a claim that was deemed improper.

Also in Florida, Senator Laurent introduced S.B. 706. On April 18, 2000 it was temporarily deferred from the Senate Committee on Fiscal Policy. 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.

The last bill in Florida, S.B. 2234, sponsored by Senator Saunders, was placed on the table in the Senate as of April 3, 2000. This measure would prohibit an HMO from denying payment to a healthcare provider for covered services unless certain conditions are meet.

Senator Madden, in Georgia, sponsored S.B. 334, which on April 19, 2000 was signed by the Governor. This measure specifies that all rural healthcare providers that meet certain conditions will be given the opportunity to apply to become participating providers in a healthcare plan. Health benefit plans are required to include a sufficient and reasonable number of providers located in rural areas.

In Hawaii, S.B. 2655 sponsored by Senator Chun-Oakland passed the House but the Senate did not agree to House amendments, so on April 17, 2000 it was sent to a conference committee. This measure would change the appeal process for health plan treatment decisions. Enrollees would be able to request an expedited appeal from a health plan. An expedited appeal may occur within a 72-hour review period when the enrollee’s life is in serious jeopardy or when the enrollee has severe pain that cannot be treated without the care that is the subject of the appeal.

H.B. 757, sponsored by Representative Damron, was sent to the Governor of Kentucky on April 11, 2000. This measure would provide for patient protection. A health plan would have to disclose all terms and conditions of a contract, produce a provider directory, disclose types of provider financial incentives, list the current waiting times for routine and emergency care from a participating provider and list procedures when treatment is denied. The health plan would also be required to have an adequate number of participating providers and specialists in all service areas covered by the plan. Lastly, this measure would also establish when emergency care must be covered without prior approval from plan.

In Maryland, on April 7, 2000 H.B. 669 became eligible for the Governor’s desk. This bill, which was sponsored by Representative Goldwater, would amend an existing state law to allow women 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, S.B. 405 became eligible for the Governor’s desk on April 10, 2000. This measure, which was sponsored by Senator Astle, would establish a provider payment procedure for health plans. A healthcare provider must be paid by the health plan within 30 days of filing a clean claim for services rendered. Non-participating providers must be paid either 125 percent of what the participating provider is paid for the same service or what is paid by other health plans to non-participating providers in the same service area, whichever is greater

A third bill in Maryland, S.B. 497, became eligible for the Governor’s desk on April 10, 2000. Senator Bromwell sponsored this measure that would require HMOs to be financially responsible for all payments to any external provider that renders healthcare services that are currently covered under the plan’s contract.

Four bills were recently introduced in Michigan that relate to managed care reform/patient protection. H.B. 5572, introduced by Representative Woronchak, was referred to the House on April 18, 2000. This measure would require the state Insurance Commissioner to create an HMO consumer guide. The guide would have to list for each HMO in the state; national accreditation with any limitations that were imposed, the quality-of-care rating for each HMO and a toll-free number set up by the Commissioner to receive inquiries or complaints. The Commissioner would be required to request information from the HMOs to determine the quality-of-care rating.

In the Michigan Senate, Senator Shagars introduced S.B. 1210 on April 12, 2000. It was then referred to the Senate Committee on Health Policy. This measure is similar to H.B. 5572.

H.B. 5576 was introduced in Michigan by Representative LaSata on April 12, 2000 and it was then referred to the House Committee on Health Policy. This measure would allow enrollees who were denied coverage to obtain an external independent review of the denial. Enrollees must, before requesting an external review, exhaust all internal review processes and then notify the state Insurance Commissioner. After evaluation, the Commissioner will then notify the plan of the request for an external review.

S.B. 1208, a similar measure to H.B. 5572, was introduced by Senator Schwartz in Michigan on April 12, 2000. It was then referred to the Senate Committee on Health Policy.

In New York, A.B. 4326 passed the Assembly and was sent to the Senate Committee on Social Services as of April 17, 2000. This measure, which was sponsored by Assembly Member Gottfried, would amend the social services law to require that Medicaid managed care participants be notified of the managed care grievance procedure, including their right to an external review.

