(1) LEGISLATIVE INTENT.—The Legislature finds that there is an increasing number of proposals which mandate that certain health benefits be provided by insurers and health maintenance organizations as components of individual and group policies. The Legislature further finds that many of these benefits provide beneficial social and health consequences which may be in the public interest. However, the Legislature also recognizes that most mandated benefits contribute to the increasing cost of health insurance premiums. Therefore, it is the intent of the Legislature to conduct a systematic review of current and proposed mandated or mandatorily offered health coverages and to establish guidelines for such a review. This review will assist the Legislature in determining whether mandating a particular coverage is in the public interest.
(2) MANDATED HEALTH COVERAGE; REPORT TO AGENCY FOR HEALTH CARE ADMINISTRATION AND LEGISLATIVE COMMITTEES; GUIDELINES FOR ASSESSING IMPACT.—Every person or organization seeking consideration of a legislative proposal which would mandate a health coverage or the 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 to the Agency for Health Care Administration and the legislative committees having jurisdiction a report which assesses the social and financial impacts of the proposed coverage. Guidelines for assessing the impact of a proposed mandated or mandatorily offered health coverage, to the extent that information is available, shall include:(a) To what extent is the treatment or service generally used by a significant portion of the population.
(b) To what extent is the insurance coverage generally available.
(c) If the insurance coverage is not generally available, to what extent does the lack of coverage result in persons avoiding necessary health care treatment.
(d) If the coverage is not generally available, to what extent does the lack of coverage result in unreasonable financial hardship.
(e) The level of public demand for the treatment or service.
(f) The level of public demand for insurance coverage of the treatment or service.
(g) The level of interest of collective bargaining agents in negotiating for the inclusion of this coverage in group contracts.
(h) To what extent will the coverage increase or decrease the cost of the treatment or service.
(i) To what extent will the coverage increase the appropriate uses of the treatment or service.
(j) To what extent will the mandated treatment or service be a substitute for a more expensive treatment or service.
(k) To what extent will the coverage increase or decrease the administrative expenses of insurance companies and the premium and administrative expenses of policyholders.
(l) The impact of this coverage on the total cost of health care.
