HB 309-FN – AS AMENDED BY THE HOUSE
4Jan2012… 2815h
4Jan2012… 0090h
2011 SESSION
01/09
HOUSE BILL 309-FN
AN ACT relative to certain insurance mandates and establishing a committee to study current insurance mandates.
COMMITTEE: Commerce and Consumer Affairs
This bill:
I. Makes insurance coverage for certified midwives optional.
II. Requires utilization review for coverage for children’s early intervention therapy services, diagnosis and treatment of pervasive developmental disorder or autism, and hearing aids.
III. Clarifies the coverage for hearing aids.
IV. Clarifies the group coverage for obesity and morbid obesity.
V. Establishes a committee to study current New Hampshire insurance mandates.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
4Jan2012… 2815h
4Jan2012… 0090h
11-0787
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eleven
AN ACT relative to certain insurance mandates and establishing a committee to study current insurance mandates.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Coverage for Certified Midwives; Individual. Amend RSA 415:6-l to read as follows:
415:6-l Coverage for Certified Midwives; Individual. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing maternity benefits, [shall] may also provide to certificate holders of such insurance, who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
2 Coverage for Certified Midwives; Group. Amend RSA 415:18-q to read as follows:
415:18-q Coverage for Certified Midwives. Each insurer that issues or renews any policy of group accident or health insurance providing maternity benefits [shall] may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
3 Coverage for Certified Midwives; Health Service Corporations. Amend RSA 420-A:17-f to read as follows:
420-A:17-f Coverage for Certified Midwives. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group accident or health insurance providing maternity benefits [shall] may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
4 Coverage for Certified Midwives; Health Maintenance Organizations. Amend RSA 420-B:8-p to read as follows:
420-B:8-p Coverage for Certified Midwives. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing maternity benefits [shall] may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
5 Coverage for Children’s Early Intervention Services; Individual. Amend RSA 415:6-n to read as follows:
415:6-n Coverage for Children’s Early Intervention Therapy Services. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, coinsurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.
6 Coverage for Children’s Early Intervention Services; Group. Amend RSA 415:18-s to read as follows:
415:18-s Coverage for Children’s Early Intervention Services. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.
7 Coverage for Children’s Early Intervention Services; Health Service Corporations. Amend RSA 420-A:17-g to read as follows:
420-A:17-g Coverage for Children’s Early Intervention Services. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, which provides coverage for outpatient services shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.
8 Coverage for Children’s Early Intervention Services; Health Maintenance Organizations. Amend RSA 420-B:8-r to read as follows:
420-B:8-r Coverage for Children’s Early Intervention Services. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.
9 Coverage for Treatment of Pervasive Developmental Disorder or Autism. Amend RSA 417-E:2, V to read as follows:
V. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department.
VI. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the insurance coverage requirements established under this section.
10 Coverage for Hearing Aids. Amend the introductory paragraph of RSA 415:6-p to read as follows:
415:6-p Coverage for Hearing Aids. Each insurer that issues or renews any individual policy or certificate for delivery in this state, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the professional services associated with the practice of fitting, dispensing, servicing, or sale of hearing instruments or hearing aids for persons under the age of 21 years when the audiogram indicates a unilateral or bilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz(Hz) to 4000Hz and for persons 21 years of age or over when the audiogram indicates a unilateral or bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction. The benefits included in this section shall not be subject to any greater deductible or coinsurance or copay than any other benefits provided by the insurer. Insurers are required to cover the cost of a hearing aid for each ear, as needed, as well as related services necessary to assess, select, and fit the hearing aid with a maximum for the hearing aid and related services of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost. The hearing aid shall be prescribed and dispensed by a licensed audiologist or hearing instrument specialist. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall not apply to the medical assistance program, pursuant to RSA 161 and RSA 167. In this section:
11 Coverage for Hearing Aids; Group. Amend the introductory paragraph of RSA 415:18-u to read as follows:
415:18-u Coverage for Hearing Aids. Each insurer that issues or renews any policy or certificate for delivery in this state of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the professional services associated with the practice of fitting, dispensing, servicing, or sale of hearing instruments or hearing aids [by a hearing instrument dispenser or other hearing care professional] for persons under the age of 21 years when the audiogram indicates a unilateral or bilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz(Hz) to 4000Hz and for persons 21 years of age or over when the audiogram indicates a unilateral or bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction. The benefits included in this section shall not be subject to any greater deductible or coinsurance or copay than any other benefits provided by the insurer. Insurers are required to cover the cost of a hearing aid for each ear, as needed, as well as related services necessary to assess, select, and fit the hearing aid with a maximum for the hearing aid and related services of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost. The hearing aid shall be prescribed and dispensed by a licensed audiologist or hearing instrument specialist. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall not apply to the medical assistance program, pursuant to RSA 161 and RSA 167. In this section:
