HB1424
To Mandate Coverage For Severe Obesity Treatments.
AI-Generated Summary
This bill mandates coverage for treatments related to severe obesity for individuals covered by the Arkansas Medicaid Program and by health benefit plans issued in Arkansas. It specifically requires coverage for bariatric surgery, including specific procedures, and associated pre- and post-operative care. The bill defines severe obesity based on Body Mass Index (BMI) with or without comorbidities. For private health insurance, it mandates coverage for medically necessary expenses related to the treatment of diseases and conditions caused by severe obesity, including specific types of bariatric surgery and comprehensive pre- and post-operative care. The bill outlines eligibility requirements for covered persons, including a written order from a healthcare provider and attestations of participation in weight loss programs and completion of evaluations. It also allows health insurers to impose limitations, such as a preoperative period of up to three months and prior authorization. However, the bill explicitly excludes coverage for injectable drugs for glucose lowering or other weight loss drugs from both Medicaid and private insurance mandates. The Department of Human Services is directed to seek federal waivers for Medicaid implementation. The Insurance Commissioner is tasked with promulgating rules for additional preoperative conditions and coverage requirements.
Potential Impact Analysis
Who Might Benefit?
Individuals in Arkansas who are eligible for the Arkansas Medicaid Program and who have severe obesity, as defined by the bill (BMI of 40 or greater, or 35 or greater with a comorbidity), would directly benefit from the mandated coverage for bariatric surgery and related care. Similarly, individuals covered by health benefit plans issued in Arkansas who meet the criteria for severe obesity would also benefit from mandatory coverage for these treatments. Healthcare providers specializing in bariatric surgery and related pre- and post-operative care would likely see an increase in patient volume and insured procedures.
Who Might Suffer?
Healthcare insurers offering health benefit plans in Arkansas would be negatively impacted by the mandate to cover treatments for severe obesity, as this would likely increase their claim costs. The bill also specifies that certain types of insurance plans are excluded from these mandates, which may indirectly affect individuals who rely on those specific types of coverage if they also have severe obesity. Furthermore, individuals seeking coverage for weight loss medications or injectable drugs to lower glucose levels, who are explicitly excluded from the mandated coverage, would not benefit from this legislation and could be negatively impacted by the continued lack of coverage for these specific treatments under these mandates.