H. B. 4016
(By Delegate Walters)
[Introduced January 10, 1996; referred to the
Committee on Banking and Insurance then Finance.]
A BILL to amend chapter thirty-three of the code of West
Virginia, one thousand nine hundred thirty-one, as amended,
by adding thereto a new article, designated article
fifteen-c, relating to requiring that all mandated health
insurance benefits be reviewed.
Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one
thousand nine hundred thirty-one, as amended, be amended by
adding thereto a new article, designated article fifteen-c, to
read as follows:
ARTICLE 15C. MANDATED BENEFITS REVIEW ACT.
§33-15C-1. Short title.
This act may be cited as the "Mandated Benefits Review Act."
§33-15C-2. Statement of purpose.
The purpose of this article is to provide for independent
review of mandated benefits. This article requires that all
existing mandated health benefits, proposals or an amendment to
a proposal for mandated benefits, mandated health insurance
coverage, and mandated offerings of health benefits be
accompanied by independently certified documentation with regard
to the proposals' social impact, medical efficacy and financial
§33-15C-3. Mandated health benefits review panel.
(a) Documentation. -- Proposals or an amendment to a
proposal for mandated health benefits or mandated health
insurance coverage shall be accompanied by adequate independently
certified documentation defining the proposals' social impact,
medical efficacy and financial impact.
Mandated benefits shall include:
(1) Any mandated coverage for specific services, treatments
(2) Any mandated direct reimbursement to specific health
(3) Any mandated offering for specific services, treatments
or practices; and
(4) Any mandated reimbursement amount to specific health
(b) Report. -- Every person or organization which promotes
or seeks sponsorship of a legislative proposal or an amendment to
a proposal which does or would mandate a health coverage or
offering of a health coverage by an insurance carrier, health
care service contractor or health maintenance organization as a
component of individual or group policies shall submit a report
to the legislative committee having jurisdiction. The committee
shall refer the proposal or any amendment to a proposal for
review to the mandated benefits review panel created by this
(c) Panel. -- The panel shall consist of three senior
researchers, two being experts in health research or
biostatistics chosen from universities within the state and the
third a senior research associate, each appointed by the
secretary of health and human resources.
(d) Panel's report. -- The panel will review the
documentation submitted with the proposed legislation and will
issue a report within thirty days as to:
(1) Whether the information is complete;
(2) Whether the research cited meets professional standards;
(3) Whether all relevant research has been brought to light;
(4) Whether the conclusions and interpretations drawn from
the evidence are consistent with the data presented. If the
panel reaches a favorable conclusion on all points, the
documentation will be certified accordingly. If the panel finds
the documentation deficient, the panel will identify the
deficiencies. The panel shall judge the completeness of the
information provided and the validity of the conclusions drawn,
based on the facts presented, but shall not comment upon the
merits or desirability of the proposal.
(e) Guidelines. -- The panel shall apply the following
guidelines in determining the adequacy of the information
(1) Evidence of social impact, to what extent is the
treatment or service:
(A) Needed by the people of this state;
(B) Available to the people of this state; and
(C) Utilized by the population of this state.
(2) If insurance coverage is not generally in place, the
panel should determine to what extent does the lack of coverage
result in inadequate health care and/or major financial hardship.
(3) The panel should determine what indications are there of
demand for the proposed health care coverage from the public at large and in collective bargaining negotiations.
(4) The panel should determine if all relevant findings
bearing on social impact have been presented.
(5) Evidence of medical efficacy:
(A) If the legislation seeks to mandate coverage of a
(i) The results of at least one professionally acceptable,
controlled trial demonstrating the medical consequences of that
therapy compared to no therapy and to alternatives therapies; and
(ii) The results of any other relevant research.
(B) If the legislation seeks to mandate coverage of
additional class of practitioners:
(i) The results of at least one professionally acceptable,
controlled trial demonstrating the medical results achieved by
the additional class of practitioners relative to those already
(ii) The results of any relevant research.
(6) Review evidence of financial impact:
(A) To what extent will the coverage increase or decrease
the cost of treatment or service;
(B) To what extent have similar mandates affected charges,
costs and payments experienced in other states with such
(C) To what extent will the coverage increase the
appropriate use of treatment or service;
(D) To what extent will the mandated treatment or service be
a substitute for more expensive or less expensive treatment or
(E) To what extent will the coverage increase or decrease
the administrative expenses of insurance companies in the premium
and administrative expenses of policyholders;
(F) To what extent do existing mandates meet the
requirements of this article;
(G) What will be the financial impact of this coverage on
small employers, medium-sized employers and large employers; and
(H) What will be the impact of this coverage on the total
cost of health care.
§33-15C-4. Review of existing mandated benefits.
(a) In addition to the duties prescribed by this article,
the panel shall undertake a separate and complete review of all
existing state mandated benefits, mandated health insurance
coverage, and mandated offerings of health benefits in the same
manner as prescribed in sections two and three of this article.
The panel shall report its findings of existing state mandated
benefits, mandated health insurance coverage, and mandated
offerings of health benefits to the legislative committee having jurisdiction no later than the first day of January, one thousand
nine hundred ninety-eight.
(b) All existing mandated benefits, mandated health
insurance coverage, and mandated offerings of health benefits
shall expire within one year after the effective date of this
article unless specifically reauthorized by the Legislature on
the basis of the review required under subsection (a) of this
NOTE: The purpose of this bill is to require that all
mandated health insurance benefits be reviewed with regard to
social impact, medical efficacy and financial impact.
This article is new; therefore, strike-throughs and
underscoring have been omitted.