Source: http://lis.virginia.gov/cgi-bin/legp604.exe?181+ful+HB332
Timestamp: 2019-02-22 14:00:44
Document Index: 368634748

Matched Legal Cases: ['§ 2', '§ 2', '§ 51', '§ 51', '§ 51', '§ 23', '§ 4']

18102920D
HOUSE BILL NO. 332 Offered January 10, 2018 Prefiled January 4, 2018 A BILL to amend and reenact § 2.2-2818 of the Code of Virginia, relating to the state employee health insurance plan; coverage for proton therapy. ---------- Patrons-- Yancey, Carter and Murphy ---------- Referred to Committee on Appropriations ----------
1. That § 2.2-2818 of the Code of Virginia is amended and reenacted as follows:
A. The Department of Human Resource Management shall establish a plan, subject to the approval of the Governor, for providing health insurance coverage, including chiropractic treatment, hospitalization, medical, surgical and major medical coverage, for state employees and retired state employees with the Commonwealth paying the cost thereof to the extent of the coverage included in such plan. The same plan shall be offered to all part-time state employees, but the total cost shall be paid by such part-time employees. The Department of Human Resource Management shall administer this section. The plan chosen shall provide means whereby coverage for the families or dependents of state employees may be purchased. Except for part-time employees, the Commonwealth may pay all or a portion of the cost thereof, and for such portion as the Commonwealth does not pay, the employee, including a part-time employee, may purchase the coverage by paying the additional cost over the cost of coverage for an employee.
23. On and after January 1, 2019, include coverage for proton therapy as follows:
a. As used in this subdivision 23:
"Aggregate amount" means the total amount paid under the state group insurance program for the applicable CPT code to deliver a biological effective dose.
"Biological effective dose" means the total, prescribed radiation dose delivered in a course of radiation therapy treatments to induce tumor cell death.
"CPT code" means the unique numerical designations established by the American Medical Association for various medical, surgical, and diagnostic services used in billing health care services.
"Eligible patient" means a patient who is prescribed proton therapy for the treatment of cancer.
"Hypofractionated proton therapy protocol" means a cancer treatment protocol that involves the delivery of fewer, larger treatment doses with proton therapy to deliver the same biological effective dose and achieve the same curative effect as X-ray radiation therapy delivered in smaller treatment doses over an extended period of time.
"Intensity modulated radiation therapy" or "IMRT" means a type of conformal radiation therapy that delivers X-ray radiation beams of different intensities from many angles for the treatment of tumors.
"Proton therapy" means the advanced form of radiation therapy that utilizes protons as an alternative radiation delivery method for the treatment of tumors.
"Radiation therapy" means the delivery of a biological effective dose with proton therapy, IMRT, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation.
"Treatment dose" means the amount of radiation delivered in a single treatment or fraction of radiation therapy.
b. The plan shall cover a physician-prescribed hypofractionated proton therapy protocol to deliver a biological effective dose for a particular indication by paying the same aggregate amount as would be paid for the delivery of the same biological effective dose with IMRT for the same indication, provided that the eligible patient is treated as part of a clinical trial or registry. The amount of reimbursement for the course of a hypofractionated proton therapy protocol shall be calculated pursuant to this subdivisions c, d, and e.
c. For a hypofractionated proton therapy protocol to be covered pursuant to this subdivision 23, the radiation oncologist prescribing a hypofractionated proton therapy protocol shall:
(1) Be board certified or board eligible in the specialty of radiation oncology; and
(2) Determine what the standard course of IMRT for the eligible patient's indication would be, if the patient were treated with IMRT instead of a hypofractionated proton therapy protocol to deliver the same biological effective dose.
d. The aggregate amount shall be calculated as the cost of an IMRT treatment dose times the number of IMRT treatments required to deliver the prescribed biological effective dose for the particular indication, as determined by the eligible patient's radiation oncologist pursuant to subdivision c. The IMRT cost per treatment dose for purposes of performing the foregoing calculation shall be the usual and customary amount paid per IMRT treatment dose under the state health insurance plan for the particular indication.
e. The amount that the state health insurance plan shall reimburse per treatment dose for hypofractionated proton therapy shall be calculated by dividing the aggregate amount as determined under subdivision d by the number of treatment doses in the hypofractionated proton therapy protocol. The aggregate amount paid for a hypofractionated proton therapy protocol shall be no greater than the aggregate amount for a standard course of IMRT treatment for the same indication. Any other services or procedures that are billed as part of a course of either hypofractionated proton therapy or IMRT treatment shall be covered at the usual and customary rates pursuant to the applicable CPT codes.
f. The benefits required by this subdivision 23 shall be subject to the annual deductible and co-insurance established for radiation therapy and other similar benefits within the policy or contract of insurance. The annual deductible and co-insurance for any radiation therapy delivery method permitted by this subdivision 23 shall be no greater than the annual deductible and co-insurance established for all other similar benefits within that policy or contract of insurance.
1. American Hospital Formulary Service -- Drug Information;
"State employee" means state employee as defined in § 51.1-124.3; employee as defined in § 51.1-201; the Governor, Lieutenant Governor and Attorney General; judge as defined in § 51.1-301 and judges, clerks and deputy clerks of regional juvenile and domestic relations, county juvenile and domestic relations, and district courts of the Commonwealth; interns and residents employed by the School of Medicine and Hospital of the University of Virginia, and interns, residents, and employees of the Virginia Commonwealth University Health System Authority as provided in § 23.1-2415; and employees of the Virginia Alcoholic Beverage Control Authority as provided in § 4.1-101.05.