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State Legislative Update

May 1 - May 5, 2000

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

Antitrust

In Florida, H.B. 1589, the “Healthcare Provider Joint Negotiation Act,” was withdrawn from further consideration on April 27, 2000. This legislation, which was sponsored by Representative Lawson, would have allowed collective negotiations by physicians with health benefit plans under certain circumstances.

Representative Trakas, of Ohio, introduced H.C.R. 65 on May 2, 2000. The resolution was then assigned to the House Committee on Rules and Reference. This measure requests that the U.S. Congress enact H.R. 1304, which would establish a federal antitrust waiver for physicians.

Children’s Health Insurance Program (CHIP)

Action was taken on CHIP-related legislation in seven states—California, Colorado, Florida, Hawaii, Maryland, New Jersey and New York. In California, S.B. 2020 was introduced on February 25, 2000. On April 26, 2000, the bill was passed as amended by the Committee on Health and Human Services and was sent to the Committee on Insurance. 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 parents and legal guardians of uninsured pupils determine eligibility for available health insurance programs for children, as well as assist with the application process.

Senator Sher introduced California S.B. 1821 on February 24, 2000. On April 26, 2000 this bill passed the Senate Committee on Appropriations. S.B. 1821 would deem children who are eligible for certain social services programs to be income-eligible for the Medi-Cal program and the Healthy Families program.

In Colorado, S.B. 223 was introduced on April 12, 2000, and on May 3, 2000 it passed both the House and Senate. This bill would make changes to the non-Medicaid state-subsidized insurance program known as the Children’s Basic Health Plan.

In Florida, H.B. 1781 was introduced on March 8, 2000. On April 27, 2000 it was placed on the House calendar. This measure relates to healthcare assistance for children, and it requires the Social Services Estimating Conference to develop certain information relating to the Florida Kidcare program.

In Hawaii, Representative Arakaki introduced H.B. 540 on January 22, 2000. On April 28, 2000 the conference draft of this measure was sent to the Governor. H.B. 540 would provide CHIP coverage to all children with family incomes of up to 300 percent of the federal poverty-level, and it would provide health insurance to all permanent legal immigrant residents, permanent residents under the cover of law, and persons from countries of the Compact of Fall Association.

In Maryland, Senator Miller introduced S.B. 863 on February 24, 2000. On April 25, 2000 the Governor signed this bill. S.B. 863 alters the family income-level eligibility requirements for CHIP participation and repeals the requirement that individuals must pay a specified annual family contribution in order to participate in CHIP.

Representative Taylor introduced Maryland H.B. 2 on January 12, 2000. On April 25, 2000 the bill was signed by the Governor. H.B. 2 expands eligibility for CHIP to those under a private-option plan. The bill requires that those enrolled in CHIP receive health benefits through either an employer-sponsored health benefit plan or through a managed care organization. This measure also establishes standards for health benefit plans participating in the program.

In New Jersey, A.B. 2035 and A.B. 461 were introduced. Both bills were assigned to the Assembly Committee on Appropriations. These bills would establish programs through New Jersey’s Kidcare to help certain dependent children purchase employer-sponsored health coverage through subsidies and state financial assistance.

In New York, A.B. 10938 was introduced on April 24, 2000 and assigned to the Assembly Committee on Health. This bill would prohibit approved organizations providing coverage under the CHIP plan from discriminating against healthcare providers that do not participate in the organization’s healthcare network.

Genetic Discrimination

California Assembly Member Papan introduced legislation to prohibit any insurance producer or underwriter from disclosing any individually identifying information about a customer’s health, or medical or genetic history. On May 2, 2000, A.B. 2797 was read on the Assembly floor for the second time and amended. It was then referred back to the Assembly Appropriations Committee.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

In Hawaii, Rep. Hiraki introduced H.B. 2797 on January 27, 2000. The House disagreed with the Senate’s amendments, and on April 16, 2000 the measure was sent to a conference committee. H.B. 2797 passed as amended in the conference draft. This bill requires 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 on April 25, 2000. The House concurred to Senate amendments on April 30, 2000. 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.

