HB 1019-2_ Filed 04/25/2003, 16:27
CONFERENCE COMMITTEE REPORT
DIGEST FOR EHB 1019
Citations Affected:
IC 27-1-3-30
;
IC 27-8-24.1
;
IC 27-13-7-18.
Synopsis: Insurance coverage matters. Requires the commissioner of insurance to establish a
voluntary task force to review mandated benefits and proposed mandated benefits and report to
the legislative council. Requires a group accident and sickness insurance policy and a group
health maintenance organization contract to provide coverage for medically necessary medical
food prescribed for treatment of an inherited metabolic disease for a covered individual or an
enrollee. (This conference committee report: Replaces provisions requiring certain
reporting by accident and sickness insurers and health maintenance organizations to the
department of insurance and analyses by the department of insurance of mandated benefits
and proposed mandated benefits with a provision requiring the commissioner of insurance
to establish a voluntary task force to perform a review of mandated benefits and proposed
mandated benefits and report to the legislative council. Requires a group accident and
sickness insurance policy and a group health maintenance organization contract to provide
coverage for medically necessary food rather than requiring an offer of coverage.)
Effective: July 1, 2003; January 1, 2004.
Text Box
Adopted Rejected
[
]
CONFERENCE COMMITTEE REPORT
MR. SPEAKER:
Your Conference Committee appointed to confer with a like committee from the Senate
upon Engrossed Senate Amendments to Engrossed House Bill No. 1019 respectfully reports
that said two committees have conferred and agreed as follows to wit:
that the House recede from its dissent from all Senate amendments and that
the House now concur in all Senate amendments to the bill and that the bill
be further amended as follows:
Delete everything after the enacting clause and insert the following:
SOURCE: IC 27-1-3-30; (03)CC101904.1. -->
SECTION 1.
IC 27-1-3-30
IS ADDED TO THE INDIANA CODE
AS A
NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2003]:
Sec. 30. (a) As used in this section, "accident and sickness
insurance policy" has the meaning set forth in
IC 27-8-14.2-1.
(b) As used in this section, "health maintenance organization"
has the meaning set forth in
IC 27-13-1-19.
(c) As used in this section, "mandated benefit" means certain
health coverage or an offering of certain health coverage that is
required under:
(1) an accident and sickness insurance policy; or
(2) a contract with a health maintenance organization.
(d) As used in this section, "mandated benefit proposal" means
a bill or resolution pending before the general assembly that, if
enacted, would require certain health coverage or an offering of
certain health coverage under:
(1) an accident and sickness insurance policy; or
(2) a contract with a health maintenance organization.
(e) The commissioner shall establish a task force to review
mandated benefits and mandated benefit proposals.
(f) The task force must consist of nine (9) members appointed by
the governor as follows:
(1) Two (2) members representing the insurance industry.
(2) Two (2) members representing consumers.
(3) Two (2) members representing health care providers.
(4) Two (2) members representing the business sector.
(5) The commissioner or the commissioner's designee.
A registered lobbyist may not serve as a member of the task force.
(g) Members of the task force shall serve on a voluntary basis
without reimbursement.
(h) The department shall provide administrative support for the
functions of the task force.
(i) The task force shall review mandated benefits and mandated
benefit proposals as determined by the members of the task force
and report to the legislative council not later than December 31 of
each year.
(j) Any recommendations made by the task force must be
approved by at least five (5) members of the task force.
(k) The department may adopt rules under
IC 4-22-2
to
implement this section.
(l) Information that identifies a person and that is obtained by
the task force under this section is confidential.
SOURCE: IC 27-8-24.1; (03)CC101904.2. -->
SECTION 2.
IC 27-8-24.1
IS ADDED TO THE INDIANA CODE
AS A
NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]:
Chapter 24.1. Coverage for Treatment of Inherited Metabolic
Disease
Sec. 1. As used in this chapter, "accident and sickness insurance
policy" has the meaning set forth in
IC 27-8-5-27
(a).
Sec. 2. As used in this chapter, "covered individual" means an
individual who is entitled to coverage under an accident and
sickness insurance policy.
Sec. 3. As used in this chapter, "inherited metabolic disease"
means a disease:
(1) caused by inborn errors of amino acid, organic acid, or
urea cycle metabolism; and
(2) treatable by the dietary restriction of one (1) or more amino
acids.
Sec. 4. As used in this chapter, "medical food" means a formula
that is:
(1) intended for the dietary treatment of a disease or condition
for which nutritional requirements are established by medical
evaluation; and
(2) formulated to be consumed or administered enterally under
the direction of a physician.
Sec. 5. An accident and sickness insurance policy must provide
coverage for medical food that is:
(1) medically necessary; and
(2) prescribed by a covered individual's treating physician for
treatment of the covered individual's inherited metabolic
disease.
Sec. 6. The coverage that must be provided under this chapter
shall not be subject to dollar limits, coinsurance, or deductibles
that are less favorable to a covered individual than the dollar
limits, coinsurance, or deductibles that apply to coverage for:
(1) prescription drugs generally under the accident and
sickness insurance policy, if prescription drugs are covered
under the accident and sickness insurance policy; or
(2) physical illness generally under the accident and sickness
insurance policy, if prescription drugs are not covered under
the accident and sickness insurance policy.
SOURCE: IC 27-13-7-18; (03)CC101904.3. -->
SECTION 3.
IC 27-13-7-18
IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE
JANUARY 1, 2004]: Sec. 18. (a) As used in this section, "inherited
metabolic disease" means a disease:
(1) caused by inborn errors of amino acid, organic acid, or
urea cycle metabolism; and
(2) treatable by the dietary restriction of one (1) or more amino
acids.
(b) As used in this section, "medical food" means a formula that
is:
(1) intended for the dietary treatment of a disease or condition
for which nutritional requirements are established by medical
evaluation; and
(2) formulated to be consumed or administered enterally under
the direction of a physician.
(c) A group health maintenance organization contract that
provides coverage for basic health care services must provide
coverage for medical food that is:
(1) medically necessary; and
(2) prescribed for an enrollee by the enrollee's treating
physician for treatment of the enrollee's inherited metabolic
disease.
(d) The coverage that must be provided under this section shall
not be subject to dollar limits, copayments, or deductibles that are
less favorable to an enrollee than the dollar limits, copayments, or
deductibles that apply to coverage for:
(1) prescription drugs generally under the group contract, if
prescription drugs are covered under the group contract; or
(2) physical illness generally under the group contract, if
prescription drugs are not covered under the group contract.
SOURCE: ; (03)CC101904.4. -->
SECTION 4. [EFFECTIVE JULY 1, 2003]
(a)
IC 27-8-24.1
, as
added by this act, applies to an accident and sickness insurance
policy that is issued, delivered, amended, or renewed after
December 31, 2003.
(b)
IC 27-13-7-18
, as added by this act, applies to a health
maintenance organization contract that is entered into, delivered,
amended, or renewed after December 31, 2003.
(Reference is to EHB 1019 as reprinted April 9, 2003.)
Conference Committee Report
on
Engrossed House
Bill 1019
Text Box
S
igned by:
____________________________ ____________________________
Representative Frenz Senator Miller
Chairperson
____________________________ ____________________________
Representative Ripley Senator Breaux
House Conferees Senate Conferees