HB 560-FN – AS INTRODUCED
2007 SESSION
01/03
HOUSE BILL 560-FN
AN ACT relative to insurance coverage for prostate cancer testing.
SPONSORS: Rep. Drisko, Hills 5; Rep. Pilliod, Belk 5; Rep. P. Allen, Ches 6; Rep. Belanger, Rock 4; Sen. Gottesman, Dist 12
This bill requires insurance coverage for testing for the presence of prostate cancer for men 50 years of age or older, and for men 45 years of age or older who are considered high risk.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
07-0129
01/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT relative to insurance coverage for prostate cancer testing.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Statement of Intent.
I. The general court recognizes that:
(a) More than 100 New Hampshire men died of prostate cancer last year.
(b) Hundreds more will die of prostate cancer in the next 10 years, mostly because their cancer was discovered too late.
(c) More than 750 men were diagnosed with prostate cancer last year.
(d) Thousands of men 50 years of age and older are not screened annually.
(e) Many men and women are not aware of the seriousness of prostate cancer.
(f) There is no organized statewide effort to inform and help men, as there is for breast cancer even though the statistics for both are highly similar.
(g) Many poor men and many men living in rural areas lack access to annual screening and treatment.
(h) Many men who have been diagnosed with prostate cancer need information to help them choose a treatment.
(i) Many men who have received treatment are suffering from incontinence, impotence, and sexual problems and could be helped by a support group.
(j) Loved ones of prostate cancer victims often need comfort.
(k) Prostate cancer support groups need to be established and assisted.
II. Therefore, the general court hereby establishes insurance coverage for prostate cancer testing as an effort to:
(a) Decrease the number of prostate cancer deaths.
(b) Decrease late stage diagnoses.
(c) Increase public awareness of prostate cancer.
(d) Promote early screening and early detection of prostate cancer.
(e) Encourage healthy lifestyle changes for cancer prevention.
(f) Educate those in public office about the importance of funding programs which are designed to reduce prostate cancer.
(g) Improve accessibility to early detection, diagnoses, and treatment.
2 New Chapter; Men’ s Health Care. Amend RSA by inserting after chapter 417-F the following new chapter:
CHAPTER 417-G
417-G:1 Definitions. In this chapter:
I. “Commissioner” means the insurance commissioner.
II. “Insurer” means any entity issuing accident or health insurance or accident and health insurance policies, contracts, certificates, or other evidence of coverage pursuant to RSA 415, 415-A, 420-A, or, 420-J.
417-G:2 Coverage for Testing for the Presence of Prostate Cancer.
I. Each insurer that issues or renews any accident or health insurance policy or accident and health insurance policy providing benefits for hospital expense, medical-surgical expense, or major medical expense shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this state, coverage for testing for the presence of prostate cancer, in accordance with the standards of the American Cancer Society, for men 50 years of age or older with a life expectancy of 10 years, and for men 45 years of age or older who are recognized as high risk. The coverage shall be as follows:
(a) An initial examination conducted by his licensed doctor and any follow-up clinical tests deemed necessary by the doctor for men 50 years of age or older, and for men 45 years of age or older who are considered high risk.
(b) An annual examination conducted by his licensed doctor and any follow-up clinical tests deemed necessary by the doctor, including a prostate-specific antigen blood test or a digital rectal examination performed in accordance with the standards of the American Cancer Society, for men 50 years of age or older and for men 45 years of age or older who are considered high risk.
II. Such benefits shall be at least as favorable as for similar examinations and tests, and shall be subject to the same dollar limits, deductibles, and co-insurance factors.
417-G:3 Rulemaking. The commissioner may adopt rules, under RSA 541-A, relative to proper testing and other benefits under this chapter.
417-G:4 Penalty. Any insurer that violates any provision of this chapter or any rule adopted pursuant to it, may, at the discretion of the commissioner, have its certificate of authority indefinitely suspended or revoked.
3 Effective Date. This act shall take effect January 1, 2008.
LBAO
07-0129
1/3/07
HB 560-FN - FISCAL NOTE
AN ACT relative to insurance coverage for prostate cancer testing.
FISCAL IMPACT:
The Department of Administrative Services and Department of Insurance state this bill may have an indeterminable fiscal impact on state revenue and may increase state, county, and local expenditures by an indeterminable amount in fiscal year 2008 and each fiscal year thereafter. There will be no fiscal impact on county and local revenue.
METHODOLOGY:
The Department of Administrative services states this bill requires health insurance providers to cover the cost for prostate cancer screenings. The Department assumes that the coverage required by this bill would result in an annual .2% increase in medical claims costs to the state health insurance program. Medical claims based on actuarial estimates are approximately $166 million in FY 2008 and $187 million in FY 2009. For years 2010 and 2011 actuarial estimates for total claims were not available. For those two years the Department applied a factor of 12.43% to both 2009 and 2010 projected claims. The 12.43% factor is based on percent increase in claim activity from 2009 over 2008. The costs were calculated as follows:
2008 $166 million x .002 = $332,000
2009 $187 million x .002 = $374,000
2010 $374,000 x 1.1243 = $420,488
2011 $420,488 x 1.1243 = $472,755
This bill does not appropriate funds for the increased cost to the state health insurance program.
The Department of Insurance states this bill requires health insurance providers to cover the cost of prostate cancer screenings. The Department indicates that the state is self insured, but often complies with mandates imposed on fully insured plans and assumes the state would comply with this mandate. The Department states to the extent that coverage is not currently provided, health insurance providers may need to increase premiums to cover these new mandates, which may affect the cost of insurance for county and local government. The pricing
LBAO
07-0129
1/3/07
differential between fully insured products and self insured products would increase and as a result some employers may choose to self fund. The state may realize an increase in premium tax revenues to the extent that premiums increase. However, this could potentially be offset by the loss in revenue attributable to employer groups switching form fully insured plans to self-funded plans. The Department cannot estimate the net premium increase or loss and therefore can not determine the fiscal impact of this bill.