CHAPTER 288
HB 826-FN – FINAL VERSION
28Mar2007… 0833h
13Jun2007… 2140eba
2007 SESSION
05/01
HOUSE BILL 826-FN
AN ACT relative to coverage of services and items under the medical assistance program.
SPONSORS: Rep. Donovan, Sull 4; Rep. D. Eaton, Ches 2; Rep. Tupper, Merr 6; Rep. Emerson, Ches 7; Sen. Gallus, Dist 1; Sen. Fuller Clark, Dist 24; Sen. Estabrook, Dist 21
COMMITTEE: Health, Human Services and Elderly Affairs
This bill requires the department of health and human services to define medical necessity in a manner consistent with the Social Security Act and to establish an independent coverage review process under the medical assistance program for services and items not otherwise covered. The bill also requires coverage for disposable incontinence supplies under the Medicaid state plan.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
28Mar2007… 0833h
13Jun2007… 2140eba
07-1118
05/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT relative to coverage of services and items under the medical assistance program.
Be it Enacted by the Senate and House of Representatives in General Court convened:
288:1 New Section; Coverage of Services and Items Under the Medical Assistance Program. Amend RSA 167 by inserting after section 3-g the following new section:
167:3-h Coverage of Services and Items Under the Medical Assistance Program.
I. It is the intent of the general court to support persons with special health care needs and disabilities with coverage of medically necessary services and items under the medical assistance program so that they may live in their homes and communities as independently as possible and with the maximum ability to be mobile and exercise self care.
II. For the purpose of providing medical assistance, the department shall develop a definition of “medical necessity” consistent with Title XIX of the Social Security Act and consistent with paragraph I.
III. The commissioner of the department of health and human services shall establish by rules adopted under RSA 541-A an independent coverage review process for any and all services and items allowable under Title XIX of the Social Security Act and not otherwise identified as a covered service or item under rules established by the department. The review process shall include consideration of extenuating circumstances unique to the medical assistance recipient that warrant coverage of the service or item. Criteria for coverage shall include all of the following:
(a) The service or item is medically necessary;
(b) The service or item does not meet the definition of medically necessary, but the department's clinical review finds that there are extenuating circumstances unique to the recipient that would make a denial for coverage clinically contraindicative;
(c) The service or item does not meet the definition of medically necessary, but the department's clinical review finds that new scientific evidence exists in the medical literature or by experts in the field about the efficacy or medical appropriateness of the requested item, and the department determines that the original basis for non-coverage was based on the previous lack of such evidence; or
(d) The service or item will prevent the need for a more costly covered service or item, including prevention of hospitalization or institutionalization.
IV. Medical assistance shall include coverage for disposable incontinence supplies under the Medicaid state plan for individuals who have a medical condition resulting in incontinence, as documented by a physician.
288:2 New Paragraph; Department of Health and Human Services; Rulemaking Relative to Coverage for Services and Items Under Medical Assistance Program. Amend RSA 167:3-c by inserting after paragraph XIII the following new paragraph:
XIV. The independent coverage review process for medically necessary services and items under RSA 167:3-h.
288:3 Effective Date. This act shall take effect 60 days after its passage.
Approved: July 3, 2007
Effective: September 1, 2007