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2018 SESSION

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HB 434 Health insurance; coverage for proton therapy.

Introduced by: David E. Yancey | all patrons    ...    notes | add to my profiles

SUMMARY AS INTRODUCED:

Health insurance; coverage for proton therapy. Requires any health insurer, corporation, or health maintenance organization issuing an insurance policy, subscription contract, or health care plan to provide coverage for physician-prescribed proton therapy for the treatment of breast, prostate cancer, or other indications under a hypofractionated protocol as part of a clinical trial or registry. The measure specifies the number of treatments for breast or prostate cancer under a hypofractionated proton therapy protocol. The measure specifies the amount payable for proton treatment deliveries at fixed percentages of the amount paid under CPT code 77523 as provided in the Commonwealth's Medicaid fee schedule, in order to provide that the cost of treatment under the hypofractionated proton therapy protocol does not exceed the cost of treatment for the corresponding standard intensity modulated radiation therapy (IMRT) protocol for the same indication. The measure provides that (i) if an insurer, corporation, or health maintenance organization is required to pay more for a course of hypofractionated proton therapy than their present, weighted average payment for a course of IMRT treatment, the insurer, corporation, or health maintenance organization is required to pay to the provider the amount of such average payment for the IMRT treatment and (ii) the provider is authorized to bill the patient for the difference.


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