Signed by Governor Kevin Stitt

Vote Smart's Synopsis:

Vote to pass a bill that prohibits denying healthcare or adjusting coverage or cost based on age or quality of life.

Highlights:

• Defines "utilization management" to include step therapy, prior authorization restrictions and the use of formulary restrictions to restrict access to a drug or other health care service prescribed by a health care provider (Sec. 3-4).

• Establishes the following conditions of care (Sec. 2):

• Physical and mental disabilities, age or chronic illness should in no way diminish a person's right to life, human dignity and equal access to medical care;

• Historically, persons with disabilities, advanced age or chronic illness have faced discrimination in the health care system, including the denial of access to life-sustaining care;

• Such discrimination is inconsistent with our society's commitment to human dignity and the full inclusion of persons with disabilities throughout society;

• Lack of access to appropriate health care can result in significant adverse health consequences for persons with disabilities, those with chronic illness, and those of advanced age, including loss of function, reduced quality of life or even death; and

• Both public and private payers have a moral, legal and ethical obligation to make health care reimbursement decisions in a transparent fashion utilizing nondiscriminatory criteria.

• Prohibits an agency from developing or employing a dollars-per-quality adjusted life year, or similar measure that discounts the value of a life because of an individual's disability, including age or chronic illness, as a threshold to establish what type of health care is cost-effective or recommended (Sec. 4).

• Requires any agency proposing new utilization management measures shall post for public comment both the proposed measure and the rationale behind the proposed measure, including the availability of alternatives, analysis of potential impact on atypical patient populations and subgroups, estimate of the population likely to be impacted by the measure and a description of both internal and third-party value assessments utilized in internal deliberations on the measure (Sec. 5).

• Requires that any agency making decisions on utilization management measures, coverage, reimbursement or incentive programs ensure that a process is in place to ensure robust stakeholder engagement and full transparency including (Sec. 6-2.B):

• Providing stakeholders with meaningful notice and opportunity to comment on the retention of any vendor providing research and analysis to the agency;

• Subjecting research and analysis relied upon by an agency to meaningful notice and comment process;

• Ensuring deliberation around the coverage or reimbursement for health care treatments and services occurs in open meetings;

• Presenting and releasing any research and analysis relied upon for decision-making in public meetings or publicly released prior to deliberation;

• Requiring full disclosure into funding sources and conflicts of interest of any third party providing research and analysis to the state;

• Prohibiting sole-source contracts for research and analysis to ensure reliance on a range of evidence; and

• Preparing an annual report assessing beneficiary access to health care treatments and services.

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that prohibits denying healthcare or adjusting coverage or cost based on age or quality of life.

Highlights:

• Defines "utilization management" to include step therapy, prior authorization restrictions and the use of formulary restrictions to restrict access to a drug or other health care service prescribed by a health care provider (Sec. 3-4).

• Establishes the following conditions of care (Sec. 2):

• Physical and mental disabilities, age or chronic illness should in no way diminish a person's right to life, human dignity and equal access to medical care;

• Historically, persons with disabilities, advanced age or chronic illness have faced discrimination in the health care system, including the denial of access to life-sustaining care;

• Such discrimination is inconsistent with our society's commitment to human dignity and the full inclusion of persons with disabilities throughout society;

• Lack of access to appropriate health care can result in significant adverse health consequences for persons with disabilities, those with chronic illness, and those of advanced age, including loss of function, reduced quality of life or even death; and

• Both public and private payers have a moral, legal and ethical obligation to make health care reimbursement decisions in a transparent fashion utilizing nondiscriminatory criteria.

• Prohibits an agency from developing or employing a dollars-per-quality adjusted life year, or similar measure that discounts the value of a life because of an individual's disability, including age or chronic illness, as a threshold to establish what type of health care is cost-effective or recommended (Sec. 4).

• Requires any agency proposing new utilization management measures shall post for public comment both the proposed measure and the rationale behind the proposed measure, including the availability of alternatives, analysis of potential impact on atypical patient populations and subgroups, estimate of the population likely to be impacted by the measure and a description of both internal and third-party value assessments utilized in internal deliberations on the measure (Sec. 5).

• Requires that any agency making decisions on utilization management measures, coverage, reimbursement or incentive programs ensure that a process is in place to ensure robust stakeholder engagement and full transparency including (Sec. 6-2.B):

• Providing stakeholders with meaningful notice and opportunity to comment on the retention of any vendor providing research and analysis to the agency;

• Subjecting research and analysis relied upon by an agency to meaningful notice and comment process;

• Ensuring deliberation around the coverage or reimbursement for health care treatments and services occurs in open meetings;

• Presenting and releasing any research and analysis relied upon for decision-making in public meetings or publicly released prior to deliberation;

• Requiring full disclosure into funding sources and conflicts of interest of any third party providing research and analysis to the state;

• Prohibiting sole-source contracts for research and analysis to ensure reliance on a range of evidence; and

• Preparing an annual report assessing beneficiary access to health care treatments and services.

Full Bill Text