2022 -- H 8219

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LC005858

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2022

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- MANDATED HEALTH

INSURANCE BENEFITS ADVISORY COUNCIL

     Introduced By: Representative P Morgan

     Date Introduced: May 06, 2022

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 42 of the General Laws entitled "STATE AFFAIRS AND

GOVERNMENT" is hereby amended by adding thereto the following chapter:

CHAPTER 14.7

MANDATED HEALTH INSURANCE BENEFITS ADVISORY COUNCIL

     42-14.7-1. Declaration.

     It is hereby declared that health benefits coverage, while providing important protection

for consumers, is costly for individuals, businesses, and government employers and programs that

pay for coverage. Mandated benefits have public health, social, financial and medical implications

for patients, providers and health plans. It is in the public interest to authorize and require the

mandated health insurance benefits advisory council to conduct independent reviews of proposed

and existing mandated benefits, to provide the general assembly with adequate and independent

documentation, defining the social and financial impact and medical efficacy of proposed and

existing mandates.

     42-14.7-2. Definitions.

     As used in this chapter:

     (1) "Carrier" means an insurance company, health service corporation, hospital services

corporation, medical services corporation or health maintenance organization authorized to issue

health benefit plans in Rhode Island.

     (2) "Council" means the mandated health insurance benefits advisory council.

     (3) "Mandated health benefit" means a benefit that a carrier must provide as part of a health

benefits plan, based on Rhode Island law, unless the benefit is also required by federal law.

     (4) "Mandated provider" means a provider type that a carrier must include as part of a

health benefits plan network, based on Rhode Island law, unless the provider mandate is also

required by federal law.

     42-14.5-3. Mandated health insurance benefits advisory council.

     There is hereby created a mandated health insurance benefits advisory council, consisting

of the following members:

     (1) A representative from two (2) medical insurance companies, to be appointed by the

health insurance commissioner.

     (2) A representative from a Rhode Island sole proprietorship business, with less than one

hundred (100) employees, to be appointed by the health insurance commissioner.

     (3) A representative of a Rhode Island based employer, with between one hundred (100)

and five hundred (500) employees, to be appointed by the health insurance commissioner.

     (4) A representative of the Rhode Island Manufacturers Association.

     (5) A representative from each Rhode Island chamber of commerce, with at least one

hundred (100) members, to be appointed by the health insurance commissioner.

     (6) Two (2) public members, to be appointed by the speaker of the house of representatives.

     (7) Two (2) public members, to be appointed by the president of the senate.

     42-14.7-4. Review of mandated benefits or providers.

     (a) The council shall review existing benefit or provider mandates (retrospective review),

and proposed benefit or provider mandates (prospective review), in accordance with the process

established in subsections (b) and (c) of this section, and in accordance with the review criteria set

forth in subsection (d) of this section.

     (b) Retrospective review process;

     (1) The council shall conduct retrospective review of all existing benefit or provider

mandates every three (3) years, or three (3) years following the enactment of an existing mandate,

whichever comes later.

     (2) An existing mandate shall sunset sixty (60) days following the council's report to the

general assembly, recommending the sunset of the mandate, unless the general assembly reenacts

the mandate.

     (3) The council shall solicit information and comments from consumers, government and

private-sector employers, relevant provider associations, advocates for a particular mandate, other

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state agencies, including, but not limited to, the executive office of health and human services

(EOHHS), department of health (DOH), the department of behavioral healthcare, developmental

disabilities and hospitals (BHDDH), the department of human services (DHS), the lieutenant

governor's office and HealthSourceRI (HSRI), and other individuals and entities with relevant

information concerning the mandate under review.

     (4) The council may, at its discretion, conduct a focused report on any existing mandate at

any time, based on new research, on medical efficacy of a mandate, or significant change in social

or financial impact.

     (c) Prospective review process:

     (1) When any bill is introduced in the general assembly that would require a carrier to

provide a mandated health benefit or require a health plan to include a specific provider type to be

covered, the chairperson of the committee, to which the bill is referred, shall request the council to

conduct an independent review of the proposed bill. The council shall conduct its review upon

receipt by the council of adequate supporting documentation from the stakeholders seeking

enactment of the bill, and upon a determination by the council, that the supporting documentation

is complete.

     (2) Any such legislation shall be accompanied by supporting documentation, detailing the

public health, social and financial impact of the proposed mandate and its medical efficacy. If the

proposed mandate will increase the cost of insurance premiums, the documentation must also

include a proposal for how to fund the increased cost.

     (3) The council shall solicit information and comments from consumers, government and

private-sector employers, relevant provider associations, advocates for a particular mandate, other

state agencies, including, but not limited to, EOHHS, DOH, BHDDH, DHS, the lieutenant

governor's office and HSRI, and other individuals and entities with relevant information concerning

the proposed mandate under review.

     (4) The council shall report its findings and recommendations to the committee with

jurisdiction over the bill, within six (6) months, following the council's determination that the

supporting documentation is complete.

     (5) The council's retrospective and prospective review must include a literature review and

financial analysis, and must include consideration of stakeholder information and comments. The

council's review shall include consideration of the following factors:

     (i) Public health;

     (ii) Impact of mandate on state's morbidity and mortality rates across subpopulations;

     (iii) Impact of mandate on health disparities;

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     (iv) Social impact;

     (v) Utilization;

     (vi) Impact of mandate on use of treatment;

     (vii) Encouragement of mandate on consumer use of appropriate treatment/service;

     (viii) Whether the mandate is typically covered by insurers in the state, including the self-

insured;

     (ix) How relevant is the mandate to Rhode Island given the prevalence of a particular

disease in the state;

     (x) Whether there are providers in the state available to provide the particular service and

how the mandate would impact the number and type of providers within the state;

     (xi) Whether there are alternative ways for consumers to obtain coverage;

     (xii) If and how lack of coverage impacts consumers' ability to afford and receive care;

     (xiii) Whether individuals are avoiding care because of lack of coverage;

     (xiv) Assessment of other states, regarding coverage of the proposed mandated benefit and

estimated costs, when available;

     (xv) Financial impact, including:

     (A) General cost of the mandate;

     (B) Costs to specific stakeholders, including, but not limited to, cost to individual

consumers, governmental and private sector employers, and public programs;

     (C) Impact of mandate on total cost of care and on administrative costs;

     (D) Cost of not passing the mandate; and

     (E) How the additional cost of the mandate would be funded; and

     (xvi) Medical efficacy, including:

     (A) Whether treatment falls within federally-defined essential health benefits;

     (B) Effect in prevention or treatment of disease or disability;

     (C) Recognition by the medical community as effective and efficacious;

     (D) Demonstration by peer-reviewed scientific literature;

     (E) Impact of service on overall quality of care provided; and

     (F) The effects of balancing the social, financial and medical input.

     42-14.7-5. Cost of review funding.

     The council may assess carriers for the cost of any review conducted under this chapter, in

accordance with § 42-14-10 (actuarial fund).

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- MANDATED HEALTH

INSURANCE BENEFITS ADVISORY COUNCIL

***

     This act would create the mandated health insurance benefits advisory council, to analyze

the state's current health insurance benefits mandates and to review retrospectively and

prospectively the mandates. The reviews of both the current and new mandates would be based

upon sound clinical and scientific medical evidence and would balance cost and benefits. The

council would consider the medical efficacy, cost and social impact of each mandate and report its

findings to the general assembly.

     This act would take effect upon passage.

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