Revision: June 7, 2012, midnight
HB 1617-FN – VERSION ADOPTED BY BOTH BODIES
05/16/12 2273s
05/16/12 2272s
6June2012… 2439CofC
2012 SESSION
01/09
HOUSE BILL 1617-FN
AN ACT repealing the certificate of need law and extending the moratorium on nursing home beds and rehabilitation beds.
SPONSORS: Rep. Holden, Hills 4
COMMITTEE: Health, Human Services and Elderly Affairs
This bill prospectively repeals the certificate of need law.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
05/16/12 2273s
05/16/12 2272s
6June2012… 2439CofC
12-2486
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twelve
AN ACT repealing the certificate of need law and extending the moratorium on nursing home beds and rehabilitation beds.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Commission on Health Care. Amend RSA 21-S:3, I-IV to read as follows:
I. “Ambulatory surgical facility” means [“ambulatory surgical facility” as defined in RSA 151-C:2, I] a health care facility or a portion of a health care facility which provides surgical treatment to patients not requiring hospitalization, and does not include the offices of private physicians or dentists, whether in individual or group practices.
II. “Commission” means the New Hampshire commission on health care cost containment, established in RSA 21-S:2.
III. “Health carrier” means any entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to provide, deliver, arrange for, pay for, or reimburse any of the costs of health services, including an insurance company, a health maintenance organization, a nonprofit health services corporation, or any other entity providing health coverage.
IV. “Hospital” means [“hospital” as defined in RSA 151-C:2, but not including governmental facilities] an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals. The term “hospital” does not include governmental facilities.
2 Health Care Commission. Amend RSA 21-S:8, II to read as follows:
II. The fund shall be capitalized through a one-time assessment administered by the department of administrative services. The assessment shall be allocated 50 percent to health carriers, as defined in RSA 420-G:2, with at least 1,000 covered lives in the state, in proportion to gross premiums written, and 50 percent to hospitals[, as defined in RSA 151-C:2, XX,] and ambulatory surgical facilities[, as defined in RSA 151-C:2, I,] in proportion to net operating revenue. The total amount of the assessment shall be $250,000. The department of health and human services and the insurance department shall each certify to the department of administrative services the allocated assessment for each affected health carrier, hospital, and ambulatory surgical facility by August 1, 2010.
3 Data Review. Amend RSA 126:26 to read as follows:
126:26 Data Review. The department of health and human services shall [provide access, without restriction, to the data collected under RSA 126:25 to the health services planning and review board. The department shall] prepare a report relative to the data collected under RSA 126:25, I on or before November 15, 1996, and annually thereafter, to the speaker of the house of representatives and president of the senate. The report shall contain, but not be limited to, an analysis and evaluation of the data collected and recommendations for improved efficiencies and for health care cost containment. The department of health and human services is also authorized to prepare periodic reports on price and utilization of health services for the purpose of encouraging competition.
4 Reference Deleted. Amend the introductory paragraph of RSA 126:28 to read as follows:
Notwithstanding any other provision of law, all information required to be filed under this subdivision[, with the exception of confidential commercial and financial information as defined in RSA 151-C:2,] shall be made available:
5 Reference Changed. Amend RSA 126:29, IV to read as follows:
IV. In addition to any other penalties provided by law, any provider required to provide data under RSA 126:25, [II] I, who willfully fails to comply with the provisions of this subdivision shall be subject to a civil penalty of $50 for each day of noncompliance, which shall not be reimbursable by any commercial insurer, nonprofit health services corporation, health maintenance organization, or multiple employer welfare arrangement as provided in RSA 415, 420-A, 420-B, and 415-E.
6 Reference Deleted. Amend RSA 126:30 to read as follows:
126:30 User Fees. Any person[, other than those covered by the fee provisions of RSA 151-C:15, I,] requesting copies of data or statistical information filed with the department of health and human services under RSA 126 or RSA 141-B shall pay to the department a fee established by the commissioner of health and human services pursuant to RSA 126:27, IV. The fee shall reflect the full costs of preparing the data for release, including the cost of personnel time, computer and any related expenses associated with fulfilling the request. Fees paid under this section shall be deposited into a revolving account which shall not lapse and shall be used in administering the responsibilities of the department of health and human services under this subdivision.
