RD29 - Mandated Coverage for Treatment for Intensity Modulated Radiation Thereapy (IMRT) for Tumors


Executive Summary:
House Bill 1405 was referred to the Advisory Commission for review by the House Committee on Commerce and Labor during the 2006 Session of the General Assembly of Virginia. House Bill 1405 was introduced by Delegate Robert J. Wittman.

House Bill 1405 adds § 38.2-3418.15 to the Code of Virginia. The bill requires insurers proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis; corporations providing individual or group accident and sickness subscription contracts; and HMO’s providing health care plans for health care services to provide coverage for treatment by intensity modulated radiation therapy (IMRT), including solid compensator-based IMRT, of breast cancer, brain tumors, prostate cancer, lung cancer, bladder cancer, cancer of the pancreas and other upper abdominal sites, spinal cord tumors, head and neck cancer, adrenal tumors, pituitary tumors, and other solid tumors in situations in which extremely high precision is required in order to spare essential surrounding normal tissue, when such treatment is performed pursuant to protocol dose volume constraints approved by the institutional review board of any United States medical teaching college or the National Cancer Institute (NCI).

The bill prohibits insurers, corporations, or HMOs from imposing copayments, fees, policy year or calendar year, or durational benefit limitations or maximum on persons for these benefits or services that are not equally imposed on all individuals in the same benefit category.

The bill applies to insurance policies, contracts, or plans delivered, issued for delivery, reissued, or extended in the Commonwealth on or after July 1, 2007, or at any time thereafter when the term is changed or a premium adjustment is made. The bill does not apply to short-term travel, accident-only, limited or specified disease policies, or individual conversion policies, or contracts designed for persons eligible for coverage under Title XVIII of the Social Security Act (Medicare), or any other similar coverage under state or federal government plans.

The Advisory Commission held a hearing on October 17, 2006 in Richmond to receive public comments on House Bill 1405. In addition to the patron, Delegate Robert J. Wittman, four doctors and a medical physicist spoke in favor of the bill. Representatives from the VAHP and Anthem Blue Cross Blue Shield spoke against House Bill 1405. Written comments in support of the bill were provided by the American College of Radiation Oncology, Associates in Medical Physics, Bethesda Regional Cancer Treatment Center, Comprehensive Physics and Regulatory Services, Ltd., Congressional Representative Jo Ann Davis, the County of Lancaster, Eastern Virginia Medical School Department of Radiation Oncology and Biophysics, Farmington Regional Radiation Therapy Services, Hematology-Oncology Associates of Fredericksburg, Inc., Mountain Regional Cancer Centers, Senator John H. Chichester, 21st Century Oncology, the Town of Montross, the Town of Warsaw, University of Louisville Health Science Center, Valley Regional Cancer Center, Virginia Cancer Institute, Westmoreland County Board of Supervisors, and eight concerned citizens. A representative from the America Cancer Society also commented on House Bill 1405. The VAHP and the Virginia Chamber of Commerce submitted comments in opposition to the bill.

The Advisory Commission voted (9 to 3) to recommend against the enactment of House Bill 1405 on November 20, 2006. The members of the Advisory Commission believed that based upon the information presented, reimbursement for most IMRT treatments is available; if coverage is denied, patients have the opportunity to file appeals to their insurer or HMO and may also request an external appeals review in some instances. The members believed a mandate is not necessary at this time.