Mandated Benefits Review - Senate Bill 1198 - Review Process

The Pennsylvania Health Care Cost Containment Council's enabling legislation, Act 89 of 1986 (as reauthorized 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 April 28, 1998, Senator Holl, Chairman of the Senate Banking and Insurance Committee, requested that the Council review the provisions of Senate Bill 1198 (PN 1487, Senator Afflerbach), which would provide for reimbursement for routine patient care costs when an insured, enrollee or subscriber participates in approved cancer clinical trials. A copy of the bill is attached.

In accordance with Act 34, notification was published in the Pennsylvania Bulletin on May 23, 1998, requesting that interested parties submit documentation and information pertaining to the bill to the Council by July 23, 1998. Letters also were sent to 28 potentially interested individuals and organizations informing them of the pending review and inviting them to submit documentation pursuant to the notice. Following the initial comment period, an opportunity was provided for interested individuals and organizations to examine the responses received and submit additional comments based on that review. The Pennsylvania Department of Health and the Insurance Department were notified of the review and received a copy of the submissions.

A list of the documentation submitted to the Council is attached.

Act 34 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.