Revision: Dec. 10, 2009, midnight
HB 1586-FN – AS INTRODUCED
2010 SESSION
01/09
HOUSE BILL 1586-FN
AN ACT relative to mandated benefits review.
SPONSORS: Rep. Renzullo, Hills 27; Rep. W. O'Brien, Hills 4; Rep. Seidel, Hills 20; Sen. Carson, Dist 14
COMMITTEE: Commerce and Consumer Affairs
This bill establishes the mandated benefits review act to provide for a review of mandated benefits by the insurance department.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
10-2005
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Ten
AN ACT relative to mandated benefits review.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Statement of Purpose. The purpose of this act is to provide for a review of mandated benefits. This act requires that a proposed mandated benefit or an amendment to an existing law or an amendment to a proposal for mandated health benefits, mandated health insurance coverage, or mandated offerings of health benefits, be reviewed by the insurance department. The insurance department shall provide to the general court an actuarially-based review with regard to the proposal’s medical efficacy and cost benefit.
2 New Section; Mandated Benefits Review Act. Amend RSA 400-A by inserting after section 39-a the following new section:
400-A:39-b Mandated Benefits Review Act.
I. In this section:
(a) “Department” means the insurance department.
(b) “Mandated benefits” shall include:
(1) Coverage for specific medical or health-related services, treatments, medications, or practices;
(2) Coverage of the services specific to health care practitioners;
(3) Requiring an offering of specific services, treatments, or practices or an expansion of an existing coverage; and
(4) Any mandated reimbursement amount to specific health care practitioners.
(c) “Offering” means that every carrier or health plan shall offer the mandated benefit to prospective customers.
(d) “Report” means an independent, actuarially-based review.
II.(a) A proposal or an amendment to an existing law or an amendment to a proposal for a new mandated health benefit shall be evaluated as to the proposal’s medical efficacy and financial impact. The standing committee having jurisdiction over the matter shall refer the proposal or any amendment to an existing law or any new amendment to a proposal to the department for review.
(b) The department shall retain an independent actuary to review the proposal or amendment within an appropriate time frame after the documentation is submitted and assure that appropriate assumptions are used to accurately demonstrate the financial impact of the proposed mandate or amendment to a proposed mandate or an amendment to an existing law. The department shall include the results of this review in the report required by subparagraph (c).
(c) The department shall review the documentation submitted with the proposed legislation and shall issue a report to the standing committee having jurisdiction over the matter as to whether:
(1) The information is complete.
(2) The research cited meets professional standards.
(3) All relevant research has been brought to light.
(4) The conclusions and interpretations drawn from the evidence are consistent with the data presented.
(d) In preparing the report required in subparagraph (c), the department shall apply the following guidelines in determining the adequacy of the information presented:
(1) If the insurance coverage is not generally in place, to what extent the lack of coverage of the proposed benefit results in financial hardship.
(2) What is the demand for the proposed health care coverage from the public at large and in collective bargaining negotiations, and to what extent voluntary coverage of the proposed benefit is available.
(3) The department, in consultation with relevant medical experts, shall consider evidence of medical efficacy:
(A) If the legislation seeks to mandate coverage of a particular therapy:
(i) The results of at least one clinical trial demonstrating the medical consequences of that therapy compared to no therapy and to alternative therapies; and
(ii) The results of any other relevant clinical research.
(B) If the legislation seeks to mandate coverage of a specific class of practitioners or medical specialty:
(i) The results of at least one professionally-acceptable, controlled trial demonstrating the medical results achieved by the specific class of practitioners or medical specialty relative to those already covered; and
(ii) The results of any relevant research.
(4) The department shall review evidence of financial impact, including but not limited to the:
(A) Extent to which coverage will increase or decrease the cost of treatment or service;
(B) Extent to which the same or similar mandates have affected charges, costs, utilization, and payments in other states;
(C) Extent to which the coverage will increase the appropriate use of the treatment or service;
(D) Extent to which the mandated treatment or service will be a substitute for more expensive or less expensive treatments or services;
(E) Extent to which the coverage will increase or decrease the administrative expenses of third party payers and the premium and administrative expenses of policyholders;
(F) Financial impact of the mandated benefit on small employers, medium-sized employers, large employers, and the state employees health benefit plan; and
(G) Financial impact of the mandated benefit on purchasers of individual coverage, state high-risk pools, and the state retirement program.
III.(a) In addition to the duties prescribed in this section, the department shall annually review 25 percent of existing state mandated benefits, mandated health insurance coverage, and mandated offerings of health benefits in the same manner as prescribed in this section. The department shall report the findings of such review to the chairs of the legislative committees having jurisdiction over insurance issues, the speaker of the house of representatives, and the president of the senate, no later than September 1 of each year.
(b) These 25 percent of existing mandated benefits shall expire on July 1 of every year unless specifically continued by the general court in the prior legislative session. Consideration of continuation of such benefits shall be based upon the review process conducted under this section.
3 Effective Date. This act shall take effect upon its passage.
LBAO
10-2005
12/07/09
HB 1586-FN - FISCAL NOTE
AN ACT relative to mandated benefits review.
FISCAL IMPACT:
The Insurance Department states this bill will increase state expenditures and have an indeterminable fiscal impact on state general fund revenue, county expenditures, and local expenditures in FY 2011 and each year thereafter. There is no fiscal impact on county and local revenue.
METHODOLOGY:
The Insurance Department states this bill requires the Department to retain an independent actuary to review both proposed health insurance benefit mandates and at least a quarter of the existing health insurance mandates each year. It is estimated an actuarial review for a health insurance benefit mandate will cost from $25,000 to $50,000 per review. The Department does not know how many benefit mandates are contained in law or would be proposed in legislation to estimate a fiscal impact. The Department is funded by assessments against insurance companies. The Department states it does not have sufficient appropriations to contract for the independent actuary and would need additional assessments against insurance companies to fund this work. The increased assessments may lead to higher premiums resulting in increased premium tax revenue. However, the Department is not able to predict if companies will absorb the additional assessments versus increasing rates. To the extent rates increase for insurance purchased by county and local governments their expenditures would increase. The Department anticipates any fiscal impact would not occur until FY 2011.