S.B. 424 was introduced by Senator Campbell in Florida on March 7, 2000, and was withdrawn from any further consideration on April 27, 2000. This legislation would have established 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 have been 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 Governor of Maine signed the legislation into law on April 27, 2000. This bill creates an independent external review process, establishes an enrollee’s right to sue health plans, grants broader access to specialists, prohibits financial incentives to providers and grants greater access to clinical trials.

Health Purchasing Cooperatives

In Florida, Senator King sponsored S.B. 2086, and on May 4, 2000 it was sent to enrollment. This measure would insure small employers under health insurance policies that would be issued to small employer health alliances, which 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.

High-Risk Health Insurance Pools

Representative Hebert sponsored Louisiana H.B. on April 26, 2000, and on May 2, 2000 it was assigned to the House Committee on Ways and Means. This bill would establish admission taxes on hospital and ambulatory surgery center stays in order to help fund losses from the Louisiana High Risk Health Pool.

Long-Term Care

Action was taken on long-term care legislation in California, Connecticut and Maine. California S.B. 2111 passed the Senate Committee on Insurance on April 26, 2000 and was assigned to the Appropriations Committee. This bill, which was introduced by Senator Dunn, would amend existing law about the consumer long-term care guide to include sections on rate histories and policy comparisons. In addition, the long-term care personal worksheets used by agents would be required to include a reference to the rate guide and information on where copies may be obtained.

In Connecticut, H.B. 5123 became law on April 20, 2000. This legislation was introduced by the Committee on Insurance, and it establishes that a life insurance policy with long-term care benefits may include a rider providing that the long-term care benefits are payable upon exhaustion of the life benefits, and the elimination period only may apply to the life policy to which the rider is attached. Attaching an elimination period to the rider is prohibited.

Finally, H.P. 33, which was sponsored by the Commission on Rate Setting in Maine, was removed from the special appropriations table on April 26, 2000. This measure recommends that the Commission examine long-term care rate settings in the state, and it would improve public education about long-term care and require the state Bureau of Insurance to report on long-term care insurance tax credits.

Managed Care Reform/Patient Protection

Representative Newton in Alabama introduced H.B. 874, which would give the state Commissioner of Insurance the authority to disapprove of any HMO policy that does not meet federal requirements. The state Commissioner of Insurance would also be required to approve health plan contracts in the state before they were issued. H.B. 874 was reported favorably with an amendment from the House Committee on Health on April 19, 2000.

On May 3, 2000 in Colorado, H.J.R. 1025, which was introduced by Representative Hagedorn, was deemed lost. This resolution would have urged Congress to amend the Employee Retirement Security Act of 1974 (ERISA) to include consumer protections and mandated benefits for self-funded insurance plans like those required of other health plans existing under Colorado state laws.

Five bills relating to managed care reform or patient protection had recent legislative activity in Florida. Senator Laurent sponsored S.B. 706, which was placed on the Senate’s table on April 25, 2000. 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.

S.B. 1508, sponsored by Senator Brown-Waite, was sent to enrollment on May 4, 2000. This measure was combined with S.B. 706. S.B. 866, sponsored by Senator King in Florida, died on the Senate’s special order calendar on May 5, 2000. This measure states that an HMO contract could not have prohibited or restricted a physician’s ability to provide hospital services to enrollees of a health plan. The HMO would not have been able to deny payment to the provider for hospital services when they were medically necessary.

Representative Villalobos introduced H.B. 149, which was similar to S.B. 866. This measure died in the Senate on May 5, 2000.

S.B. 1580 was withdrawn from any further consideration on April 27, 2000 in Florida. This measure, sponsored by Senator Campbell, would have provided a grievance process for health plan subscribers. Grievances brought by health plan subscribers against an HMO would have been required to go through a formal internal appeals process. If a subscriber was unhappy with the internal appeal decision, then an external appeal could have been sought. The state Healthcare Administration would have overseen the appeals process and determined if it was followed correctly.

The Georgia Governor signed S.B. 432 into law on April 27, 2000. Senator Polak sponsored this act, which amends an existing state law relating to insurance. S.B. 432 requires those individuals that make treatment decisions to posses either a bachelors or higher degree in any health related field that is specified by the state Insurance Commissioner.