A.B. 6811, sponsored by Assembly Member Grannis, passed the Assembly in New York and was then referred to the Senate Committee on Social Services on April 17, 2000. This bill would amend an existing law relating to managed care in order to increase an enrollee’s access to specialized medical care under a managed care health plan.

On April 14, 2000 in Oklahoma, the Governor signed H.B. 2183 into law. This measure which was sponsored by Representative Adair, requires health plans that already include vision care or medical treatment of the eye to allow optometrists to be an enrollee’s eye-care treatment provider. H.B. 2072 was passed by the Senate in Oklahoma and was sent to the House for concurrenceon April 18, 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 was not required to be covered by the plan.

In Oklahoma, S.B. 1588 passed the House and was sent to the Senate for concurrence on April 13, 2000. This measure was sponsored by Senator Monson and relates to the Oklahoma managed care act by modifying the definitions of terms used in the act.

Representative Kisber in Tennessee sponsored H.B. 1192, which was referred to the House Committee on Finance, Ways and Means on April 11, 2000. Managed care entities would be required by this measure to establish procedures for the prompt payment of healthcare provider claims. The health plan would be required within 10 days to determine if the claim is clean. Within 20 days the plan must either approve or deny claim, and then they would have another 10 days to pay the claim. If the plan does not comply with these set time periods, a 12 percent penalty would be added to the amount of the claim to be paid to the provider.

Two bills, S.B. 269 sponsored by Senator Breske, and S.B. 246 sponsored by Senator Rosenzweig, in Wisconsin, failed to pass pursuant to Joint Rule 1 on April 6, 2000. S.B. 269 would have required every healthcare plan to implement an internal grievance procedure as well as an independent review procedure for enrollees to utilize when treatment was denied. The enrollee would have had to exhaust the grievance procedure before requesting, with a written notice to the insurer and the insurance commissioner, an independent review.

S.B. 246 would have required insurers to establish an independent review procedure when treatment costing more than $500 was denied. The request for the review would have had to occur within a year of the treatment denial by plan. This measure would have also required the health plan to send along with original denial, the review applications and appeal procedure information to the enrollee.

Mandated Benefits

Cancer-Related Mandates: Delaware and Maryland lawmakers addressed legislation concerning mandating coverage for cancer screening or treatment services. In Delaware, legislation was introduced by Delegate Maier that would require certain health insurance carriers and HMOs to provide coverage for certain types of colorectal cancer screening according to specified guidelines. A.B. 564 was assigned to the House Committee on Economic Development, Banking and Insurance on April 20, 2000.

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 was sent to the Governor for signature on April 7, 2000.

Also in Maryland, Senator Teitelbaum introduced a bill to require specified types of health plans to provide enrollees with coverage of colorectal cancer screening tests according to guidelines established by the American Cancer Society. S.B. 174 was defeated in the House Committee on Economic Matters on April 6, 2000.

Children’s Health Mandates: Seven states—Florida, Maine, Maryland, New York, Oklahoma, Virginia and Wisconsin—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 on April 24, 2000 and was sent to the Senate.

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 was placed on the Senate’s calendar on April 16, 2000

Finally, Florida S.B. 1836, which was sponsored by Senator Dawson, was withdrawn from consideration on April 18, 2000. This measure would have required specified insurers and HMOs to provide coverage for one routine eye examination for children annually.

Maine lawmakers also took action on a newborn hearing-screening bill. The Governor signed H.P. 1260, which was introduced by Representative Fuller, on April 10, 2000. This legislation will 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, is awaiting signature by the Governor. This legislation would prevent specified health plans, carriers and HMOs from denying coverage for rehabilitation services for enrolled children under certain circumstances.

New York S.B. 7225, sponsored by Senator LaValle, 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. This legislation was amended in the Senate Insurance Committee on April 13, 2000.

Representative Cox of Oklahoma sponsored H.B. 2576, which was signed by the Governor on April 14, 2000. This measure amended the state’s existing law mandating coverage for childhood immunizations, by excluding certain short-term health insurance policies from the definition of health benefit plan.

