Assessment of Health Insurance Benefit Mandates for Fertility Preservation Among 11 US States.
Assessment of Health Insurance Benefit Mandates for Fertility Preservation Among 11 US States.
复制标题
对美国 11 个州保留生育能力的健康保险福利要求的评估。
DOI：
10.1001/jamahealthforum.2021.4309
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
H. Su
中科院分区：
文献类型：
--
作者：
Ricardo E Flores Ortega;Sara W. Yoeun;Omar Mesina;B. Kaiser;Sara B. McMenamin;H. Su
重要性
美国多个州最近通过了法律，强制要求健康保险涵盖生育力保存 (FP) 服务，以改善癌症患者获得护理的机会，因为 FP 服务费用可能令人望而却步。尚未解答的关键问题包括福利授权法律和法规的异质性以及这种差异如何影响实施、获取和利用。
目的
描述州级 FP 健康保险福利强制法律法规的设计，并得出最佳实践和实施需求的指导。
设计、环境和人口
对美国 11 项州法律和相关保险公司法规进行了法律规划和实施科学框架指导的分析，这些法律要求为因医疗而导致医源性不孕风险的患者提供 FP 服务的健康保险福利。按主题（如覆盖范围规范）总结法律法规的设计特点和实施过程。
曝光
国家管辖。
主要成果和措施
主要成果是强制 FP 保险范围的范围和特殊性以及临床实践指南和保险公司法规在实施中的作用。
结果
2017 年 6 月至 2021 年 3 月期间，11 个州通过了 FP 福利强制法。各州执行任务的中位时间（范围）为 283 天（0-640 天），大多数州在法律生效后发布了监管指南。虽然胚胎冷冻保存等标准护理程序需要医学评估、药物、超声检查和实验室监测、卵母细胞取出、胚胎衍生、冷冻保存和储存，但法律和/或监管指南中指定包含或排除的服务存在差异。大多数州法律和监管指南均参考医学会临床实践指南和联邦政策（《平价医疗法案》和《健康保险流通与责任法案》）。
结论和相关性
在对 11 项州级 FP 福利指令的定性评估中，在指令的设计和实施中确定了可能影响患者获取的变化。由于临床利益相关者旨在理解和/或制定这些法律及其实施，关键考虑因素包括具有临床意义的福利设计的特异性和灵活性、扩大临床实践指南以告知福利覆盖范围、纳入公共保险和自我保险人群以实现普遍可及，以及州和联邦政策之间的一致性。
Importance
Multiple US states recently passed laws mandating health insurance coverage for fertility preservation (FP) services to improve access to care for patients with cancer, for whom FP service expenses can be prohibitive. Key unanswered questions include how heterogeneous benefit mandate laws and regulations are and how this variation may affect implementation, access, and utilization.
Objective
To describe the design of state-level FP health insurance benefit mandate laws and regulations and derive guidance on best practices and implementation needs.
Design, Setting, and Population
Legal mapping and implementation science framework-guided analyses were conducted on 11 US state laws that mandate health insurance benefit coverage for FP services for patients at risk of iatrogenic infertility from medical treatments and on related insurer regulations. Design features of laws and regulations and the implementation process were summarized by themes (eg, coverage specification).
Exposures
State jurisdiction.
Main Outcomes and Measures
Main outcomes were the scope and specificity of mandated FP insurance coverage and the role of clinical practice guidelines and insurer regulations in implementation.
Results
Between June 2017 and March 2021, 11 states passed FP benefit mandate laws. States took a median (range) of 283 (0-640) days to implement mandates, and a majority issued regulatory guidance after the law was in effect. While standard-of-care procedures such as embryo cryopreservation require medical evaluation, medications, ultrasonography and laboratory monitoring, oocyte retrieval, embryo derivation, cryopreservation, and storage, there was variation in which services were specified for inclusion or exclusion in the laws and/or regulator guidance. The majority of state laws and regulator guidance reference medical society clinical practice guidelines and federal policies (Affordable Care Act and Health Insurance Portability and Accountability Act).
Conclusions and Relevance
In this qualitative assessment of 11 state-level FP benefit mandates, variation that may influence patient access was identified in the design and implementation of the mandates. As clinical stakeholders aim to understand and/or shape these laws and their implementation, key considerations included specificity and flexibility of benefit design to be clinically meaningful, expansion of clinical practice guidelines to inform benefit coverage, inclusion of publicly insured and self-insured populations for universal access, and consistency between state and federal policies.
影响因子：
6.7
作者：
Penzias, Alan;Bendikson, Kristin;Stovall, Dale
通讯作者：
Stovall, Dale