In Hawaii, Senator Chun-Oakland introduced S.B. 2655 on January 26, 2000, which was sent to the Governor on May 3, 2000. This measure would change the appeal process for a contested health plan treatment decision. Enrollees would be able to request an expedited appeal from the health plan. An expedited appeal could occur within a 72-hour review period when the enrollee’s life was in serious jeopardy or when the enrollee had severe pain that could not be treated without the care that is the subject of the appeal.

Two bills in Michigan had recent legislative activity. H.B. 5683 was introduced by Representative Woodward on April 26, 2000 and then referred to the House Committee on Health Policy. This measure would amend the state public health code. An enrollee would have the ability to appeal a denial of treatment to an independent medical review organization. The decision made by the review organization would be binding for both the HMO and the enrollee. This measure would also create the Office of Patient Advocacy, which would assist enrollees with appeals.

The second bill in Michigan was introduced and then assigned to the House Committee on Insurance and Financial Services on May 2, 2000. Representative Reeves sponsored H.B. 5720, which would require an HMO to provide coverage for a second opinion when requested by a health plan enrollee. The second opinion would have to be completed by a qualified health professional that was trained in the same field of medicine as the enrollee’s illness, disease or condition that requires the second opinion.

In New Hampshire, H.B. 1377, sponsored by Representative Martel, passed the House and then the Senate on April 27, 2000. This bill would prohibit managed care organizations from excluding healthcare providers that are not certified by the American Board of Medical Specialists 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.

Assembly Member Smith in New Jersey introduced A.B. 2314 on May 1, 2000. This measure would prohibit health insurance carriers that offer prescription drug coverage to require enrollees to purchase prescription drugs in the double-dose tablet or pill form. The carrier could be fined no less than $250 and no greater than $10,000 each day it is in violation of the measure.

The Senate in Oklahoma passed H.B. 2072, but the House refused to concur with the Senate’s amendments. On May 4, 2000, the House named conferees for the bill’s conference committee. 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 is not required to be covered by the plan.

Also in Oklahoma, the Senate refused to concur with the House amendments to S.B. 1588 on April 27, 2000. This measure, sponsored by Senator Monson, relates to the Oklahoma managed care act by modifying definitions of terms used in the act.

On May 2, 2000 in Rhode Island, H.B. 7468 was passed by the House and then assigned to the Senate. Representative Ginaitti sponsored this measure, which would require an HMO to provide temporary credentials to a healthcare provider while the HMO reviews the provider’s application to participate in the HMO’s network.

Senator Womack of Tennessee sponsored S.B. 2795, which was recommended for passage from the Senate Committee on Commerce, Labor and Agriculture on May 2, 2000, then referred to the Senate Committee on Finance, Way and Means. This bill specifies that HMOs may not deny payment for a pre-authorized service after the provider renders the service.

In Tennessee, on May 3, 2000, H.B. 3072 was read for a second time and held on the Senate desk. Representative Kisber introduced H.B. 3072. This bill would provide that in the case of an enrollee who has been determined by his/her physician to have a life-threatening illness, the health plan’s internal appeals procedure does not need to be completed before initiating an independent review process of a health plan’s treatment decision.

Mandated Benefits

Clinical Trial Mandates: Legislation mandating coverage of clinical trial expenses was addressed in three states—Arizona, California and Minnesota. In Arizona, Senator Solomon’s measure, S.B. 1213, became law on April 24, 2000. This bill establishes that an insurer under certain specified circumstances must cover routine patient care costs incurred by a participant in specified types of cancer clinical trials. This measure also prohibits insurer liability for any damages incurred by the patient due to treatment provided during the trial.

Senator Speier’s bill, S.B. 1838, passed the California Senate’s Insurance Committee on April 26, 2000 and was referred to the Senate Appropriations Committee. This legislation would require specified health insurance carriers to provide enrollees with coverage of routine patient care costs associated with clinical trial participation for life-threatening prostate cancer under certain specified circumstances. This coverage must be provided to enrollees on or after January 1, 2001, and the health plans must annually report to the state the number of enrollees that received coverage as a result of this mandate.

In Minnesota, S.F. 3156, which was sponsored by Senator Berglin, was assigned to the House Ways and Means Committee on April 26, 2000. This legislation would require health benefit plans to provide coverage for participation in medical clinical trials under specified conditions.

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:

Alabama S.B. 584 was introduced by Senator Escott-Russell on April 25, 2000. This measure would require that specified health benefit plans, which provide prescription drug coverage also provide enrollees with coverage for FDA-approved contraceptive drugs and devices.

