CHAPTER 33
HB 228 – FINAL VERSION
21Mar2007… 0119h
2007 SESSION
01/09
HOUSE BILL 228
AN ACT relative to the definition of “medical necessity” under the managed care law.
SPONSORS: Rep. McLeod, Graf 2; Rep. Nordgren, Graf 9; Rep. DeStefano, Merr 13; Sen. Odell, Dist 8; Sen. Hassan, Dist 23
This bill codifies a definition of “medical necessity” for purposes of the managed care law. Current law requires each insurer to maintain a definition of “medical necessity” and to file such definition with the insurance department.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
21Mar2007… 0119h
07-0809
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT relative to the definition of “medical necessity” under the managed care law.
Be it Enacted by the Senate and House of Representatives in General Court convened:
33:1 New Paragraph; Definition Added; Medical Necessity. Amend RSA 420-J:3 by inserting after paragraph XXV-a the following new paragraph:
XXV-b. “Medical necessity” means health care services or products provided to an enrollee for the purpose of preventing, stabilizing, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease in a manner that is:
(a) Consistent with generally accepted standards of medical practice;
(b) Clinically appropriate in terms of type, frequency, extent, site, and duration;
(c) Demonstrated through scientific evidence to be effective in improving health outcomes;
(d) Representative of “best practices” in the medical profession; and
(e) Not primarily for the convenience of the enrollee or physician or other health care provider.
33:2 Repeal. RSA 420-J:7-a, relative to filing requirements for medically necessary definitions, is repealed.
33:3 Effective Date. This act shall take effect 60 days after its passage.
Approved: May 14, 2007
Effective: July 13, 2007