12 Committee Established.
I. There is established a committee to study current New Hampshire insurance mandates.
(a) The membership of the committee shall be as follows:
(1) Three members of the house of representatives, appointed by the speaker of the house of representatives.
(2) Two members of the senate, appointed by the president of the senate.
(b) Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.
II. The committee shall study current New Hampshire insurance mandates. The committee’s study shall include, but not be limited to, the costs of such mandates and whether some or all of the mandates should be optional. The committee shall also review the “essential benefits” section of the Patient Protection and Affordable Care Act of 2009, as amended, when it is released and compare that section with the mandates under New Hampshire law.
III. The members of the study committee shall elect a chairperson from among the members. The first meeting of the committee shall be called by the first-named house member. The first meeting of the committee shall be held within 45 days of the effective date of this section. Three members of the committee shall constitute a quorum.
IV. The committee shall report its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, and the state library on or before November 1, 2012.
13 Coverage for Obesity and Morbid Obesity; Group. Amend RSA 415:18-t to read as follows:
415:18-t Coverage for Obesity and Morbid Obesity; Group. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the diseases and ailments caused by obesity and morbid obesity and treatment for such, [including] which may include bariatric surgery, when the prescribing physician has issued a written order stating that treatment is medically necessary and in accordance with the patient qualifications and treatment standards set forth by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons. Such treatment standards may include, but not be limited to, pre-operative psychological screening and counseling, behavior modification, weight loss, exercise regimens, nutritional counseling, and post-operative follow-up, overview, and counseling of dietary, exercise, and lifestyle changes. The covered insured shall be at least 18 years of age. The benefits included in this section shall be subject to the terms and conditions of the policy and shall be no less extensive than coverage provided for similar conditions or illnesses.
14 Effective Date.
I. Section 12 of this act shall take effect upon its passage.
II. The remainder of this act shall take effect 60 days after its passage.
LBAO
11-0787
Revised 02/10/11
HB 309 FISCAL NOTE
AN ACT relative to certain insurance mandates and establishing a committee to study current insurance mandates.
FISCAL IMPACT:
The Insurance Department states this bill will have an indeterminable fiscal impact on state general fund revenue, and county and local expenditures in FY 2011 and each year thereafter. The New Hampshire Association of Counties states this bill may decrease county expenditures by an indeterminable amount in FY 2011 and each year thereafter. The New Hampshire Municipal Association states this bill may decrease local expenditures by an indeterminable amount in FY 2011 and each year thereafter. There is no fiscal impact on state expenditures, or county and local revenue.
METHODOLOGY:
The Insurance Department states this bill repeals all state mandated benefits that are not included as federally defined essential benefits. The Department states the State of New Hampshire employee benefit plan is not subject to the insurance mandates because the State is self-insured, therefore no fiscal impact on state expenditures. The Department further indicates the fiscal impact of this bill on state general fund revenue and on county and local expenditures can not be determined.
The New Hampshire Association of Counties states to the extent county health insurance provider contracts included mandate coverage being repealed by this bill, county expenditures may decrease by an indeterminable amount.
The New Hampshire Municipal Association states to the extent eliminating mandatory coverage affects insurance rates, there may be an indeterminable decrease on municipal expenditures.