House File 2128 - Introduced
HOUSE FILE
BY TOMENGA, CLUTE, R. OLSON, MAY,
JACOBY, HOFFMAN, BUKTA, FOEGE,
ANDERSON, BAILEY, MASCHER, and
WIENCEK
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act establishing a state health insurance mandate commission.
2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
3 TLSB 5301HH 82
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PAG LIN
1 1 Section 1. NEW SECTION. 514C.23 STATE HEALTH INSURANCE
1 2 MANDATE COMMISSION.
1 3 1. DEFINITIONS. As used in this section, unless the
1 4 context otherwise requires:
1 5 a. "Carrier" means an entity subject to the insurance laws
1 6 and regulations of this state, or subject to the jurisdiction
1 7 of the commissioner, that contracts or offers to contract to
1 8 provide, deliver, arrange for, pay for, or reimburse any of
1 9 the costs of health care services, including an insurance
1 10 company offering sickness and accident plans, a health
1 11 maintenance organization, a nonprofit health service
1 12 corporation, an organized delivery system, or any other entity
1 13 that provides a plan of health insurance, health benefits, or
1 14 health services.
1 15 b. "Commissioner" means the Iowa commissioner of
1 16 insurance.
1 17 c. "Mandated health care benefit" means coverage that is
1 18 required or required to be offered under this chapter or other
1 19 state law in an individual or group hospital or health care
1 20 service contract if the law mandating coverage does any of the
1 21 following:
1 22 (1) Stipulates coverage for specific health care services,
1 23 benefits, technologies, or treatments.
1 24 (2) Places limitations or restrictions on deductibles,
1 25 coinsurance, copayments, or annual or lifetime maximum benefit
1 26 amounts.
1 27 (3) Designates a specific category of health care provider
1 28 from whom an insured is entitled to receive care.
1 29 (4) Requires coverage for all services that a health care
1 30 provider recommends that are consistent with "generally
1 31 accepted principles of professional medicine" or a similar
1 32 standard.
1 33 (5) Requires a specific level of payment or rate of
1 34 reimbursement.
1 35 d. "Small employer" means a person actively engaged in
2 1 business who, on at least fifty percent of the employer's
2 2 working days during the preceding year, employed not less than
2 3 two and not more than fifty full=time equivalent eligible
2 4 employees, as defined in section 513B.2.
2 5 2. EVALUATION BY COMMISSION.
2 6 a. When a bill is requested, the legislative services
2 7 agency shall make an initial determination of whether the bill
2 8 contains a requirement for a mandated health care benefit. If
2 9 a mandated health care benefit may be required as a result of
2 10 the bill, that fact shall be included in the explanation of
2 11 the bill.
2 12 b. A bill containing a notice that the bill contains a
2 13 requirement for a mandated health care benefit shall not be
2 14 voted out of a standing committee of the house of
2 15 representatives or the senate until the chairperson of the
2 16 committee has referred the bill to the commissioner for review
2 17 and evaluation by the state health insurance mandate
2 18 commission created in this section and a report has been
2 19 received from the commission by the speaker of the house of
2 20 representatives and the president of the senate.
2 21 c. Upon referral of such a bill to the commissioner, the
2 22 commissioner shall convene the state health insurance mandate
2 23 commission to conduct a review and evaluation of the bill.
2 24 The commission shall prepare a written report, with the
2 25 assistance of the commissioner, that sets forth the
2 26 commission's findings, evaluations, and recommendations. The
2 27 completed report shall be transmitted to the speaker of the
2 28 house of representatives and to the president of the senate
2 29 within ninety days from the date the commissioner receives
2 30 referral of the bill. The report shall include a financial
2 31 impact analysis performed by an actuary who is a member of the
2 32 American academy of actuaries and who certifies that the
2 33 analysis is consistent with accepted actuarial techniques.
2 34 d. The report shall include but is not limited to a review
2 35 and evaluation of all of the following, to the extent that the
3 1 information is available:
3 2 (1) Public impact, including all of the following:
3 3 (a) The extent to which the mandated health care benefit
3 4 is generally utilized by a significant portion of the
3 5 population.
