Keeping current with new state mandated benefits, as well as changes to existing ones, presents a continuing challenge for health insurers in the current state legislative sessions. Apart from these required benefit levels and scope of coverage, are the growing number of legislative proposals the industry has seen over the past several years.
New Jersey’s AB 989 and SB 1834 address the increasingly frequent state actions concerning the mandated coverage of oral anticancer medications on no less favorable basis than intravenous anticancer medications. Delaware’s HB 265, titled “The Delaware Cancer Treatment Access Act,” proposes that insurers make equal reimbursement for oral and intravenous anticancer medications. HB 1158 in Missouri proposes a new statutory requirement to establish equal out-of-pocket requirements for oral anticancer medications and intravenously administered chemotherapy.
Another area that states have focused on recently concerns hearing aid coverage for children. Utah’s HB 303 seeks to require a health benefit plan to cover hearing aids for children with hearing impairments. Mississippi’s HB 80 addresses coverage for hearing aids for dependent children and South Carolina’s SB 1043 also seeks to require group health insurance and group health benefit plans to cover hearing aids and replacement hearing aids for an insured with impaired hearing and who is twenty-one years of age or less.
Other legislative considerations include New Jersey’s SB 497 which would require health insurers to provide coverage for positron emission tomography to diagnose Alzheimer’s disease and Utah’s HB 211 which seeks to require coverage for the use of an amino acid-based elemental formula, regardless of the delivery method of the formula, for the diagnosis or treatment of an eosinophilic gastrointestinal disorder.
Arizona’s HB 2739 concerns the coverage of childhood and adolescent vaccines. If this bill were enacted as filed, insurers would be prohibited from:
- Imposing any deductible, copayment or other cost sharing in relation to child and adolescent vaccines recommended by the U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices
- Placing a dollar limit on childhood and adolescent immunization coverage
Another Arizona initiative, HB 2666, addresses the emerging issue of telemedicine where health insurers would be required to provide coverage for health care services provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the insured and a health care provider. Insurers would be allowed to limit the coverage to those health care providers in a telemedicine network and to impose deductibles, copayment or coinsurance requirements for this type of health care service if the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation for the same health care service.
Identifying and monitoring all the mandated benefits proposals, in many cases through to enactment, are key steps in ensuring that those bills requiring implementation are processed in a compliant and timely manner to meet the requisite state effective dates.
Keep current with mandated benefits legislative trends with NILS INsource.