In Virginia, H.B. 914, by Delegate Bryant, would require certain insurers to provide coverage for all routine childhood immunizations for children from birth to age three. This bill was enacted into law on April 5, 2000.

Clinical Trial Mandates: Lawmakers in Arizona and Wisconsin took action on bills mandating coverage of clinical trial participation. In Arizona, mandate legislation introduced by Senator Soloman was sent to the Governor on April 12, 2000. S.B. 1213 would require certain health insurance carriers to cover expenses incurred by enrollees participating in certain clinical trials for the treatment of cancer.

Wisconsin A.B. 672 by Assembly Member Richards was defeated on April 6, 2000 pursuant to S.J.R. 1. This measure would have required certain health insurance carriers to provide coverage for healthcare costs incurred by enrollees during clinical trial participation for the treatment of cancer in children under specified conditions.

Contraceptive Mandates: Delaware, Iowa, Massachusetts, Rhode Island and Wisconsin all addressed legislation concerning coverage of contraceptives. On April 12, 2000 the Delaware House Committee on Appropriations reported S.B. 87 out of the committee without issuing a recommendation. This bill, which was sponsored by Senator Henry last session, would require insurance coverage of all FDA-approved prescription contraceptive drugs and devices.

Iowa S.F. 2126 was signed into law on April 20, 2000. This measure would require specified types of insurers to provide coverage for prescription contraceptive drugs, devices and services. Senator Johnson was the sponsor of this measure.

The Senate Committee on Ways and Means in Massachusetts introduced S.B. 2155 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 churches or church-controlled organizations would not be required to offer these benefits in plans they provide to employees.

In Rhode Island, Representative Ajello’s bill, H.B. 7574 passed the House Committee on Health, Education and Welfare as amended on April 4, 2000. This legislation would mandate insurance coverage for all federally approved contraceptive drugs, devices and related services.

Legislation introduced last year by Wisconsin Assembly Member Berceau was defeated on April 6, 2000 pursuant to S.J.R. 1. This legislation would have required all health insurers, including managed care entities, which provide coverage for outpatient health services to also cover contraceptive articles and services.

Drug-related Mandates: In California, Connecticut and Hawaii, lawmakers took action on drug-related mandates. California S.B. 2046 would amend the state’s existing law prohibiting certain insurers from excluding coverage for prescription drugs on the basis that the drugs were not approved for marketing by the FDA for the prescribed indication if certain conditions are met. This legislation specifies that one of the acceptable conditions is if a drug is prescribed for a disabling or chronic condition.

Connecticut S.B. 582 addresses the issue of drug formularies by requiring all insurers with restrictive formularies to provide reasonable access and coverage of all prescription drugs and all drugs on the formulary. This bill, which was written by the Senate Insurance Committee, was reported out of the Legislative Commissioner’s office on April 13, 2000 as substituted and reissued with file number 605.

Two bills in Hawaii, S.B. 2657 by Senator Chun-Oakland and H.B. 2392 by Representative Kawakami, were pending in a conference committee as of April 16, 2000. Each of these measures 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.

Infertility Mandates: Legislation concerning insurance coverage of infertility diagnosis and treatment services was addressed by the legislatures of California, Oklahoma and Wisconsin 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 April 10, 2000 and amended. The measure was then re-referred to the Senate Committee on Rules.

In Oklahoma, Representative Davis’ bill, H.B. 1338, passed the Senate on April 11, 2000 as amended and was re-referred to the House for concurrence. This bill would require certain health insurance carriers to provide coverage for the diagnosis of infertility, as well as for specific infertility treatments.

A.B. 565, introduced by Assembly Member Wasserman of Wisconsin, was defeated on April 6, 2000 according to S.J.R. 1. This bill would have required certain insurers to provide coverage for the diagnosis and treatment of infertility.

Other Mandates: Statelawmakers 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:

Connecticut S.B. 406 would require specified health insurance carriers to provide coverage for pain treatment and provide enrollees with access to pain treatment specialists. This measure would also prohibit carriers from penalizing providers who order care consistent with the provisions of this act. This legislation, which was introduced by the Senate Committee on Insurance, passed the Senate on April 18, 2000 and was referred to the House.

