Mandated Benefits Review - Senate Bill 599 - Review Process

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 March 31, 1998, Senator Edwin G. Holl, Chairman of the Senate Banking and Insurance Committee, requested that the Council review the provisions of Senate Bill 590 (PN 622 - Senator Williams). Under this bill, if an insurance company or private or public health program reimburses for acupuncture services, it must reimburse licensed acupuncturists at the same rate, regardless of whether the provider is a licensed physician acupuncturist or a licensed non-physician acupuncturist. Currently, non-physician acupuncturists are permitted to practice only under the supervision of physician acupuncturists.

Notification was published in the Pennsylvania Bulletin on May 2, 1998, requesting that interested parties submit documentation and information pertaining to the bill to the Council by July 2, 1998. Letters were also sent to 21 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. A list of 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 outlines 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.