In Florida, H.B. 399 was ordered enrolled on May 3, 2000. Representative Prieguez originally sponsored this legislation, and it would require certain insurers and managed care entities to provide coverage for newborn hearing screening and referrals for any necessary ongoing treatment services.

Also in Florida, S.B. 164 was passed by the Senate and sent to the House. Senator Scott sponsored this bill, and it would require specified health insurance carriers and HMOs to include coverage for the treatment of autism spectrum disorder. Insurers and HMOs would be able to confirm the diagnosis and review the appropriateness of the patient’s treatment plan.

Hawaii lawmakers approved a conference draft of H.B. 2392 on April 28, 2000. This legislation, which was introduced by Representative Kawakami, would require certain health insurance policies to cover diabetes self-management training, equipment, education and supplies, among other things.

Iowa H.F. 754 was sent to the Governor on April 25, 2000. This bill would require specified private health insurers and HMOs to provide coverage for anesthesia and hospitalization charges associated with the provision of dental care services. The House Committee on Human Resources introduced this measure.

Two mandate bills were introduced in Michigan on May 2, 2000. Representative Jacobs sponsored H.B. 5702, which requires HMOs to provide continuity of care for individuals with serious chronic illnesses. H.B. 5707 was introduced by Representative Baird and would require HMOs to provide coverage for all health services considered medically necessary. Both measures are currently pending before the House Committee on Insurance and Financial Services.

In New York, A.B. 9679 by Assembly Member Klein passed the Assembly Committee on Health and was assigned to the Assembly Committee on Ways and Means on May 2, 2000. This measure would require HMOs and other managed care entities to provide coverage for end-of-life care. These insurers would be required to establish payment rates for acute-care services, and would be prohibited from seeking reimbursement from the insured, except in the form of copayments, coinsurance, deductibles or visit fees.

Finally, in Oklahoma, H.B. 1338 was sent to the Governor for signature on May 3, 2000. This legislation would require health benefit plans to provide coverage for the diagnosis and treatment of infertility. The bill specifies that only certain types of infertility treatments would have to be covered. Representative Davis was the sponsor of this measure.

Medical Savings Accounts

Representative Alons in Iowa introduced H.R. 125 on April 25, 2000. This resolution would request that Congress enact federal legislation to equalize the tax treatment of medical savings accounts and third-party health insurance coverage.

Mental Health and Substance Abuse Parity

Parity legislation was addressed recently in four states—Florida, Massachusetts, New York and Vermont. In Florida, legislation introduced by Senator Myers was withdrawn from consideration on April 26, 2000. This legislation would have required certain group health insurers to offer coverage for mental health conditions other than serious mental illnesses.

In Massachusetts, legislation introduced last session by Senator Bernstein became law on May 2, 2000. This legislation will provide all individuals covered by the state group insurance commission for public employees with coverage for certain biologically based mental illnesses.

The New York Senate Committee on Alcoholism and Drug Abuse approved S.B. 3946 on May 2, 2000. This bill, which was introduced by Senator McGee, would establish that individuals with family plan coverage through specified types of health carriers must receive coverage for alcoholism and/or substance abuse treatment, unless such treatment was deemed unnecessary through proper channels.

Representative Alfano, of Vermont, sponsored H.B. 628, which was approved by the Senate Finance Committee as amended on April 28, 2000. This bill would require each health insurance carrier in the state to annually file a report with the state Commissioner of Banking, Insurance, Securities and Health Administration concerning quality measures for mental health and substance abuse services. The report would also have to include the company’s loss ratio for mental health and substance abuse treatment expenses. H.B. 628 is currently pending before the Senate Appropriations committee.

The Uninsured

Legislation in Arizona sponsored by Representative Knaperak became law on May 2, 2000. This legislation establishes the Premium Sharing Program in the state to help subsidize health insurance coverage for uninsured state residents. H.B. 2262 funds the program through revenues from the state’s share of the master tobacco settlement of 1998.

In Colorado, H.J.R. 1048 was adopted by the House and referred to the Senate. Representative Tochtrop sponsored this resolution, which asks the state Healthcare Task Force to report on methods to decrease the number of uninsured individuals in the state.