RD54 - House Bill 2426 (2007) and Senate Bill 991 (2007): Repeals of the Mandated Offer of Coverage for Bone Marrow Transplants or Stem Cell Transplants for Breast Cancer


Executive Summary:
House Bill 2426 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 of Virginia. House Bill 2426 was introduced by Delegate Kathy J. Byron.

Senate Bill 991 was referred to the Advisory Commission for review by the Senate Committee on Commerce and Labor during the 2007 Session of the General Assembly of Virginia. Senate Bill 991 was introduced by Senator Harry B. Blevins.

House Bill 2426 repeals in its entirety § 38.2-3418.1:1 in the Code of Virginia. Senate Bill 991 amends § 38.2-3418.1:1 in the Code of Virginia by removing the mandated offer of coverage requirement for dose-intensive chemotherapy/ autologous bone marrow transplants, but would continue to require companies to offer and make available coverage of stem cell transplants for the treatment of breast cancer.

Section 38.2-3418.1:1 is applicable to 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 health maintenance organizations (HMOs) providing health care plans. The section requires that coverage be made available for the treatment of breast cancer by dose-intensive chemotherapy/autologous bone marrow transplants or stem cell transplants when performed pursuant to protocols approved by the institutional review board of any United States medical teaching college including, but not limited to, National Cancer Institute protocols that have been favorably reviewed and utilized by hematologists or oncologists experienced in dose-intensive chemotherapy/autologous bone marrow transplants or stem cell transplants.

The section requires that copayments for this coverage under policies, contracts or plans should not be greater than for any other coverage, and coverage shall be subject to the same deductible as any other coverage. A different deductible may be offered and made available. The section does not apply to short-term travel, accident-only, limited or specified disease policies, or to short-term nonrenewable policies of not more than six months’ duration.

The Advisory Commission held a hearing on July 18, 2007 in Richmond to receive public comments on House Bill 2426 and Senate Bill 991. In addition to the patron, Delegate Kathy J. Byron, a representative of the Virginia Association of Health Plans (VAHP) spoke in favor of the bills. Written comments in support of the bills were provided by the Virginia Breast Cancer Foundation (VBCF) and VAHP. A member of the Advisory Board of Massey Cancer Center who is also cancer survivor spoke against House Bill 2426 and Senate Bill 991. A physician on the staff of the Virginia Commonwealth University (VCU), Massey Cancer Center provided expert testimony at the September 20, 2007 meeting.

The Advisory Commission voted on September 20, 2007 to recommend the enactment of House Bill 2426 (Yes-7, No-2). The members voted unanimously (Yes-9, No-0) to recommend the enactment of Senate Bill 991 and conform it to House Bill 2426. The Advisory Commission believed that based upon the information presented, high-dose intensive chemotherapy/autologous bone marrow transplants or stem cell transplants are currently not considered the standard of care for the treatment of breast cancer. The members believed that a mandate is no longer needed. Patients have opportunities to participate in clinical trials to obtain these procedures if their particular condition warrants the treatments and they meet the requirements of a trial because of the mandated coverage of clinical trials in Section 38.2-3418.8.