3 6 (b) The extent to which insurance coverage for the
3 7 mandated health care benefit is already generally available,
3 8 and if coverage is not generally available, the extent to
3 9 which the lack of coverage results in persons forgoing
3 10 necessary health care treatments or results in unreasonable
3 11 financial hardship to patients.
3 12 (c) The extent to which the mandated health care benefit
3 13 is covered by self=funded employers' groups.
3 14 (d) The level of public demand for the mandated health
3 15 care benefit.
3 16 (e) The level of public demand for insurance coverage of
3 17 the mandated health care benefit.
3 18 (f) The level of interest of collective bargaining agents
3 19 in negotiating privately for inclusion of the coverage in
3 20 group health insurance contracts.
3 21 (2) Medical impact, including all of the following:
3 22 (a) The extent to which the mandated health care benefit
3 23 is recognized by the medical community as being effective in
3 24 the treatment of patients.
3 25 (b) The extent to which the mandated health care benefit
3 26 is recognized by the medical community as being effective as
3 27 demonstrated by a review of scientific and peer=reviewed
3 28 literature.
3 29 (c) The extent to which the mandated health care benefit
3 30 is available and utilized by health care providers in the
3 31 state.
3 32 (d) The extent to which the mandated health care benefit
3 33 makes a positive contribution to the health status of the
3 34 population, including the ramifications of using alternatives
3 35 to or not providing the mandated health care benefit.
4 1 (e) The extent to which the mandated health care benefit
4 2 would diminish or eliminate access to currently available
4 3 health care services.
4 4 (3) Financial impact, including all of the following:
4 5 (a) The extent to which the mandated health care benefit
4 6 will increase or decrease the cost of health care benefits
4 7 over the next five years.
4 8 (b) The extent to which the mandated health care benefit
4 9 will increase the appropriate use of the health care benefit
4 10 over the next five years.
4 11 (c) The extent to which the mandated health care benefit
4 12 will be a substitute for a more expensive health care benefit
4 13 over the next five years.
4 14 (d) The impact of the mandated health care benefit on
4 15 small employers.
4 16 (e) The extent to which the costs resulting from lack of
4 17 coverage for the mandated health care benefit are currently
4 18 paid by or will be shifted to other payers, including both
4 19 public and private entities.
4 20 (f) The extent to which the mandated health care benefit
4 21 will increase or decrease the administrative expenses of
4 22 carriers and the premiums and administrative expenses of
4 23 policyholders.
4 24 (g) The impact of the mandated health care benefit on the
4 25 total cost of health care over the next five years.
4 26 3. COMMISSION == ESTABLISHMENT.
4 27 a. A state health insurance mandate commission is
4 28 established to review legislation that proposes to mandate
4 29 health care benefits in this state.
4 30 b. The commission shall consist of the following members:
4 31 (1) The commissioner or the commissioner's designee.
4 32 (2) The chairperson and the ranking member of the senate
4 33 commerce committee or designees of either, both of whom shall
4 34 be ex officio, nonvoting members of the commission.
4 35 (3) The chairperson and the ranking member of the house
5 1 commerce committee or designees of either, both of whom shall
5 2 be ex officio, nonvoting members of the commission.
5 3 (4) Five members appointed by the governor, one of whom
5 4 shall be a representative of a small employer, one a
5 5 representative of a large employer, one a member of a
5 6 collective bargaining unit, one a person who has individual
5 7 health insurance coverage, and one representing the general
5 8 public.
5 9 (5) Four members appointed by the commissioner, one of
5 10 whom shall be an expert in the field of health insurance, one
5 11 an expert in medical research, one an expert in the field of
5 12 social sciences, and one an actuary.
5 13 c. Members of the commission who are appointed shall be
5 14 appointed for three=year terms and shall be balanced as to
5 15 political affiliation as provided in section 69.16. However,
5 16 a member shall serve until a successor has been appointed and
5 17 qualified. A vacancy on the commission shall be filled for
5 18 the unexpired portion of the regular term in the same manner
5 19 as regular appointments are made.
5 20 d. Members of the commission shall receive a per diem and
5 21 mileage, at the same rate that is paid to members of the
5 22 general assembly, when attending to the duties of the
5 23 commission.
