Colorado Legislative Council Staff

REVISED NO FISCAL IMPACT

(replaces fiscal impact dated January 15, 1999)

TITLE:            CONCERNING MEDICALLY NECESSARY THERAPY FOR CHILDREN UP TO FIVE YEARS OF AGE, AND, IN CONNECTION THEREWITH, SPECIFYING COVERAGE FOR THE CARE AND TREATMENT OF MEDICALLY DIAGNOSED CONGENITAL DEFECTS AND BIRTH ABNORMALITIES.

Summary of Assessment

            The reengrossed bill includes clarifying language relative to medically necessary therapy for children up to five years of age:

            •   insurance benefits available to newborn children shall include coverage of all medically necessary care and treatment of congenital defects and birth abnormalities for the first 31 days of the newborn's life, notwithstanding policy limitations and exclusions applicable to other conditions or procedures covered by the policy;

            •   copayment, deductible, and aggregate dollar limit provisions for coverage of an infant diagnosed with congenital defects and birth abnormalities shall be no higher than generally applicable under the policy to all other sickness, diseases, and conditions otherwise covered; and

            •   there shall be no age limit on benefits for newborn children born with cleft lip or cleft palate or both.

            The reengrossed bill requires that after the first 31 days of life, policy limitations and exclusions generally applicable under the insurance policy may apply, except that all individual and group health plans shall provide medically necessary physical, occupational, and speech therapy for the care and treatment of a child's congenital defects and birth abnormalities up to five years of age, and specifies the level of said therapy benefits. Therapy benefits are subject to certain existing statutory provisions on waiver of affiliation periods applicable to a preexisting condition. The health care service plan issued by an entity subject to the provisions of part 4 (health maintenance organizations) may provide that the benefits required in the bill shall be covered benefits only if the services are rendered by a provider designated by and affiliated with the health maintenance organization.

            The reengrossed bill includes an effective date of January 1, 2000, and applies to health care policies and contracts issued or renewed on or after that date.

            Section 24-50-605, C.R.S. As a result of SB 98-51, Concerning Mandated Insurance Coverages for State Employees, the executive director of the Department of Personnel is required to provide a financial impact statement to the legislative committee of reference for any proposed mandated coverage that relates to either the state's share of the employee benefit premium or the state employee's share of the premium (Section 10-16-104, C.R.S.). The Blue Cross and Blue Shield of Colorado analysis of HB 99-1088 estimates the employee's share of the premium (for family coverage) for the state's self-funded plans will increase $7.34 annually under the bill. Information provided by Rocky Mountain HMO and Kaiser Permanente indicated no additional fiscal impact as a result of the bill; PacifiCare indicated a $.15 per member per month fiscal impact.

            The bill is assessed as having no state or local fiscal impact.

Departments Contacted

            Health Care Policy and Financing

            Personnel

            Regulatory Agencies