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PA Bulletin, Doc. No. 99-2098



Mandated Benefits

[29 Pa.B. 6291]

   Section 9 of Act 34 of 1993 requires that the Health Care Cost Containment Council review existing or proposed mandated health benefits on request of the executive and legislative branches of government. The Council has been requested by Senator Edwin G. Holl, Chairperson of the Senate Banking and Insurance Committee, to review House Bill 854, Printers Number 2459 (Micozzie), the Medical Foods Insurance Coverage Act. House Bill 854 would require health insurance policies to provide coverage for low protein modified food products for the treatment of phenylketonuria (PKU), branched-chain ketonuria, galactosemia and hemocystinuria. Coverage would be limited to $2,500 for an insured individual for any continuous period of 12 months.

   The Council is requesting that anyone supporting or opposing these mandated insurance benefits provide six copies of such documentation to the Council no later than February 11, 2000. The documentation should be mailed to Flossie Wolf, Health Care Cost Containment Council, 225 Market Street, Suite 400, Harrisburg, PA 17101.

   Documentation submitted should be in accordance with any or all of the following information categories described in section 9 of Act 34:

   (i)  The extent to which the proposed benefit and the services it would provide are needed by, available to and utilized by the population of the Commonwealth.

   (ii)  The extent to which insurance coverage for the proposed benefit already exists, or if no such coverage exists, the extent to which this lack of coverage results in inadequate health care or financial hardship for the population of the Commonwealth.

   (iii)  The demand for the proposed benefit from the public and the source and extent of opposition to mandating the benefit.

   (iv)  All relevant findings bearing on the social impact of the lack of the proposed benefit.

   (v)  Where the proposed benefit would mandate coverage of a particular therapy, the results of at least one professionally accepted, controlled trial comparing the medical consequences of the proposed therapy, alternative therapies and no therapy.

   (vi)  Where the proposed benefit would mandate coverage of an additional class of practitioners, the results of at least one professionally accepted, controlled trial comparing the medical results achieved by the additional class of practitioners and those practitioners already covered by benefits.

   (vii)  The results of any other relevant research.

   (viii)  Evidence of the financial impact of the proposed legislation, including at least:

   (A)  The extent to which the proposed benefit would increase or decrease cost for treatment or service.

   (B)  The extent to which similar mandated benefits in other states have affected charges, costs and payments for services.

   (C)  The extent to which the proposed benefit would increase the appropriate use of the treatment or service.

   (D)  The impact of the proposed benefit on administrative expenses of health care insurers.

   (E)  The impact of the proposed benefits on benefits costs of purchasers.

   (F)  The impact of the proposed benefits on the total cost of health care within the Commonwealth.

Executive Director

[Pa.B. Doc. No. 99-2098. Filed for public inspection December 10, 1999, 9:00 a.m.]

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