CHAPTER 299

HB 1281-FN – FINAL VERSION

12Mar2014… 0832h

05/01/14 1508s

05/01/14 1595s

4Jun2014… 1988CofC

2014 SESSION

14-2370

01/04

HOUSE BILL 1281-FN

AN ACT relative to copayments for certain providers.

SPONSORS: Rep. D. Sullivan, Hills 42; Rep. Sapareto, Rock 6; Rep. Major, Rock 14; Rep. Weyler, Rock 13; Sen. Woodburn, Dist 1; Sen. Larsen, Dist 15; Sen. Bradley, Dist 3; Sen. Soucy, Dist 18

COMMITTEE: Commerce and Consumer Affairs

AMENDED ANALYSIS

This bill declares that insurers issuing or renewing individual or group policies pursuant to the Patient Protection and Affordable Care Act of 2009 shall not charge copayments, coinsurance, or office deductibles for chiropractors and physical therapists that are greater than such amounts charged for the services of primary care physicians licensed under RSA 329. This bill requires the insurance commissioner to compile certain data on member cost sharing and to make certain reports.

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

12Mar2014… 0832h

05/01/14 1508s

05/01/14 1595s

4Jun2014… 1988CofC

14-2370

01/04

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Fourteen

AN ACT relative to copayments for certain providers.

Be it Enacted by the Senate and House of Representatives in General Court convened:

299:1 New Section; Insurance; Individual; Copayments for Certain Providers. Amend RSA 415 by inserting after section 6-r the following new section:

415:6-s Copayments, Coinsurance, or Office Visit Deductibles for Certain Providers.

I. Each insurer that issues or renews any 2014 Patient Protection and Affordable Care Act of 2009, Public Law 111-148 - compliant individual policy, plan, or contract of accident or health insurance that constitutes health coverage for the services of chiropractors licensed under RSA 316-A, or physical therapists licensed under RSA 328-A, shall not charge a copayment, coinsurance, or office visit deductible that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician licensed under RSA 329.

II. The commissioner shall compile available data and prepare reports concerning member cost sharing and the impact on utilization of services for physical therapy and chiropractic care. The first report shall be due by December 1, 2014, and shall analyze all New Hampshire insurance markets and identify differences in cost sharing and utilization of health services for the purpose of determining if there is a statistical association between the use of physical therapy and chiropractic care services and copayment amounts. The commissioner shall also seek to determine whether the overall costs of patients that utilize chiropractic care or physical therapists are less when the patient has lower copayment amounts for these services, and if any observed lower overall patient costs are caused by reductions in other health care services and better health care outcomes, not patient health status.

III. A second report shall be due October 1, 2017, with requirements to provide the same information, but using the most current data available.

IV. The insurance department shall consult with providers in preparing the scope of this study and gathering research for the study. Data shall include, but not be limited to, the costs for all physician services, medication, imaging, hospitalization, and procedures, such as spinal injections. For purposes of ensuring a more complete comparison, the top 50 ICD codes for diagnosis treated by physical therapists and chiropractors shall be analyzed and a comparison of the total cost of low copay plans and high copay plans shall be conducted.

V. The commissioner shall make the reports, together with any recommendations for legislation, to the president of the senate, the speaker of the house of representatives, the governor, and the chairs of the house and senate commerce committees.

299:2 New Section; Insurance; Group; Copayments for Certain Providers. Amend RSA 415 by inserting after section 18-w the following new section:

415:18-x Copayments, Coinsurance, or Office Visit Deductibles for Certain Providers. Each insurer that issues or renews any 2014 Patient Protection and Affordable Care Act of 2009, Public Law 111-148 - compliant small group policy of group or blanket accident or health insurance that constitutes health coverage for the services of chiropractors licensed under RSA 316-A, or physical therapists licensed under RSA 328-A, shall offer an optional plan which shall not charge a copayment, coinsurance, or office visit deductible that is greater than the copayment, coinsurance, or office visit deductible amount charged to the insured for the services of a primary care physician licensed under RSA 329.

II. The commissioner shall compile available data and prepare reports concerning member cost sharing and the impact on utilization of services for physical therapy and chiropractic care. The first report shall be due by December 1, 2014, and shall analyze all New Hampshire insurance markets and identify differences in cost sharing and utilization of health services for the purpose of determining if there is a statistical association between the use of physical therapy and chiropractic care services and copayment amounts. The commissioner shall also seek to determine whether the overall costs of patients that utilize chiropractic care or physical therapists are less when the patient has lower copayment amounts for these services, and if any observed lower overall patient costs are caused by reductions in other health care services and better health care outcomes, not patient health status.

III. A second report shall be due October 1, 2017, with requirements to provide the same information, but using the most current data available.

IV. The insurance department shall consult with providers in preparing the scope of this study and gathering research for the study. Data shall include, but not be limited to, the costs for all physician services, medication, imaging, hospitalization, and procedures, such as spinal injections. For purposes of ensuring a more complete comparison, the top 50 ICD codes for diagnosis treated by physical therapists and chiropractors shall be analyzed and a comparison of the total cost of low copay plans and high copay plans shall be conducted.

V. The commissioner shall make the reports, together with any recommendations for legislation, to the president of the senate, the speaker of the house of representatives, the governor, and the chairs of the house and senate commerce committees.

299:3 Health Service Corporations; Copayments for Certain Specialists. Amend RSA 420-A:2 to read as follows:

420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:18, V, RSA 415:18, VII(g), RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.

299:4 Health Maintenance Corporations; Copayments for Certain Specialists. Amend RSA 420-B:20, III to read as follows:

III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.

299:5 Applicability; Effective Date. The provisions of sections 1 and 2 of this act shall take effect and apply January 1, 2015 to health insurance plans effective on or after January 1, 2015 and sold exclusively off the federally-facilitated exchange. For health insurance plans sold through the federally-facilitated exchange and those same plans sold off the federally-facilitated exchange, the provisions of sections 1 and 2 shall take effect and apply January 1, 2016.

299:6 Health Services Corporations; Copayments for Certain Specialists. RSA 420-A:2 is repealed and reenacted to read as follows:

420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:18, V, RSA 415:18, VII(g), RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.

299:7 Health Maintenance Corporations; Copayments for Certain Specialists. RSA 420-B:20, III is repealed and reenacted to read as follows:

III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.

299:8 Repeal. The following are repealed:

I. RSA 415:6-s, relative to copayments for certain providers.

II. RSA 415:18-x, relative to copayments for certain providers.

299:9 Effective Date.

I. Sections 1 and 2 of this act shall take effect as provided in section 5 of this act.

II. Sections 6-8 of this act shall take effect October 1, 2017.

III. The remainder of this act shall take effect 60 days after its passage.

Approved: August 1, 2014

Effective Date: I. Sections 1 and 2 shall take effect as provided in section 5.

II. Sections 6-8 shall take effect October 1, 2017.

III. Remainder shall take effect September 30, 2014.