In Florida, S.B. 996, which was introduced by Senator Clary, was temporarily deferred on April 5, 2000. This legislation would require certain private insurers and managed care entities to cover clinical laboratory services under specified conditions.

Iowa H.F. 754 passed the House on April 10, 2000 and replaced its companion legislation, S.F. 2408, in the Senate. This bill, which was introduced by the House Committee on Human Resources, would require certain health insurers and HMOs to provide coverage for general anesthesia and related hospitalization and facilities charges when they are determined to be necessary for patient treatment.

Virginia S.B. 541 was enacted into law on April 5, 2000. This measure will require certain health insurers, HMOs and the state employees health benefit plan to offer coverage for the treatment of morbid obesity through either gastric bypass surgery or other means recognized by the National Institutes of Health as effective for the treatment and reversal of morbid obesity.

Medical Savings Accounts

In Colorado, H.B. 1295 sponsored by Representative Lawrence was postponed indefinitely as of April 17, 2000. This bill would amend the state’s existing law concerning health insurance tax incentives by replacing the term “tax deduction” with “tax credit.” A tax credit would be available to employers who contribute to MSAs for employees. The credit would equal 25 percent of the total amount the employer contributed, but the credit could not exceed $50,000 per year. Any credit that exceeded the employer’s tax liability could have been carried over and used during the following five years.

Mental Health and Substance Abuse Parity

Parity legislation was addressed by six states—Alaska, California, Kansas, Massachusetts, New Hampshire and Wisconsin. In Alaska, legislation introduced by Representative Davis, passed the House Committee on Health, Education and Social Services on April 15, 2000 and was assigned to the House Committee on Labor and Commerce. This bill would repeal existing provisions concerning the termination of required mental health coverage.

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 amended on the Senate floor and sent back to the Senate Committee on Insurance on April 10, 2000.

Kansas S.B. 547 passed the Senate on April 7, 2000 and was referred to the House. This bill, which was sponsored by the members of the Senate Committee on Financial Institutions, would require certain types of health insurance to include coverage for specified types of mental health conditions.

In Massachusetts, the conference committee considering S.B. 2036, concerning insurance coverage of certain biologically based mental illnesses for active and retired Commonwealth employees, introduced S.B. 2172 as substitute text on April 12, 2000. On April 24, the conference committee’s bill was adopted and sent to the Governor for approval.

Representative Crosby of New Hampshire introduced H.B. 1134 in January of 2000, and April 7, 200 it was signed into law. This legislation creates a state committee to investigate mental health treatment services provided by managed care plans in the state.

Finally, in Wisconsin, A.B. 793 by Assembly Member Bock and S.B. 308 by Senator Panzer both failed to pass pursuant to S.J.R. 1. Both of these measures would have required insurance coverage of specified nervous and mental disorders, including alcoholism and other drug abuse problems.

Ombudsman

Senator Madden sponsored S.B. 479 in Georgia. The Governor signed this measure on April 19, 2000. This measure creates a state mental health, mental retardation and substance abuse ombudsman. The position is a full-time employee that works for the consumers’ insurance advocate in the Governor’s office. The ombudsman advocates the rights of those with disabilities, and promotes their well being and quality of life. One duty of the ombudsman is 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.

Michigan H.B. 5686 was introduced on April 27, 2000 by Representative Hart, and is pending in the House Committee on Health Policy. H.B. 5686 would authorize the creation of a managed care ombudsman’s office within the state’s legislative council. The managed care ombudsman, who would be appointed and governed by the state legislative council, would run the office. The duties of the managed care ombudsman would include advising the legislature on managed care issues, addressing managed care issues involving the state Department of Community Health and/or the Insurance Bureau of the state Department of Consumer and Industry Services and researching matters that impact the quality, delivery, cost and operation of managed care for consumers. In addition, the ombudsman would be required to serve as a resource to consumers who have managed care concerns.

The Uninsured

Legislation in Arizona sponsored by Representative Knaperak was sent to the Governor on April 18, 2000. This 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.