RD53 - House Bill 2156 (2007): Mandated Coverage for Second Opinion Evaluations of Primary Malignant Brain Tumors at National Cancer Institute Comprehensive Cancer Centers


Executive Summary:
House Bill 2156 was referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) for review by the House Committee on Commerce and Labor during the 2007 Session of the General Assembly. House Bill 2156 was introduced by Delegate John M. O’Bannon III.

House Bill 2156 would add § 38.2-3418.15 to the Accident and Sickness Provisions Chapter of the Insurance Code and would amend § 38.2-4319 in the Health Maintenance Organizations (HMOs) Chapter to make the provisions applicable to HMOs. The bill applies to insurers that issue individual or group accident and sickness policies that provide hospital, medical and surgical coverage on an expense incurred basis, corporations providing individual or group accident and sickness subscription contracts, and each HMO providing health care plans for health care services. The bill requires that insurers, corporations, and HMOs provide coverage for a second opinion evaluation of a primary malignant brain tumor at a medical center designated by the National Cancer Institute (NCI) as a comprehensive cancer center.

The bill prohibits insurers, corporations and HMOs from imposing a copayment, fee, policy year or calendar year, or durational benefit limitation or maximum that is not equally imposed on all individuals in the same category. The bill applies to all policies, contracts, and plans delivered, issued for delivery, reissued, or extended in Virginia on and after January 1, 2008 or when there is a change in any term of the policy, contract or plan or any change is made in the premium.

The bill does not apply to short-term travel, accident-only, limited or specified disease, or individual conversion policies or contracts, or policies or contracts designed for issuance to people eligible for Medicare, or any other similar coverage under state or federal plans.

The Advisory Commission held a public hearing on July 18, 2007 in Richmond to receive public comments on House Bill 2156. Delegate O’Bannon and Delegate John S. Reid spoke in favor of the bill. Two concerned citizens also spoke in favor of the bill. A representative of the Virginia Association of Health Plans (VAHP) spoke in opposition to the bill. Written comments in support of the bill were received from the Cullather Brain Tumor Quality of Life Center at St. Mary’s Hospital (Cullather Center), Delegate Paula J. Miller, and Dr. Michael Friedman, President and CEO of City of Hope National Medical Center. Written comments in opposition to the bill were submitted by VAHP.

The Advisory Commission voted on September 20, 2007 to recommend against the enactment of House Bill 2156 (Yes-5, No-4). The Advisory Commission members recognized the expertise available at NCI comprehensive cancer centers. However, the Advisory Commission had concerns about the need to require the proposed coverage from one type of facility when coverage for second opinions for primary brain tumors is currently available at many facilities in the Commonwealth for most Virginians with health care coverage. Two NCI cancer centers that treat brain cancer patients are located in Virginia, and many Virginians with coverage have access to NCI comprehensive cancer centers in other states.