FIRST REGULAR SESSION
SENATE BILL NO. 484
90TH GENERAL ASSEMBLY
INTRODUCED BY SENATOR YECKEL.
Read 1st time February 24, 1999, and 1,000 copies ordered printed.
TERRY L. SPIELER, Secretary.
S1934.03I
AN ACT
To amend chapter 376, RSMo, by adding thereto four new sections relating to mandated health benefits.
Section A. Chapter 376, RSMo, is amended by adding thereto four new sections, to be known as sections 376.1400, 376.1403, 376.1407 and 376.1409, to read as follows:
376.1400. As used in sections 376.1400 to 376.1409, "mandated health benefits" includes, but is not limited to, either or both of the following:
(1) Any required coverage, or required offering of coverage, for the expenses of specified services, treatments, diseases, or lengths of stay under any policy, contract, plan or other arrangement providing sickness and accident or other health care benefits to policyholders, subscribers, members or other beneficiaries;
(2) Any required direct reimbursement, or required amount of reimbursement, of health care providers under any policy, contract, plan or other arrangement providing sickness and accident or other health care benefits to policyholders, subscribers, members or other beneficiaries.
376.1403. 1. There is hereby created the "Mandated Health Benefits Review Commission".
2. The commission, in accordance with section 376.1407, shall evaluate the social and financial impact of bills that are introduced in the general assembly and that contain provisions for mandated health benefits.
3. The commission shall consist of the following members:
(1) One member of the minority party of the senate, appointed by the president pro tem of the senate;
(2) One member of the majority party of the senate, appointed by the president pro tem of the senate;
(3) One member of the minority party of the house of representatives, appointed by the speaker of the house of representatives;
(4) One member of the majority party of the house of representatives, appointed by the speaker of the house of representatives;
(5) The director of the department of health or the director's designee;
(6) The director of the department of insurance or the director's designee;
(7) One citizen representing small businesses in Missouri;
(8) One citizen representing health insurance in Missouri.
4. The members of the commission shall choose one member of the senate and one member of the house of representatives to serve as co-chairpersons of the commission. All staff for the board shall be hired by the commission and staff salaries shall be paid by the department of insurance.
5. Members of the general assembly appointed to the commission shall be members of the commission only so long as they are members of the general assembly.
376.1407. 1. If a bill contains a provision for mandated health benefits and is introduced in or is pending before the general assembly on or after the effective date of this section, the mandated health benefits review commission shall review the bill and prepare a mandated health benefits analysis in accordance with this section.
2. The commission shall prepare the mandated health benefits analysis before the bill is recommended for passage by the committee of the house of representatives or senate to which it is referred.
3. In the preparation of a mandated health benefits analysis, the commission, to the extent that information is available, shall evaluate the social and financial impact of the bill by considering, at a minimum the following:
(1) With respect to the social impact of the bill:
(a) The extent to which the proposed mandated health benefit is needed by, available to, and utilized by the public;
(b) If the proposed mandated health benefit is not generally available, the extent to which the absence of the benefit results in inadequate health care;
(c) If the proposed mandated health benefit is not generally available, the extent to which the absence of the benefit results in unreasonable financial hardship;
(d) The extent of public demand for the proposed mandated health benefit and the source and extent of opposition to mandating the benefit;
(e) The extent of public demand for the inclusion of the proposed mandated health benefit in policies, contracts, plans or other arrangements negotiated through collective bargaining;
(f) If the proposed mandated health 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;
(g) If the proposed mandated health benefit would mandate coverage of an additional class of providers, the results of at least one professionally accepted, controlled trial comparing the medical results achieved by the additional class of providers and those providers already covered.
(2) With respect to the financial impact of sections 376.1400 to 376.1409:
(a) The extent to which mandating the benefit will increase or decrease the cost of the service, treatment, or stay;
(b) The extent to which mandating the benefit will increase the appropriate use of the service, treatment, or stay;
(c) The extent to which the service, treatment or stay required to be covered will be a substitute for more expensive service, treatment, or stays;
(d) The extent to which mandating the benefit will increase or decrease the administrative expenses of policyholders, subscribers, members, or other beneficiaries under policies, contracts, plans, or other arrangements;
(e) The impact of mandating the benefit on the total cost and availability of health care and health care coverage within this state;
(f) The extent to which a similar mandated health benefit in other states has affected charges, costs, and payments for services, treatments, or stays in those states.
4. In the preparation of a mandated health benefits analysis, the commission may contract with an independent firm for actuarial analysis or may request any person, state university, or agency of the state or a political subdivision of the state to provide available information that the commission considers necessary to carry out its duties under this section.
5. The failure of the commission to prepare a mandated health benefits analysis shall not be construed as impairing the validity of any bill truly agreed to by the general assembly.
376.1409. The mandated health benefits review commission shall distribute copies of mandated health benefits analyses prepared in accordance with section 376.1407, as follows:
(1) A copy to the governor, the president pro tem of the senate, the speaker of the house of representatives, and the member of the general assembly who introduced the bill;
(2) A copy to the chairperson of the committee to which the bill is referred, together with a copy to each member of that committee.