Colorado Legislative Council Staff
NO FISCAL IMPACT
Rep. S. Williams
Sen. J. Johnson
January 30, 1998
Will Meyer (866-4976)
TITLE: CONCERNING HEALTH CARE COVERAGE PARITY FOR TEMPOROMANDIBULAR DISORDERS.
Summary of Assessment
The provisions of this bill would require health insurance plans and policies, including plan certificates or contracts of a health maintenance organization (HMO’s), that provide coverage on a group or individual basis for treatment of any bone or joint of the skeletal structure not to exclude or deny the same coverage for treatment involving any bone or joint of the face, neck or head (temporomandibular disorders). The provisions of this bill would apply to policies, plans, or contracts issued or renewed on or after January 1, 1999. The bill would become effective upon signature of the Governor.
Background. The provisions of this bill would affect health care coverages provided by health insurance carriers and HMO’s, but not self-funded health care plans. Self-funded health plans currently cover more than 40 percent of the state’s work force (both private and public), and more than 60% of state employees. Consequently, the provisions of this bill would not apply to a large percentage of the state’s workforce. In the case of the state, the provisions of the bill would apply only to HMO contract costs and any increases in these costs would be reflected in premiums paid by participating state employees.
However, it is the policy of the state’s self-insurance plan to follow health insurance mandates, as a matter of good public policy. To the extent that the state were to change the self-funded plan’s coverage, cost to the state’s self-funded plan would increase and these increased costs would be reflected in premiums paid by participating employees. Over time, these costs would be incorporated in the annual Total Compensation Survey. Any recommended increases to maintain parity with the private sector would impact the costs of the state.
Department of Regulatory Agencies. Given the January 1, 1999 effective date of the provisions of this bill, changes in policy or plan coverage required by the bill would be incorporated in ongoing certifications by health insurance companies and would not require additional, supplemental certification filings. This bill would have no fiscal impact to the Division of Insurance.
Department of Personnel. The State Benefits Fund, which is used to provide medical health care coverage for state employees, is administered by the Department of Personnel. The fund consists of both state contributions and employee premiums. The state contribution amount is limited by statute. Consequently, any changes in health care coverages, or changes to contracts with HMO’s or other providers that affect the fund balance must be covered by corresponding changes to the premiums charged to state employees, unless the state’s contribution is amended by legislation. The bill would not affect the state’s contribution. This bill would nave no fiscal impact to the Department of Personnel.
Department of Health Care Policy and Finance. The coverages required by this bill are already a covered benefit in fee-for-service Medicaid and would not affect the cost to the state to provide Medicaid benefits. This bill would have no fiscal impact to the Department of Health Care Policy and Finance.
The provisions of this bill would not impact any other agency of the state, or unit of local government. Therefore, this bill is assessed as having no fiscal impact.
Regulatory Agencies Personnel Health Care Policy and Financing