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    Document Summary
    - Report Published -

    Report Document No. 22
    PUBLICATION YEAR 2010

    Document Title
    Report of the Special Advisory Commission on Mandated Health Insurance Benefits - House Bill 2337: Coverage for the Expense of Amino Acid-Based Elemental Formulas

    Author
    Special Advisory Commission on Mandated Health Insurance Benefits

    Enabling Authority
    2.2-2505

    Executive Summary
    House Bill 2337 was referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) for review by the House Committee on Commerce and Labor during the 2009 Session of the General Assembly. House Bill 2337 was introduced by Delegate Kristen J. Amundson.

    House Bill 2337 would amend Section 38.2-4319 and add Section 38.2-3418.15 to the Code of Virginia. The bill requires insurers to provide coverage for the provision of amino acid-based elemental formulas, regardless of the method of intake, for the diagnosis and treatment of Immunoglobulin E and non Immunoglobulin E mediated allergies to multiple food proteins for enrollees under age 10, severe food protein induced enterocolitis syndrome, eosinophilic disorders as evidenced by the results of a biopsy, and impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, and motility of the gastrointestinal tract. The bill applies to each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis; corporations providing individual or group accident and sickness subscription contracts; and HMOs providing health care plans for health care services. House Bill 2337 provides that the ordering physician must issue a written order stating that the amino acid-based elemental formula is medically necessary for the treatment of a disease or disorder noted in the bill. House Bill 2337 also provides that a private review agent, acting on behalf of an insurer, nonprofit health service plan, or HMO, may review the ordering physician’s determination of the medical necessity of the amino acid-based elemental formula for the treatment of the disease or disorder.

    House Bill 2337 prohibits insurers, corporations or HMOs from imposing any copayment, fee, policy year or calendar year, or durational benefit limitation or maximum for benefits or services that is not equally imposed on all individuals in the same benefit category.

    House Bill 2337 applies to policies, contracts and plans delivered, issued for delivery, reissued, or extended in the Commonwealth on or after January 1, 2010, or any time thereafter when any term of the policy, contract, or plan is changed or premium is adjusted. The bill does not apply to short-term travel, accident-only, limited or specified disease policies, or individual conversion policies or contracts, nor to policies designed for issuance to persons eligible for Medicare, or similar coverage under state or federal government plans.

    The Advisory Commission held a hearing on June 29, 2009 in Richmond to receive public comments on House Bill 2337. Delegate Amundson spoke in favor of the bill. A representative of the VAHP spoke in opposition to House Bill 2337. Written comments in support of the bill were provided by Children’s MAGIC, seven citizens, and two physicians. The VAHP and Virginia Chamber of Commerce (VCC) provided written comments in opposition to House 2337.

    The Advisory Commission voted unanimously (10 to 0) on November 17, 2009 to recommend against the enactment of House Bill 2337. The Advisory Commission members believed that based upon the information presented and reviewed, a mandate for the coverage of amino acid-based elemental formulas is not necessary at this time.