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Show efficiently as possible, the commission was empowered to contract with community health centers, health maintenance organizations, and other managed care providers. The legislation emphasized "payment methodologies that promote cost-effective care, including prospectively establishing a fixed amount of compensation for services received by each recipient." Also, recipients under the plan could be "required to utilize a closed panel of health care providers selected by the commission." Finally, the commission was authorized to assess a copayment at the time of service. Under the bill, "essential health care benefits" were defined as: (1) care provided in the office by a physician, physician assistant, or a nurse practitioner; and (2) diagnostic testing. While some may have viewed this level of "essential" health care as inadequate, it was largely dictated by the fiscal and political realities of funding a comprehensive health insurance plan. Senator Shepherd, herself a former small business owner, was sensitive to the fact that some small firms were marginally profitable. Although new taxes on employers would be closely scrutinized, she also wanted to address our current system where medical costs of the uninsured are paid for by the insured. Small firms that offered health insurance to their employees were sometimes at a competitive disadvantage to firms that did not. The balance between protecting small firms while still providing access to an essential level of care was struck by proposing to assess a $15 per employee monthly payroll tax on employers who did not offer a minimum level of health insurance benefits. Senator Shepherd argued this amount was sufficient to fund the "essential care" while still protecting financially vulnerable small businesses. After being debated on the Senate floor, SB 195 was referred to the Access to Health Care Task Force for further study. Appropriation for Practice Guidelines A final recommendation of the task force was that the Legislature should appropriate $60,000 for the Department of Health's funding of demonstration projects to find the best ways of encouraging physicians to follow practice guidelines. The Legislature approved this request and the Access to Health Care Task Force has since funded four demonstration projects, each testing a different method of disseminating practice guidelines. 1993 General Session The Access to Health Care Task Force presented two bills to the 1993 General Session - HB 130, entitled "Increasing Access to Health Care" and HB 67, "Health Coverage and Cost Containment Commission." As originally proposed by the task force, HB 130 contained the following provisions: (1) requires dependent coverage up to age 26; (2) requires continuity of coverage for all insurance companies and modified community rating for small groups; (3) establishes a new grant program to expand the availability of primary care that would replace the existing Utah Medical Assistance Program; (4) directs the Commissioner of Insurance to establish uniform claim forms and compatible electronic billing systems; (5) requires insurance companies to provide premium quotes on designated benefit packages; (6) grants limited liability for health care providers who give charity care; (7) requires disclosure by health care providers of ownership of certain medical equipment and labs; and (8) amends state insurance laws to clarify that a preferred provider organization may limit the number of providers, within a class, that it places on a panel. When the draft recommendations were presented by the task force to the Legislative Health and Environment and Human Services Interim Committees, the repeal of the Utah Medical Assistance Program was removed from the bill. This left no way to fund the primary care grant program. Before the bill was introduced, its sponsor, Representative R. Mont Evans, added a provision that directed the Department of Health to require some Medicaid recipients to make small co-payments at the time of service. It was Utah's Health: An Annual Review 1993 107 |