Bill Summary – FastDemocracy

 State of Arkansas
 93rd General Assembly
 Fiscal Session, 2022                                                                                   SR 8
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 By: Senators Rice, Hickey, Irvin, Beckham, L. Chesterfield, J. Dismang, Elliott, J. English, Flippo,
 Gilmore, Hill, K. Ingram, G. Leding, B. Sample
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                                     SENATE RESOLUTION
                 TO AUTHORIZE THE INTRODUCTION OF A NONAPPROPRIATION
                 BILL TO ESTABLISH COVERAGE FOR THE DIAGNOSIS AND
                 TREATMENT OF MORBID OBESITY UNDER THE STATE AND
                 PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM.
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                                                 Subtitle
                        TO AUTHORIZE THE INTRODUCTION OF A
                        NONAPPROPRIATION BILL TO ESTABLISH
                        COVERAGE FOR THE DIAGNOSIS AND TREATMENT
                        OF MORBID OBESITY UNDER THE STATE AND
                        PUBLIC SCHOOL LIFE AND HEALTH INSURANCE
                        PROGRAM.
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 BE IT RESOLVED BY THE SENATE OF THE NINETY-THIRD GENERAL ASSEMBLY OF THE
 STATE OF ARKANSAS:
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          THAT Senator Rice or Senator Irvin is authorized to introduce a bill
 which as introduced will read substantially as follows:
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 "Title
 AN ACT TO ESTABLISH COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF MORBID
 OBESITY UNDER THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM;
 TO DECLARE AN EMERGENCY; AND FOR OTHER PURPOSES.
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 Subtitle
 TO ESTABLISH COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF MORBID OBESITY UNDER
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 THE STATE AND PUBLIC SCHOOL LIFE AND HEALTH INSURANCE PROGRAM; AND TO DECLARE
 AN EMERGENCY.
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 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:
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      SECTION 1.    Arkansas Code Title 21, Chapter 5, Subchapter 4, is amended
 to add an additional section to read as follows:
      21-5-419.    Coverage for diagnosis and treatment of morbid obesity 
 Legislative findings and intent  Definitions  Rules.
      (a)   The General Assembly finds that:
            (1)    Morbid obesity causes many medical problems and costly
 health complications, such as diabetes, hypertension, heart disease, and
 stroke;
            (2)    The cost of managing the complications of morbid obesity,
 largely due to inadequate treatment, far outweighs the cost of expeditious
 and effective medical treatment;
            (3)    The recommended guidelines developed by the National
 Institutes of Health, the American Society for Metabolic and Bariatric
 Surgery, the American Obesity Association, and Shape Up America and embraced
 by the American Medical Association and the American College of Surgeons are
 that patients who are morbidly obese receive responsible and affordable
 medical treatment for their obesity;
            (4)    The rate of bariatric surgery use has increased in the past
 decade to more than one hundred seventy thousand (170,000) surgical
 procedures per year in the United States;
            (5)    Payers can rely on bariatric surgery paying for itself
 through decreased comorbidities within two (2) to four (4) years;
            (6)    In 2019, the majority of members who had bariatric surgery
 under the State and Public School Life and Health Insurance Program had a
 total per-member per-month cost reduction of thirty-seven percent (37%),
 primarily due to a reduction of forty-five percent (45%) in medical per-
 member per-month costs;
            (7)    There is a clinical and financial benefit to reducing the
 burden of chronic disease through coverage; and
            (8)    The diagnosis and treatment of morbid obesity should be a
 clinical decision made by a physician based on evidence-based guidelines.
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      (b)   It is the intent of the General Assembly to provide coverage for
 the diagnosis and treatment of morbid obesity.
      (c)   As used in this section:
               (1)   "Body mass index" means body weight in kilograms divided by
 height in meters squared; and
               (2)   "Morbid obesity":
                        (A)   Means a weight that is at least two (2) times the
 ideal weight for frame, age, height, and sex of an individual as determined
 by an examining physician; and
                        (B)   May be measured as a body mass index:
                               (i)     Equal to or greater than thirty-five kilograms
 per meter squared (35 kg/m2) with comorbidity or coexisting medical
 conditions such as hypertension, cardiopulmonary conditions, sleep apnea, or
 diabetes; or
                               (ii)    Greater than forty kilograms per meter squared
 (40 kg/m2).
