NO. 59. AN ACT RELATING TO HEALTH INSURANCE PLAN REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY NATUROPATHIC PHYSICIANS and for recommended prostate cancer screening.
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 8 V.S.A. § 4088d is added to read:
§ 4088d. COVERAGE FOR COVERED SERVICES PROVIDED BY
(a) A health insurance plan shall provide coverage for medically necessary health care services covered by the plan when provided by a naturopathic physician licensed in this state for treatment within the scope of practice described in chapter 81 of Title 26. Health care services provided by naturopathic physicians may be subject to reasonable deductibles, co‑payment and co‑insurance amounts, fee or benefit limits, practice parameters, cost‑effectiveness and clinical efficacy standards, and utilization review consistent with any applicable regulations published by the department of banking, insurance, securities, and health care administration. Any amounts, limits, standards, and review shall not function to direct treatment in a manner unfairly discriminative against naturopathic care, and collectively shall be no more restrictive than those applicable under the same policy to care or services provided by other primary care physicians, but may allow for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers. A health insurance plan may require that the naturopathic physician’s services be provided by a licensed naturopathic physician under contract with the insurer or shall be covered in a manner consistent with out‑of‑network provider reimbursement practices for primary care physicians; however, this shall not relieve a health insurance plan from compliance with the applicable rule 10 network adequacy requirements adopted by the commissioner. Nothing contained herein shall be construed as impeding or preventing either the provision or the coverage of health care services by licensed naturopathic physicians, within the lawful scope of naturopathic practice, in hospital facilities on a staff or employee basis.
(b) As used in this section, “health insurance plan” means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402. The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage.
The general assembly finds:
(1) The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).
(2) While medical organizations, including the American Academy of Family Physicians, the American Cancer Society, the American College of Physicians–American Society of Internal Medicine, the American Medical Association, and the American Urologic Association do not recommend universal or routine prostate cancer screening, those organizations do, however, generally agree that men over age 50 and those with increased risk for prostate cancer are appropriate candidates for screening.
Sec. 3. 8 V.S.A. chapter 107, subchapter 10 is added to read:
Subchapter 10. Prostate Screenings
§ 4100f. PROSTATE SCREENINGS; COVERAGE REQUIRED
(a) Health insurers shall provide coverage for prostate cancer screenings consistent with the recommendations by the Centers for Disease Control and Prevention or upon recommendation of a health care provider. Benefits provided shall be at least as favorable as coverage for other cancer screening procedures and subject to the same dollar limits, deductibles, and coinsurance factors within the provisions of the policy.
(b) For purposes of this section, “health insurer” is defined by subdivision 9402(9) of Title 18. The term does not apply to coverage for specified disease or other limited benefit coverage.
Sec. 4. APPLICABILITY AND EFFECTIVE DATE
This act shall take effect on October 1, 2007 and shall apply to all health benefit plans on and after October 1, 2007 on such date as a health insurer offers, issues, or renews the health benefit plan, but in no event later than October 1, 2008.
Approved: Became law without governor’s signature.