SB 3-FN - AS INTRODUCED

2015 SESSION

15-0957

01/09

SENATE BILL 3-FN

AN ACT relative to payment for reasonable value of services.

SPONSORS: Sen. Daniels, Dist 11; Sen. Hosmer, Dist 7; Sen. Birdsell, Dist 19; Sen. Cataldo, Dist 6; Sen. Little, Dist 8; Sen. Avard, Dist 12; Sen. Lasky, Dist 13; Sen. Stiles, Dist 24; Sen. Fuller Clark, Dist 21; Sen. Prescott, Dist 23; Sen. Watters, Dist 4; Sen. Kelly, Dist 10; Sen. Boutin, Dist 16; Rep. Packard, Rock 5; Rep. Kurk, Hills 2; Rep. W. O'Brien, Hills 5; Rep. Cooney, Graf 8

COMMITTEE: Commerce

ANALYSIS

This bill requires the insurance department to set rates for payment for medical services necessary for the treatment of injured workers under workers’ compensation.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

15-0957

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Fifteen

AN ACT relative to payment for reasonable value of services.

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

1 Workers’ Compensation; Payment for Reasonable Value of Services. Amend RSA 281-A:24, I and II to read as follows:

I. The employer or the employer’s insurance carrier shall pay the full amount of the health care provider’s bill which shall not exceed the rate of payment set forth in paragraph VI unless the employer or employer’s insurance carrier can show just cause as to why the total amount should not be paid. Effort shall be made to resolve any dispute as to the reasonable value of service prior to applying to the commissioner for resolution of such a dispute. Whenever an injured employee receives medical and hospital service or other remedial care under the provisions of this chapter and a dispute arises between the employer and the person, firm, or corporation rendering such service or care as to the reasonable value of the service or care, the commissioner shall have exclusive jurisdiction to determine the reasonable value of such service or care. Following the commissioner’s determination, any interested party may petition for a hearing and all interested parties shall be entitled to notice and hearing if it is determined that all reasonable efforts to resolve the dispute have failed. The commissioner or the commissioner’s authorized representative shall make a finding as to the reasonable value of such services or care rendered, and such findings shall be final.

II. If the commissioner finds that a health care provider, health care facility, or rehabilitation provider has required unnecessary treatment, hospitalization, rehabilitation services or office visits, or other excessive charges, including charges that exceed the rate of payment set forth in paragraph VI, the health care provider, health care facility, or rehabilitation provider shall not receive payment under this chapter from a carrier, employer, or employee for the excessive fees or unnecessary treatment, hospitalization, rehabilitation services, or visits. In addition, the health care provider, health care facility, or rehabilitation provider shall be required to return to the carrier, self-insurer, employer or injured employee any such fees or charges already collected.

2 New Paragraph; Workers’ Compensation; Payment for Reasonable Value of Services. Amend RSA 281-A:24 by inserting after paragraph V the following new paragraphs:

VI.(a) The insurance department shall set the rate for payment for medical services necessary for the treatment of injured workers at 150 percent of the Medicare rate until July 1, 2016.

(b) After July 1, 2016, the insurance department shall annually set the maximum rate for payment for medical services that are necessary for the treatment of injured workers. This rate of payment shall be based on the average group health payments by using the comprehensive health care information system, established in RSA 420-G:11-a. Regardless of the date of injury, payment for medical services shall be based on the payment rates in this paragraph in effect on the date on which the medical service is provided. The insurance commissioner shall adopt rules, pursuant to RSA 541-A, to establish an additional percentage to be added to the rate of payment, not to exceed 2 percent for providers by specialty who provide proof of increased costs to treat workers’ compensation patients and relative to other matters necessary for the proper administration of this program.

3 Insurance; Comprehensive Health Care Information System. Amend RSA 420-G:11-a, I to read as follows:

I. The department and the department of health and human services shall enter into a memorandum of understanding for collaboration in the development of a comprehensive health care information system. The memorandum of understanding shall include a description of the data sets that will be included in the comprehensive health care information system, the criteria and procedures for the development of limited use data sets, the criteria and procedures to ensure that Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant limited use data sets are accessible, and a proposed time frame for the creation of a comprehensive health care information system. To the extent allowed by HIPAA, the data shall be available as a resource for insurers, employers, providers, purchasers of health care, and state agencies to continuously review health care utilization, expenditures, and performance in New Hampshire and to enhance the ability of New Hampshire consumers and employers to make informed and cost-effective health care and workers’ compensation choices. The data shall be available as a resource to the department in complying with RSA 281-A:24. In presenting data for public access, comparative considerations shall be made regarding geography, demographics, general economic factors, and institutional size. Notwithstanding HIPAA or any other provision of law, the comprehensive health care information system shall not include or disclose any data that contains direct personal identifiers. For the purposes of this section, “direct personal identifiers” include information relating to an individual that contains primary or obvious identifiers, such as the individual’s name, street address, e-mail address, telephone number, and social security number.

4 Effective Date.

I. RSA 281-A:24, VI(b) as inserted by section 2 of this act and section 3 of this act shall take effect July 1, 2016.

II. The remainder of this act shall take effect January 1, 2016.

LBAO

15-0957

01/22/15

SB 3-FN - FISCAL NOTE

AN ACT relative to payment for reasonable value of services.

FISCAL IMPACT:

METHODOLOGY: