- Report Published -
|Mandated Coverage for Treatment of Brain Tumors at National Cancer Institute Centers of Excellence|
|Special Advisory Commission on Mandated Health Insurance Benefits|
|House Bill 623- Treatment of Malignant Brain Tumors at National Cancer Institute Centers of Excellence|
The House Committee on Commerce and Labor referred House Bill 623 to the Advisory Commission during the 2006 Session of the General Assembly. House Bill 623 was introduced by Delegate John M. O’Bannon, III.
The Advisory Commission held a hearing on October 17, 2006 in Richmond to receive public comments on House Bill 623. Delegate John S. Reid introduced the bill. A representative of the Cullather Brain Tumor Quality of Life Center at St. Mary’s Hospital (Cullather Center) and three concerned citizens spoke in favor of the bill. A representative of the Virginia Association of Health Plans (VAHP) spoke in opposition to the bill.
Written comments in support of the bill were provided by a representative of the Cullather Center and a concerned citizen. Written comments in opposition to the bill were submitted by VAHP and the Virginia Chamber of Commerce.
House Bill 623 would add § 38.2-3418.15 and would amend § 38.2-4319 in the Code of Virginia. The original language of the bill requires that insurers, corporations, and HMOs provide coverage for treatment of a malignant brain tumor at a National Cancer Institute (NCI) Center of Excellence within 300 miles of a patient’s residence if the patient elects to have treatments performed at a center and the treatment is otherwise covered. The bill applies to insurers that issue individual and group accident and sickness policies that provide hospital, medical and surgical coverage on an expense incurred basis, corporations providing individual and group accident and sickness subscription contracts, and each HMO providing health care plans for health care services.
The bill prohibits insurers, corporations, and HMOs from imposing a copayment, fee, policy year or calendar year, or durational benefit limitation or maximum that is not equally imposed on all individuals in the same category. The bill applies to all policies, contracts, and plans delivered, issued for delivery, reissued, or extended in Virginia on or after January 1, 2007 when there is change in any term of the contract, or plan, or any change is made in the premium.
The bill does not apply to short-term travel, accident-only, limited or specified disease policies, or individual conversion policies or contracts, or policies or contracts designed for issuance to people eligible for Medicare, or any other similar coverage under state or federal plans.
Delegate O’Bannon indicated, prior to the public hearing, that the language of the bill was intended to require coverage at NCI cancer centers. Written comments provided for the hearing from proponents stated that the bill was intended to require coverage for the treatment of primary malignant brain tumors. Changes in the bill language were suggested by the proponents that would require coverage for second opinions, Phase I and Phase 2 clinical trials otherwise covered by the policy if the covered patient elects to have treatment performed at a NCI comprehensive cancer center located within 300 miles of the patient’s residence.
After the public hearing, Delegate O’Bannon requested by a letter dated November 9, 2006, that the bill be revised to limit its scope. Delegate O’Bannon requested the bill be changed to require coverage of a second opinion at a NCI comprehensive cancer center for primary malignant brain tumors. The revision would require coverage for Phase III clinical trials and would allow insurers and HMOs to negotiate with the comprehensive centers for any ongoing treatment. At the November 20, 2006 meeting of the Advisory Commission, Delegate O’Bannon stated that the revisions would not mandate a treatment regimen be covered after a second opinion was received.
The Advisory Commission voted 8 to 3 with one abstention against recommending the original bill language. The Advisory Commission considered making no recommendation to the General Assembly and the Senate and House Committees on Commerce and Labor because the research that was conducted, presented, and reviewed addressed the original bill language. Concern was expressed about the Advisory Commission’s ability to provide an informed recommendation on the revised language offered by Delegate O’Bannon on November 20, 2006. A motion to make no recommendation on the bill was defeated by a vote of 5 to 4 with 3 abstentions.
Delegate O’Bannon withdrew the proposals from Advisory Commission review after the second vote.