State‐Mandated Benefit Review Laws

Abstract

Objective. To determine which states have laws that require the review of mandated health insurance benefits and describe the various approaches states take in reviewing mandated benefits, as stated in the mandated benefit review (MBR) laws. Data Sources. We queried online databases of the individual state statutes and reviewed the state statutes and state legislative agendas for all 50 states and Washington, DC to identify those states with active MBR laws as of September 2004. Study Design. We reviewed the identified MBR laws to catalog their various components. The components chosen for this analysis include: general review strategy, designated reviewers, time frame for conducting reviews, criteria used in the review, requirements to use actuaries, sources of funding, and state data collection systems. Two of the authors independently created analysis categories and coded the MBR laws to document details on the major components of the laws. Principal Findings. We identified 26 state MBR laws active as of September 2004. A majority of the MBR laws specified a prospective review approach and only one law used an exclusively retrospective review approach. A substantial amount of variation was found with regards to the designated reviewers, time frames for conducting reviews, and criteria used in the review. Few states specified the use of actuaries, sources of funding, and state data collection systems. Conclusions. The number of states that have enacted MBR laws has increased substantially in recent years, however, different states have structured the review of mandated benefits differently, according to the values and perceived needs of the state legislatures. It is important that states increasingly consider a broader scope of review criteria so state decision makers can position themselves to mandate only those benefits that add real value to the state's health care system.

The political roots of health insurance benefit mandates

“…3.3.1 Mandate review boards. According to Bellows et al (2006), 26 states have established mandate review boards. These boards issue reports on proposed mandates, attempting to predict their effects.…”

“…Data on mandate review boards come from Bellows et al (2006). They identify 26 states with review boards as of 2006 and provide the year that each board began.…”

The Affordable Care Act's Preventive Services Mandate: Breaking down the Barriers to Nationwide Access to Preventive Services

“…In general, state benefit mandates require health insurers and/or health plans to provide coverage for a specific group of people (e.g., dependants), coverage for a specific disease or condition (e.g., Lyme disease or infertility), reimbursement for services provided by specific types of providers (e.g., podiatrists or nurse midwives), reimbursement for certain types of medical devices or pharmaceuticals (e.g., hearing aids or Chantix), or provide reimbursement for a minimum quantity of benefits (e.g., coverage for minimum hospital stay after mastectomy). 81 Since the 1970s, these mandates, the overwhelming majority of which do not cover preventive services, have grown in number, and more are enacted every year. 82 Many reasons have been cited to explain the proliferation of state benefit mandates.…”

Translating Medical Effectiveness Research into Policy: Lessons from the California Health Benefits Review Program

“…A study of states with mandate review laws as of September 2004 found that twenty‐five of twenty‐six states stipulated that reviewers use specific criteria to evaluate the bills. Furthermore, twelve of these states (48 percent) required reviewers to examine the medical effectiveness of the technologies or interventions that the proposed mandates would require health plans and health insurers to cover (Bellows, Halpin, and McMenamin 2006).…”