      (d)(1)     Each state and public school employee's health benefit plan
 under the program that is offered, issued, or renewed on or after January 1,
 2023, shall offer coverage for the diagnosis and treatment of morbid obesity.
               (2)   The coverage for the diagnosis and treatment of morbid
 obesity offered under subdivision (d)(1) of this section shall include
 without limitation coverage for bariatric surgery, including:
                        (A)   Gastric bypass surgery;
                        (B)   Adjustable gastric banding surgery;
                        (C)   Sleeve gastrectomy surgery; and
                        (D)   Duodenal switch biliopancreatic diversion.
               (3)(A)     Priority on coverage for the diagnosis and treatment of
 morbid obesity offered under subdivision (d)(1) of this section shall be for
 participants who have at least one (1) diagnosis that bariatric surgery has
 been recognized by medical science to reduce healthcare costs.
                        (B)   The diagnosis described in subdivision (d)(3)(A) of
 this section shall include without limitation:
                               (i)     Cardiovascular disease;
                               (ii)    Coronary artery disease;
                               (iii)    Diabetes mellitus;
                               (iv)    Evidence of fatty liver disease, including
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 without limitation nonalcoholic fatty liver disease or nonalcoholic
 steatohepatitis;
                             (v)     Gastroesophageal reflux disease refractory to
 medical therapy;
                             (vi)     Hyperlipidemia;
                             (vii)     Lower extremity lymphatic or venous
 obstruction;
                             (viii)     Mechanical arthropathy in a weight-bearing
 joint or symptomatic degenerative joint disease in a weight-bearing joint;
                             (ix)     Obstructive sleep apnea;
                             (x)(a)     Poorly controlled hypertension.
                                      (b)   As used in subdivision (d)(3)(B)(x)(a) of
 this section, "poorly controlled hypertension" means a systolic blood
 pressure of at least one hundred forty millimeters of mercury (140 mmHg) or a
 diastolic blood pressure of ninety millimeters of mercury (90 mmHg) or
 greater, despite medical management; or
                             (xi)     Pulmonary hypertension.
                    (C)(i)     Any additional clinical recommendations for adding
 or removing diagnoses under subdivision (d)(3)(B) of this section as being
 recognized by medical science to reduce healthcare costs and that are
 determined by the Director of the Employee Benefits Division in consultation
 with the University of Arkansas for Medical Sciences and consistent with
 guidelines or recommendations issued by the American Society for Metabolic
 and Bariatric Surgery shall result in the diagnoses' being added or removed.
                             (ii)     Additional guidelines or recommendations that
 may be considered under subdivision (d)(3)(C)(i) of this section include
 without limitation those issued by:
                                      (a)   The American Diabetes Association;
                                      (b)   The American Association of Clinical
 Endocrinology; and
                                      (c)   The American Gastroenterological
 Association.
      (e)   The coverage for morbid obesity diagnosis and treatment offered
 under this section does not diminish or limit benefits otherwise allowable
 under the Arkansas State Employees Health Benefit Plan and the Arkansas
 Public School Employees Health Benefit Plan.
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      (f)   To ensure the financial soundness and overall well-being of the
 program, the State Board of Finance, subject to approval of the Legislative
 Council, may:
            (1)    Discontinue or suspend a plan option offered under
 subsection (d) of this section;
            (2)    Promulgate a rule to establish an annual expenditure limit
 on a plan option offered under subsection (d) of this section; or
            (3)    Promulgate rules to implement this section.
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      SECTION 2.    EMERGENCY CLAUSE.       It is found and determined by the
 General Assembly of the State of Arkansas that the State and Public School
 Life and Health Insurance Program is inadequate to provide sustainable
 affordable health benefits for public school employees and state employees;
 that an urgent need exists to address the state's funding and administration
 of benefits for public school employees and state employees in order for the
 program to remain viable and to avoid severe financial hardship to plan
 participants; and that this act is immediately necessary to provide
 affordable health benefit options in a timely manner to the state's public
 school employees participating in the program and state employees
 participating in the program.     Therefore, an emergency is declared to exist,
 and this act being immediately necessary for the preservation of the public
 peace, health, and safety shall become effective on:
            (1)    The date of its approval by the Governor;
            (2)    If the bill is neither approved nor vetoed by the Governor,
 the expiration of the period of time during which the Governor may veto the
 bill; or
            (3)    If the bill is vetoed by the Governor and the veto is
 overridden, the date the last house overrides the veto."
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