CCS HCS HB 600 & 388 -- HEALTH INSURANCE COVERAGE

The bill requires health plans to cover formula recommended by a
physician for the treatment of a patient with phenylketonuria or
any inherited disease of amino and organic acids.  The covered
service may not be subject to any greater deductible or
copayment than other similar health care services provided by
the plan.  The bill also:

(1)  Adds certified nurse midwives and ambulatory surgical
centers to the list of health care providers required to collect
specimens for PKU testing;

(2)  Eliminates criminal penalties for parents who refuse to
have their child tested, but requires parents to document their
refusal;

(3)  Requires health care providers to provide parents with
information about testing and PKU;

(4)  Authorizes the Department of Health to collect fees for the
testing.  The fees must be considered as a cost payable by a
third party payer and must not be considered as part of a
provider's internal laboratory costs;

(5)  Requires the department to provide formula for the
treatment of PKU if an applicant has exhausted all benefits from
third party payers and if the department receives appropriations
to provide PKU formula; and

(6)  Repeals the provisions relating to rulemaking in HB 335.
The bill also places any rule promulgated under its authority
under certain standards for withstanding a challenge, requires
the court to award reasonable fees and expenses to any
prevailing party in such a challenge, and requires that rules
promulgated pursuant to the bill expire on August 28th of the
year after they become effective unless extended by statute.
These rules provisions have a conditional termination date.  In
addition, rulemaking authority delegated prior to the effective
date of the bill is repealed.  A statement of nonseverability
applies to this provision.

HCS HB 600 & 388 -- HEALTH INSURANCE COVERAGE (Carter)

The substitute requires health plans to cover formula or dietary
products prescribed by a physician for the treatment of a
patient with phenylketonuria or any inherited disease of amino
and organic acids.  The covered service may not be subject to
any greater deductible or copayment than other similar health
care services provided by the plan.

The substitute also:

(1)  Adds certified nurse midwives and ambulatory surgical
centers to the list of health care providers required to collect
specimens for PKU testing;

(2)  Eliminates criminal penalties for parents who refuse to
have their child tested, but requires parents to document their
refusal;

(3)  Requires health care providers to provide parents with
information about testing and PKU and authorizes the Department
of Health to collect fees for the testing;

(4)  Prohibits third party payers from considering the
department's fee as part of a provider's internal laboratory
costs; and

(5)  Requires the department to provide formula for the
treatment of PKU if an applicant has exhausted all benefits from
third party payers and if the department receives appropriations
to provide PKU formula.

The substitute has an emergency clause.

FISCAL NOTE:  Estimated Net Increase to General Revenue Fund of
$69,604 for FY 1998, $82,968 for FY 1999, and $82,397 for FY
2000.  Estimated Net Increase to Insurance Dedicated Fund of
$14,250 to $28,500, $0 for FY 1999, and $0 for FY 2000.

HCS HB 600 & 388 -- HEALTH INSURANCE

CO-SPONSORS:   Harlan (Carter)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Critical
Issues by a vote of 21 to 0.

The substitute requires health plans to cover formula or dietary
products prescribed by a physician for the treatment of a
patient with phenylketonuria or any inherited disease of amino
and organic acids.  The covered service may not be subject to
any greater deductible or copayment than other similar health
care services provided by the plan.

The substitute has an emergency clause.

FISCAL NOTE:  Estimated Increase to General Revenue Fund of
$69,604 in FY 1998, $82,968 in FY 1999, & $82,397 in FY 2000.
Estimated Net Increase to Insurance Dedicated Fund of $14,250 to
$28,500 in FY 1998, $0 in FY 1999, & FY 2000.

PROPONENTS:  Supporters say that the formula is necessary for
persons with PKU or similar diseases.  There is no reasonable
explanation why some health plans cover the formula and others
do not.

Testifying for the bill were Representatives Carter and
Luetkenhaus; American Association of Retired Persons; and
Department of Health.

OPPONENTS:  Those who oppose the bill say that the required
coverage is too broad and should be limited to formula and only
PKU patients.  The required coverage will be too costly.

Testifying against the bill were Blue Cross; and General
American Life Insurance Co.

Katharine Hickel, Research Analyst

HB 600 -- Health Insurance

Sponsor:  Carter

This bill requires health benefit plans, including limited
mandate health insurance policies and contracts, to pay for
dietary products necessary in the treatment of amino and organic
acid diseases.