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Related Experiment Videos

State-mandated benefit review laws.

Nicole M Bellows1, Helen Ann Halpin, Sara B McMenamin

  • 1Center for Health and Public Policy Studies, University of California-Berkeley, Berkeley, CA 94720-7360, USA.

Health Services Research
|May 18, 2006
PubMed
Summary

Twenty-six states had active mandated health insurance benefit review laws in 2004, with significant variation in review strategies and criteria. States should broaden review criteria to ensure mandated benefits add real value.

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Area of Science:

  • Health Policy
  • Health Insurance Law
  • Public Health

Background:

  • State-mandated health insurance benefits are common, but their review processes vary.
  • Understanding these review processes is crucial for evaluating the value and cost-effectiveness of mandated benefits.

Purpose of the Study:

  • To identify states with laws requiring review of mandated health insurance benefits.
  • To describe the diverse approaches states employ in reviewing these benefits.

Main Methods:

  • A comprehensive review of state statutes and legislative agendas for all 50 states and Washington, DC was conducted.
  • Identified mandated benefit review (MBR) laws active as of September 2004 were analyzed for key components.
  • Analysis included review strategy, designated reviewers, timelines, criteria, actuary use, funding, and data collection systems.

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Main Results:

  • Twenty-six states had active MBR laws in September 2004.
  • Most laws favored prospective review, with only one exclusively retrospective approach.
  • Significant variation existed in designated reviewers, review time frames, and criteria; few states mandated actuary use or specified funding/data collection.

Conclusions:

  • The number of states enacting MBR laws has grown, but implementation details differ significantly.
  • State legislatures structure MBR laws based on unique values and needs.
  • States should consider expanding review criteria to ensure mandated benefits provide genuine value to the healthcare system.