Mandated Benefits Review - Senate Bill 1198 - Comparison to Senate Bill 1334 (of 1995)

In September of 1996, the Council completed a review of Senate Bill 1334 (of 1995) at the request of Senator Edwin G. Holl, Chairman of the Senate Banking and Insurance Committee. Senate Bill 1334 provided for reimbursement for patient care costs when an insured, enrollee or subscriber participates in a cancer clinical trial.

The Council report on Senate Bill 1334 (of 1995) stated, "the Pennsylvania Health Care Cost Containment Council concludes that it is unable to make a recommendation regarding the passage of Senate Bill 1334 in its current form, and that it is unlikely that a formal Mandated Benefits Review Panel could or would conclude any differently, now or in the future." In our report to the General Assembly, the Council found the following:

  1. "The results of independent staff research lead the Council to conclude that the concrete, independent information and data needed for the Council to make a recommendation based upon the "social and financial impact and medical efficacy of the proposal," as provided by law, simply is not available;
  2. The information submitted to the Council is insufficient to be used in any estimation of the costs associated with implementation of Senate Bill 1334; and
  3. The information available to the Council is clearly insufficient to lend itself to analysis either by staff or by the formal Mandated Benefits Review process outlined in Act 34 of 1993, nor does it seem likely in the future. As a result, the Pennsylvania Health Care Cost Containment Council concludes that inasmuch as neither proponents nor opponents have submitted sufficient documentation necessary for a review pursuant to paragraphs (3) and (4), Section 9 of Act 34 of 1993, it is unable to provide the necessary and required social and financial impact or the medical efficacy information on the proposed mandated health benefit contained in Senate Bill 1334."

The bill currently under review, Senate Bill 1198, is very similar to Senate Bill 1334 (of 1995). While there are slight differences in the two bills, the intent appears to be the same.

The first difference between Senate Bill 1198 and Senate Bill 1334 (of 1995) is the addition of the word "routine" before the phrase "patient care costs." This addition may have been an attempt to tighten up the language surrounding the issue of what is considered to be "patient care costs."

Another difference is the addition of the word "approved" prior to the phrase "cancer clinical trials." In Senate Bill 1198, third-party reimbursement would apply only to "routine patient care costs" when an insured, enrollee or subscriber participates in "approved cancer clinical trials." This change may also be the result of the Council's analysis of Senate Bill 1334 (of 1995) and an attempt to further clarify language in the bill.

A third difference between the two bills is that Senate Bill 1198 broadens the scope of cancer clinical trials which are eligible for coverage. In Senate Bill 1334 (of 1995), eligible options were limited to those cancer clinical trials authorized by the National Institutes of Health or the U.S. Food and Drug Administration. Senate Bill 1198 would apply to cancer clinical trials authorized by those two agencies as well as trials authorized by the U.S. Department of Defense and the U.S. Department of Veterans Affairs.

The composition of the proposed Cancer Clinical Trials Review Board evolved slightly since the initial proposal in Senate Bill 1334 (of 1995). In Senate Bill 1198, the consumer representative on the Board would be a consumer of oncology services, whereas in Senate Bill 1334 (of 1995) this representative would merely be a health care consumer.

The final noticeable difference between the two bills does not impact the intent of the legislation. Senate Bill 1334 (of 1995) would have had a sunset date of June 30, 2003 and Senate Bill 1198 (of 1997) has a sunset date of June 30, 2005. This change does not have an impact on the actual length of the proposed legislation (which would be 8 years in both cases).