Health Impact, Cost, and Coverage Program Act

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Policy Status

  • Type: Model Policy
  • Status: Draft
  • Date Introduced: December 4, 2025

Task Forces

  • Health and Human Services

    • Tags

  • SNPS 2025

    • Summary

    The Health Impact, Cost, and Coverage Program Act establishes a program to analyze the impact of proposed legislative mandates on health benefit plan issuers or administrators in a state. 
    Draft

    Health Impact, Cost, and Coverage Program Act

    Be it enacted by the legislature of [state]:  

    Section 1. Title 

    This Act shall be known as the Health Impact, Cost, and Coverage Analysis Program Act. 

    Section 2. Definitions 

    A. “Analysis Program” means the Health Impact, Cost, and Coverage Analysis Program established under Section 3. 

    B. “Center” means [the designated academic or governmental institution responsible for administering the Analysis Program]. 

    C. “Enrollee” means an individual who is enrolled in a health benefit plan, including a covered dependent. 

    D.  “Health Benefit Plan Issuer” means an insurer, health maintenance organization, or other entity authorized to provide health benefits coverage under the laws of this state. 

    E. “Health Care Provider” means a physician, facility, or other person who is licensed, certified, registered, or otherwise authorized to provide a health care service. 

    F. “Health Care Service” means a service, procedure, drug, or device to diagnose, prevent, alleviate, cure, or treat a human disease, injury, or abnormal physical or mental condition. 

    G. “Mandate” means a legislative provision that requires a health benefit plan issuer or administrator to: 

    1. provide coverage for a health care service;
    2. increase or decrease payments to health care providers; or
    3. implement a new contractual or administrative requirement.

    Section 2. Establishment of Analysis Program. 

    The Center shall establish the Analysis Program to prepare analyses of legislative documents that would impose new mandates on health benefit plan issuers or administrators in this state.  

    Section 3. Requests for Analysis. 

    1. During or between legislative sessions, the presiding officers of each legislative chamber or chairs of committees with jurisdiction may submit a request to the Analysis Program on a legislative proposal that would impose a new mandate on health benefit plan issuers or administrators in this state.  
    2. A request submitted under this section must include a copy of the relevant legislative document. 

    Section 4. Impact Analysis of Legislation on Health Coverage Costs 

    1. The Program shall use data compiled by [the state’s all-payer claims database, if available] and peer-reviewed literature to estimate the: 
      • (a) expected change in total cost of health coverage, including dollar amounts;
      • (b) impact on use of relevant health care services;
      • (c) change in administrative expenses for issuers and enrollees;
      • (d) cost to private and public sector entities;
      • (e) existing coverage
      • (f) market availability and usage of relevant services;
      • (g) scientific support for services, including FDA and CMS determinations; and
      • (h) short- and long-term cost projections.
    2. In conducting an analysis under this section, the analysis program may consult with persons with relevant knowledge and expertise, including independent actuaries. 

    Section 5. Reporting. 

    1. The Center must issue a written report within 60 days of receiving a request, or within 30 days during a legislative session. 
    2. The report shall be delivered to legislative leadership and posted online. It must include:
      • (a) aggregated responses to any data call;
      • (b) the text of the data call under Section 6;
      • (c) methodologies used; and
      • (d) no disclosure of individual insurer responses.

    Section 6. Data Calls. 

    1. [State insurance regulators] shall issue data calls as requested by the Center to ensure the availability of relevant financial and utilization data. 
    2. Health insurers shall respond within 10 days or a date set by the Center. Responses must include calculation methodologies and are exempt from public disclosure.