Mandated Benefits Review Process - HB 656

The Pennsylvania Health Care Cost Containment Council's enabling legislation, Act 89 of 1986 (as re-authorized by Act 34 of 1993), provides that the Council review existing or proposed mandated health benefits when requested by the executive and legislative branches of government.

On February 10, 1998, Senator F. Joseph Loeper, Majority Leader and Chairman of the Senate Committee on Rules and Executive Nominations, requested that the Council review the provisions of House Bill 656 (PN 2505 - Representative Wright), which would require insurers to provide coverage for certain diabetic supplies, medication, and services and require any insurer underwriting Medicare or Medicaid insurance for Pennsylvania residents to provide coverage for hearing aids in accordance with the "Hearing Aid Sales Registration Law."

Notification was published in the Pennsylvania Bulletin on March 14, 1998, requesting that interested parties submit documentation and information pertaining to the bill to the Council by May 29, 1998. Letters were also sent to 22 potentially interested individuals and organizations informing them of the pending review and inviting them to submit information pursuant to the notice. Following the initial comment period, an opportunity was provided for interested individuals and organizations to examine the responses received. The Pennsylvania Department of Health and the Insurance Department were notified of the review and received a copy of the submissions. Respondents were also given an opportunity to review the documentation received and submit a second round of documentation.

In addition to the formal submissions, the Council received approximately 100 letters from Pennsylvania residents supporting the diabetes coverage called for in House Bill 656, some of which provided information about their personal struggle with diabetes. A list of the formal documentation submitted to the Council is attached.

Act 34 also provides for a preliminary Council staff review of submitted materials to determine if documentation submitted is sufficient to proceed with the formal Mandated Benefits Review process outlined in the Act. This report presents the results of the Council's preliminary staff review and the conclusions of the Council regarding whether the material is sufficient to proceed with the formal review process.