5 24 e. The commission shall not conduct business until all
5 25 members of the commission have been appointed or selected and
5 26 qualify. A majority of the members of the commission shall
5 27 constitute a quorum. The commissioner or the commissioner's
5 28 designee shall serve as chairperson of the commission.
5 29 f. Staff and administrative support for the commission
5 30 shall be furnished by the insurance division.
5 31 g. The commission may do all of the following:
5 32 (1) Hold public hearings.
5 33 (2) Conduct research.
5 34 (3) Receive testimony from experts.
5 35 (4) Review, for purposes of comparison, the health
6 1 benefits mandated in other states and the jurisdiction and
6 2 effect of such mandates.
6 3 (5) Contract with experts to develop needed data
6 4 concerning a proposed mandate.
6 5 (6) Perform other actions necessary to accomplish the
6 6 commission's assigned tasks.
6 7 4. COMMISSION BUDGET.
6 8 a. The commissioner shall propose a budget for the first
6 9 year of operation of the state health insurance mandate
6 10 commission, subject to the approval of the state health
6 11 insurance mandate commission.
6 12 b. On or after July 1, 2009, and each July 1 thereafter,
6 13 the state health insurance mandate commission shall review the
6 14 costs of the commission's operation for the preceding year and
6 15 develop a budget for the commission's operation for the
6 16 current fiscal year.
6 17 5. RULES. The commissioner shall adopt rules deemed
6 18 necessary for the administration of this section in accordance
6 19 with chapter 17A.
6 20 EXPLANATION
6 21 This bill adds new Code section 514C.23 creating a state
6 22 health insurance mandate commission consisting of 14 specified
6 23 members and chaired by the commissioner of insurance or the
6 24 commissioner's designee.
6 25 The bill provides that when a bill is requested, the
6 26 legislative services agency shall make an initial
6 27 determination of whether the bill contains a requirement that
6 28 a mandated health care benefit be offered in all individual or
6 29 group hospital or health care service contracts in this state,
6 30 and if so, notice of that fact must be included in the
6 31 explanation of the bill.
6 32 The bill further provides that if such a notice is included
6 33 in the explanation of the bill, the bill shall not be voted
6 34 out of a standing committee of the house of representatives or
6 35 the senate until the chairperson of the committee has referred
7 1 the bill to the commissioner of insurance for findings,
7 2 evaluations, and recommendations by the state health insurance
7 3 mandate commission. The bill provides that upon receiving
7 4 such a referral, the insurance commissioner shall convene the
7 5 commission, and after completing its review and evaluation the
7 6 commission shall prepare and transmit a written report to the
7 7 speaker of the house of representatives and to the president
7 8 of the senate setting forth the commission's findings,
7 9 including an evaluation of the public, medical, and financial
7 10 impacts, to the extent that the information is available, of
7 11 the proposed mandated health care benefit within 90 days from
7 12 the date the commissioner receives referral of the bill. The
7 13 report must include a financial impact analysis performed by
7 14 an actuary who is a member of the American academy of
7 15 actuaries and who certifies that the analysis is consistent
7 16 with accepted actuarial techniques.
7 17 The bill provides for the organization of the state health
7 18 insurance mandate commission, including three=year terms for
7 19 appointed members, balance in political affiliation,
7 20 vacancies, compensation for a per diem and mileage, quorums,
7 21 and staff and administrative support from the insurance
7 22 division. The bill specifies that the commission may hold
7 23 public hearings, receive testimony from experts, compare
7 24 health benefits mandated in other states, contract with
7 25 experts to develop needed data, and perform other actions
7 26 necessary to accomplish the commission's assigned tasks.
7 27 The bill also provides that the commissioner of insurance
7 28 shall propose a budget for the first year of operation of the
7 29 new commission subject to approval by the commission. The
7 30 bill provides that on or after July 1, 2009, and each July 1
7 31 thereafter, the commission shall review the costs of the
7 32 preceding year and develop a budget for the commission's
7 33 operation for the current fiscal year.
7 34 The bill allows the commissioner of insurance to adopt
7 35 rules deemed necessary for the administration of the new Code
8 1 section in accordance with Code chapter 17A.
8 2 LSB 5301HH 82
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