NOTE: As provided in LFC policy, this report is intended for use by the standing finance committees of the legislature.  The Legislative Finance Committee does not assume responsibility for the accuracy of the information in this report when used in any other situation.



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F I S C A L I M P A C T R E P O R T





SPONSOR: Feldman DATE TYPED: 02/23/01 HB
SHORT TITLE: Insurance Coverage of Cancer Clinical Trials SB 240/aSPAC/aSCORC
ANALYST: Wilson


APPROPRIATION



Appropriation Contained
Estimated Additional Impact
Recurring

or Non-Rec

Fund

Affected

FY01 FY02 FY01 FY02
See Narrative



(Parenthesis ( ) Indicate Expenditure Decreases)





SOURCES OF INFORMATION



LFC files

Public Regulation Commission



No Response

Health Policy Commission

Attorney General's Office

Retiree Health Care Authority

General Services Department



SUMMARY



     Synopsis of SCORC Amendment



The SCORC amendment enlarges the scope of the clinical trial that must be covered to include early detection and the prevention of reoccurrence. The amendment also adds a section stating that if a patient is denied coverage they may appeal to the Superintendent of Insurance and that appeal must be handled within thirty days. The amendment also clarifies that the health insurer does not have to pay for tests that are related to the research of the clinical trial. The rest of the amendment is technical changes.



SUBSTANTIVE ISSUE



The portion of the amendment that covers the appeal rights should track with the managed health care regulations promulgated by the Superintendent. Many of the patients who are entering clinical trials cannot wait thirty days. The managed health care regulations call for expedited reviews of 72 hours, or more rapidly if necessary.





Synopsis of SPAC Amendment



There is a technical problem on page 6: strike lines 1, 2 and 3. It was replaced on the previous page in the amendment.



The amended bill does not cover specific disease policies. Does this include a cancer policy?



     Synopsis of Original Bill



SB 240 requires that health care plans cover the routine patient care costs incurred while a patient is participating in phase I, II, III or IV of a cancer clinical trial.



     Significant Issues.



Persons currently participating in clinical trials have medical benefits excluded because they are considered experimental and therefore they are not covered. SB 240 requires that an insurance health plan cover "routine benefits." These routine costs are a medical service or treatment that is a benefit under a health plan that would be covered if the patient were receiving standard cancer treatment.



FISCAL IMPLICATIONS



SB 240 might cause a small increase in health premiums paid by the State on behalf of the state employees, the retirees and public school employees since this would extend coverage in the health plans.



POSSIBLE QUESTIONS



Why does SB 240 only cover clinical trials for cancer? Aren't there clinical trials for other diseases?



DW/ar/njw