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    Document Summary
    - Report Published -

    Report Document No. 56
    PUBLICATION YEAR 2009

    Document Title
    House Bill 667 (2008): Mandated Coverage of Alternatives to Surgery

    Author
    Special Advisory Commission On Mandated Health Insurance Benefits

    Enabling Authority
    2.2-2504 (6.)

    Executive Summary
    House Bill 667 was referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) for the review by the House Committee on Commerce and Labor during the 2008 Session of the General Assembly. House Bill 667 was introduced by Delegate Robert G. Marshall.

    House Bill 667 would add Section 38.2-3407.9:03 to the Accident and Sickness Provisions of the Code of Virginia. The bill applies to insurers issuing individual or group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, corporations providing individual or group subscription contracts; and Health Maintenance Organizations (HMOs) providing health care plans. The bill requires those insurers, corporations, and HMOs to provide coverage for nonsurgical treatment if they cover surgical treatment of a medical condition or disease. The nonsurgical treatment must be less expensive; less dangerous; not experimental or investigational; generally recognized by the regional medical community as appropriate for the condition or disease; and not less efficacious than the surgical treatment.

    The language of House Bill 667 requiring coverage of “any nonsurgical treatment of a medical condition” could include hundreds of medical situations and numerous treatments. The patron of the legislation informed the Advisory Commission by letter of June 30, 2008 that the intent of House Bill 667 was to address situations where a feeding tube would have to be inserted surgically in a child to obtain coverage for amino acid-based formulas because coverage was not provided for orally administered formulas. Amended language was not received from the patron prior to analysis of the bill. Therefore, the analysis prepared for the Advisory Commission review and the report address the broader language of the bill as it was referred to the Advisory Commission.

    The Advisory Commission scheduled a public hearing for September 29, 2008 in Richmond to receive comments on the bill. At the meeting, Delegate Marshall advised the Advisory Commission that it was not necessary to hear House Bill 667 because of the similarity of the intent of the bill with House Bill 669 that would mandate coverage for amino acid-based formulas and House Bill 615 that would mandate coverage for amino acid-based elemental formulas. No individuals or representatives of any organizations indicated a desire to speak at the meeting. Written comments in opposition to the bill were received from the Virginia Association of Health Plans. Written comments in opposition to any new mandated benefits were received from the Virginia Chamber of Commerce and comments on the adverse impact of mandated benefits on the number of insureds in small businesses were received from the National Federation of Independent Business.

    Delegate Marshall asked that House Bill 667 be deferred until 2009 along with House Bill 669. He indicated at the November 19, 2008 meeting that House Bill 667 was intended to complement House Bill 669 that would mandate coverage for amino acid-based formulas. Delegate Marshall asked that House Bill 669 be deferred until 2009 along with legislation introduced by Delegate Amundson (House Bill 615) that would require coverage for amino acid-based elemental formulas.

    The Advisory Commission agreed to defer House Bill 667 until 2009.