Executive Summary - HB 656

After reviewing the staff analysis of House Bill 656, the Pennsylvania Health Care Cost Containment Council finds evidence to suggest that providing diabetics with supplies, medication, self-management education, and medical nutrition therapy can be both medically and cost effective. In general, the Council believes that recommending the passage of legislation requiring health related mandates be limited to those measures which are of proven efficacy and cost effectiveness. Based upon the documentation received during this review and the Council's analysis of its own data, we find evidence to suggest that the diabetes portion of this bill can meet this standard. If this bill results in increased numbers of diabetics complying with recommended self-management procedures, then it has the potential to provide savings both in terms of health care dollars and improved quality of life. We note the following points:

Hearing Aid Benefits in House Bill 656

The Council has serious concerns about the proposed coverage for hearing aids called for in this bill. One of the amendments to House Bill 656, amendment A0470, eliminates the hearing aid portion of the bill. If the General Assembly enacts House Bill 656, we recommend the adoption of Amendment A0470. We received no documentation in support of this measure. Opponents of the hearing aid benefit noted the significant costs and further suggested that the language in the bill is not clear with regard to allowable reimbursement. In addition, opponents questioned the General Assembly's authority to mandate the benefits of a federal program.

Amendments to House Bill 656

The Council was asked to review two amendments to House Bill 656: Amendment A0470 and Amendment A0388. Amendment A0470 contains multiple components. As noted earlier, we recommend that the General Assembly adopt Amendment A0470 that eliminates the hearing aid portion of House Bill 656 if this bill is enacted. We also support the other components of this amendment. First, it clarifies that the only "orthotics" coverage mandated by House Bill 656 is "orthotics related to the treatment of diabetes illness." Second, it provides that diabetes outpatient self-management training and education shall be provided "by an individual with expertise in diabetes self-management, training and education". We believe that these issues are relevant to diabetes treatment. Amendment A0388 provides that diabetes outpatient self-management training and education shall be provided under the supervision of a "certified, registered, or" licensed health care professional. This amendment is also relevant to this legislation. We recommend that both amendments be adopted if House Bill 656 is enacted.

Council Recommendation

In summary, the Council finds evidence to recommend the passage of House Bill 656 contingent upon the adoption of amendments A0388 and A0470, which clarify issues related to diabetes treatment and education, and, in the case of A0470, eliminates the hearing aid portion of this bill.

Finally, the Council's enabling legislation provides for a preliminary staff review of submitted materials to determine if documentation received is sufficient to proceed with the formal Mandated Benefits Review process outlined in Act 34 of 1993. While many submissions were received regarding the diabetes portion of this bill, there was limited information suggesting specific opposition to the proposed diabetes benefits. Little information was received with regard to hearing aid coverage. We conclude, therefore, that a full review by a Mandated Benefits Review Panel is not warranted; nor, given the documentation received, do we believe a panel of experts would come to conclusions different than the ones reached here.