Table 1.
Institutional Structure of State Health Benefits Review Programs
| State* | Commission† | Department of Insurance‡ | Legislative Services§ | Sponsors¶ | Other State Agency∥ | University |
|---|---|---|---|---|---|---|
| Arizona | ✓ | |||||
| Arkansas | ✓ | |||||
| California | ✓ | |||||
| Colorado** | ✓ | ✓ | ||||
| Florida | ✓ | |||||
| Georgia | ✓ | |||||
| Hawaii†† | ✓ | |||||
| Indiana‡‡ | ✓ | ✓ | ||||
| Kansas | ✓ | |||||
| Kentucky | ✓ | |||||
| Louisiana | ✓ | |||||
| Maine | ✓ | |||||
| Maryland | ✓ | |||||
| Massachusetts | ✓ | |||||
| Minnesota | ✓ | |||||
| Nevada§§ | ✓ | |||||
| New Hampshire | ✓ | |||||
| New Jersey | ✓ | |||||
| North Carolina | ✓ | |||||
| North Dakota | ✓ | |||||
| Ohio | ✓ | |||||
| Pennsylvania | ✓ | |||||
| South Carolina | ✓ | |||||
| Tennessee | ✓ | |||||
| Texas | ✓ | |||||
| Utah | ✓ | |||||
| Virginia | ✓ | |||||
| Washington | ✓ | |||||
| Wisconsin | ✓ |
States listed here have a formal mandate evaluation program or process; or they have a law requiring evaluation of health insurance mandate bills by sponsors of a bill.
Commission-based programs usually consist of individuals appointed by the executive branch and the legislative branch and represent different industry and consumer interests. Commissions that evaluate health insurance benefits often conduct other types of analysis related to health care programs in the state.
“Department of Insurance” programs includes the “Insurance Commissioner,”“Office of Insurance,” or the equivalent agency in that respective state. These are housed in the executive branch of the state government.
“Legislative Services” programs include those that are housed at the departments or agencies designed to support the state legislature.
The requirement for conducting evaluations falls primarily on the bill sponsors. Sponsors may mean a member of the state legislature but usually mean an outside organization or association advocating for passage of the bill.
“Other State Agency” programs include those that are housed at another agency under the executive branch besides the Department of Insurance.
Colorado has two separate laws: One creates a mandate evaluation commission that is to sunset in May 2005 and another law requires any sponsor of a legislation to provide a “social” and “financial” impact analysis of the proposal to the legislative committee with jurisdiction.
Hawaii's mandate evaluation is conducted by the State Auditor, who reports to and is considered part of the legislative branch.
Indiana has a “Mandate Health Benefit Task Force” whose members are appointed by the governor and is staffed by the Insurance Commissioner.
Nevada's legislature passed two concurrent resolutions to study (1) the cost of existing mandates (1990) and (2) whether any existing mandates ought to be repealed (1992). Both of these were conducted by subcommittees appointed by the Legislative Commission.
Note: Those states listed here are different from those listed in Bellows et al, in this issue. Bellows and colleagues examine the characteristics of state laws that have established mandate review evaluation programs in the U.S. This article summarizes information gathered by CHBRP through interviews with officials in each state. Differences between laws that authorize mandate evaluation programs and the actual program implementation occur for several reasons: (1) there has not been enough time to develop a program or process in compliance with the new law; (2) the laws do not always explicitly dictate the criteria and steps for mandate evaluations. The implementation of such laws and policies are subject to interpretation, therefore, and can vary from time to time (for example, with changes in administration); or (3) state governments and their various departments do not always uniformly implement laws related to mandate evaluation programs or processes even when criteria and steps for evaluations are explicitly defined. This may occur due to several reasons, including limits on data availability, limits on staff and funding, or the political climate in the state.