NCOIL adopts two new health insurance model laws

Belmar, NJ – At the 2023 National Council of Insurance Legislators Summer National Meeting in Minneapolis, the organization adopted two new NCOIL Model Laws. The Models were first adopted by the group’s Health Insurance and Long-Term Care Issues Committee, Chaired by West Virginia Delegate Steve Westfall, and passed by NCOIL as a whole on Saturday July 22^nd.

The two new Models are the NCOIL Biomarker Testing Insurance Coverage Model Act, sponsored by New York Assemblywoman Pamela Hunter, NCOIL Treasurer, and co-sponsored by Minnesota Senator Paul Utke, NCOIL Secretary, and the NCOIL Hospital Price Transparency Model Act sponsored by Texas Representative Tom Oliverson, M.D., NCOIL Vice President, and co-sponsored by Kentucky Representative Rachel Roberts, Vice Chair of the Committee.

Del. Westfall said, “The Committee has worked tirelessly to get these two Models to a place where they could be considered and I thank the sponsors and co-sponsors for listening to and incorporating input from a wide range of perspectives during the drafting and deliberation process. Hospital price transparency and health insurance coverage for biomarker testing are two issues of great interest to the public and these Models will provide effective guidance for legislators to bring back to their states.”

“I was pleased to see the committee adopt two bills that are so important in helping patients to navigate the healthcare marketplace,” said Arkansas Representative Deborah Ferguson, DDS, NCOIL President, “I am confident that these Models will prove to be very useful to legislators and I’ll be watching with great interest as bills based on the Models are introduced in legislatures across the country.”

The NCOIL Biomarker Testing Insurance Coverage Model Act requires insurance coverage for biomarker testing for the purposes of diagnosis, treatment, appropriate management, or ongoing monitoring of a covered person’s disease or condition.  Approximately ten states have enacted similar legislation, with another ten states having introduced bills that largely mirror the Model.

The Model is intended to only apply post-diagnosis, and will help give more patients the ability to have a biomarker test conducted to guide treatment decisions in instances when the test provides clinical utility as demonstrated by medical and scientific evidence, including, but not limited to: labeled indications for a test approved or cleared by the Food and Drug Administration (FDA) of the United State government or indicated tests for an FDA approved drug; Centers for Medicare and Medicaid Services (CMS) National Coverage Determinations or Medicare Administrative Contractor (MAC) Local Coverage Determinations; or nationally recognized clinical practice guidelines.

“The passage of this Model is an important step in making sure patients are able to make the best-informed decisions about the treatment options available to them when they need it most,” said Asw. Hunter. “We heard a range of differing opinions on this issue, but as NCOIL continues to prove, we were able to come together and adopt a Model on a vitally important issue that can be used to protect patients all across the country.”

During the drafting and deliberation process, NCOIL legislators and staff heard from a wide array of interested parties including: America’s Health Insurance Plans (AHIP); the American Cancer Society Cancer Action Network; Biotechnology Innovation Organization (BIO); Blue Cross Blue Shield Association; California Health Benefits Review Program (CHBRP); ERISA Industry Committee (ERIC); GO2 Foundation for Lung Cancer; International Foundation for Autoimmune & Autoinflammatory Arthritis; National Comprehensive Cancer Network (NCCN); Ochsner Cancer Institute; and the UC San Diego Moore Cancer Center.

The NCOIL Hospital Price Transparency Model Act will enable states to implement laws and regulations that mandate healthcare facilities to disclose prices for specific items and services, offering patients accessible and transparent pricing information. Facilities will be required to maintain a list of standard charges for their items and services as well as provide a consumer-friendly list of shoppable services available at the facility. Non-compliance can result in a corrective action plan, administrative penalties, and a prohibition of collective debt actions against patients.  The genesis for the Model and similar state laws is a very similar federal hospital price transparency regulation that hospitals have not been fully compliant with.

Rep. Oliverson said, “Lack of transparency in hospital pricing over the years has resulted in a lack of competition in the marketplace and led to rising healthcare costs across the nation. Unfortunately, this has made healthcare unaffordable for many Americans. This Model, combined with increased compliance with the federal regulation, will help ensure that consumers are empowered to make the best healthcare decisions for themselves and their families.”

During the drafting and deliberation process, the Committee heard from a wide array of interested parties including: the American Hospital Association (AHA); the Cicero Institute; the Council for Affordable Health Coverage; the National Academy for State Health Policy (NASHP); PatientRightsAdvocate.org; and the Texas Public Policy Foundation.

NCOIL CEO Commissioner Tom Considine said, “The passage of these two Models really underscores how NCOIL continues to be on the cutting edge of emerging healthcare public policy issues. It also shows NCOIL’s commitment to hearing different perspectives on all types of issues and being willing to make changes to Models throughout the drafting process.  These are two issues that are very important to consumers so kudos to the Committee for working hard to reach a bipartisan consensus and getting these models over the finish line.”

A full copy of the models can be viewed at the links below:

https://ncoil.org/wp-content/uploads/2023/07/NCOIL-Hospital-Price-Transparency-Model-Final-July-2023-1.pdf

https://ncoil.org/wp-content/uploads/2023/07/NCOIL-Biomarker-Model-Final-July-2023.pdf