SB77 (2005) Detail

Relative to the review of proposed health care provider contracts.


CHAPTER 161

SB 77 – FINAL VERSION

03/10/05 0470s

25May2005… 1335h

2005 SESSION

05-0789

01/09

SENATE BILL 77

AN ACT relative to the review of proposed health care provider contracts.

SPONSORS: Sen. Flanders, Dist 7; Sen. Clegg, Dist 14; Sen. Odell, Dist 8; Sen. Barnes, Dist 17; Sen. Martel, Dist 18; Rep. Hunt, Ches 7; Rep. S. Francoeur, Rock 15; Rep.  MacKay, Merr 11

COMMITTEE: Banks and Insurance

AMENDED ANALYSIS

This bill requires a health carrier to furnish a provider with a complete copy of a proposed health care provider contract. The bill also requires that a health carrier give a 60-day notice to a provider before there is a material change in the applicable fee schedule.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/10/05 0470s

25May2005… 1335h

05-0789

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Five

AN ACT relative to the review of proposed health care provider contracts.

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

161:1 Managed Care; Provider Contracts. Amend RSA 420-J:8, VIII to read as follows:

VIII.(a) No contract between a health carrier and a participating provider shall contain any payment or reimbursement provision the terms of which creates an inducement for the provider to not provide medically necessary care to covered persons. Nothing in this section shall be construed to prohibit the use of payment arrangements between a health carrier and a participating provider or provider group which involve capitation, withholds or other arrangements.

(b) Prior to the execution of a health care provider contract, a health carrier shall furnish to the contracting entity, in writing or in electronic format, a complete copy of the proposed contract including all attachments and exhibits. The health carrier shall also make available to the contracting entity, in writing or in electronic format, the most current provider manual.

(c) The contracting entity may request that a health carrier disclose the fees applicable to specified procedure codes that pertain to the entity’s practice or specialty or a method or process that allows the contracting entity to determine the fees pursuant to the terms of the contract. Upon request by the contracting entity, the insurer shall furnish, in writing or in an electronic format, the requested procedure codes within 30 calendar days from receipt of the request.

(d) No provider contract shall allow for a material change in the applicable fee schedule unless notice of such change is given at least 60 days in advance of the effective date.

161:2 Effective Date. This act shall take effect 60 days after its passage.

(Approved: June 21, 2005)

(Effective Date: August 20, 2005)