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State-Mandated Benefit Review Laws

Authors

  • Nicole M. Bellows,

    1. Graduate Student Researcher, is with the Center for Health and Public Policy Studies, University of California, Berkeley, School of Public Health, Berkeley CA,
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  • Helen Ann Halpin,

    1. Graduate Student Researcher, is with the Center for Health and Public Policy Studies, University of California, Berkeley, School of Public Health, Berkeley CA,
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    • Address correspondence to Helen Ann Halpin, Ph.D., Professor of Health Policy, Director Center for Health and Public Policy Studies, University of California Berkeley, School of Public Health, 140 Warren Hall, Berkeley, CA 94720-7360. Nicole M. Bellows, MHSA, Graduate Student Researcher, is with the Center for Health and Public Policy Studies, University of California, Berkeley. School of Public Health, Berkeley CA. Sara B. McMenamin, Ph.D., Assistant Research Professor and Research Director, is with the Center for Health and Public Policy Studies, University of California Berkeley, School of Public Health, Berkeley, CA.

  • Sara B. McMenamin

    1. Graduate Student Researcher, is with the Center for Health and Public Policy Studies, University of California, Berkeley, School of Public Health, Berkeley CA,
    Search for more papers by this author

Abstract

Objective. To determine which states have laws that require the review of mandated health insurance benefits and describe the various approaches states take in reviewing mandated benefits, as stated in the mandated benefit review (MBR) laws.

Data Sources. We queried online databases of the individual state statutes and reviewed the state statutes and state legislative agendas for all 50 states and Washington, DC to identify those states with active MBR laws as of September 2004.

Study Design. We reviewed the identified MBR laws to catalog their various components. The components chosen for this analysis include: general review strategy, designated reviewers, time frame for conducting reviews, criteria used in the review, requirements to use actuaries, sources of funding, and state data collection systems. Two of the authors independently created analysis categories and coded the MBR laws to document details on the major components of the laws.

Principal Findings. We identified 26 state MBR laws active as of September 2004. A majority of the MBR laws specified a prospective review approach and only one law used an exclusively retrospective review approach. A substantial amount of variation was found with regards to the designated reviewers, time frames for conducting reviews, and criteria used in the review. Few states specified the use of actuaries, sources of funding, and state data collection systems.

Conclusions. The number of states that have enacted MBR laws has increased substantially in recent years, however, different states have structured the review of mandated benefits differently, according to the values and perceived needs of the state legislatures. It is important that states increasingly consider a broader scope of review criteria so state decision makers can position themselves to mandate only those benefits that add real value to the state's health care system.

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