7 Acute Care Centers; Reference Deletion. Amend RSA 141-C:26 to read as follows:
141-C:26 Acute Care Centers. The commissioner, with the written approval of the governor, may establish, operate, or authorize the operation of temporary acute care centers for the purpose of the delivery of acute medical services to persons who would normally require admission to an acute care hospital, when there is a public health incident as defined in RSA 508:17-a, II(c) and when the acute care hospitals in the area do not have the physical and human resources necessary to meet the demand or anticipated demand for medical care. Any such facility so established or designated shall be exempt from the provisions of RSA 151 [ and RSA 151-C]. The commissioner shall adopt rules, pursuant to RSA 541-A, regarding the facility and staffing requirements, screening and admission criteria, payment and reimbursements, clinical standards, recordkeeping, and discharge criteria for acute care centers. In adopting such rules, the commissioner shall take into consideration, to the extent feasible, the rights and responsibilities of patients set forth in RSA 151:21. For purposes of immunity, actions taken pursuant to this section shall be considered an emergency management function under RSA 21-P:41, I.
8 Definition Clarified. Amend RSA 151:2, I(a) to read as follows:
(a) Hospitals, [as defined in RSA 151-C:2,] and infirmaries or health services maintained by an educational institution. For the purposes of this subparagraph “hospital” means an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals.
9 Hospital Rates for Self-Pay Patients; Reference Deletion. Amend RSA 151:12-b to read as follows:
151:12-b Hospital Rates for Self-Pay Patients. When billing self-pay patients for a service rendered, a hospital[, as defined in RSA 151-C:2,] shall accept as payment in full an amount no greater than the amount generally billed and received by the hospital for that service for patients covered by health insurance. A hospital shall determine the amount generally billed to health carriers in a manner consistent with Section 9007 of the Patient Protection and Affordable Care Act of 2009. A hospital shall provide written notice to a self-pay patient in advance of providing a service and at the time the service is billed regarding the requirements under this section. For the purposes of this section “hospital” means an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals.
10 Disclosure of Information; Hospitals and Physician Hospital Organizations; Reference Deletion. Amend RSA 151:31, I to read as follows:
I.(a) Hospitals[, as defined in RSA 151-C:2,] shall make an annual report, beginning on November 1, 2000, to the attorney general including the following information:
[(a)] (1) The hospital’s financial relationships with physician hospital organizations.
[(b)] (2) Number and type of providers employed by the hospital, and any affiliates, as defined in RSA 541-C:2, II, and contracting with or through physician hospital organizations.
[(c)] (3) Frequency of contract negotiations with providers and physician hospital organizations.
[(d)] (4) The number of primary care physicians and specialty care physicians, by specialty, that are employed by each hospital or affiliate.
[(e)] (5) The number of primary care physicians and specialty care physicians, by specialty, that are members of the hospital’s active medical staff.
[(f)] (6) An organizational chart showing the corporate structure of the hospital and any affiliates including a description of the type of services provided by each entity.
[(g)] (7) A list of physician practices that are owned by the hospital and its affiliates, or which contract with the hospital and any affiliates for the provision of professional services.
[(h)] (8) A copy of the policy adopted by the hospital, and any affiliates, requiring physicians employed by such hospital to notify their patients when they are referring a patient for professional services to be provided by a physician employed by the same hospital or affiliate. The policy shall also expressly state that no physician employed by the hospital or any affiliate is required or in any way obligated to refer patients to physicians also employed or under contract with the hospital or any affiliate.
(b) For the purposes of this section “hospital” means an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals.
11 Definition Clarified. Amend RSA 153-A:2, XI to read as follows:
XI. “Facility” means a hospital as defined in RSA [151-C:2, XX] 151:2, I(a).
12 Reference Clarification. Amend RSA 161-J:2, II(d) to read as follows:
(d) A hospital [as defined in RSA 151-C:2, XX] which means an institution which is engaged in providing to patients, under supervision of physicians, diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of such persons. The term “hospital” includes psychiatric and substance abuse treatment hospitals.
13 Reference Deleted. Amend RSA 195-D:3, XII to read as follows:
XII. “Nursing home,” notwithstanding any other provision of law to the contrary, means any nonprofit or charitable institution or organization, public or private, which is exempt from federal taxation pursuant to section 501 of the United States Internal Revenue Code of 1986 as amended, and which is engaged in the operation of, or formed for the purpose of operating, a facility in which nursing care, sheltered care, intermediate care, life-care or continuing care, and medical services are prescribed by or performed under the general direction of persons licensed to practice medicine or surgery in New Hampshire, and in whole or in part is, or shall be upon completion, [(a)] licensed as a residential care facility under RSA 151:2, I(e) or [(b) can be upon receipt of a certificate of need under RSA 151-C ] licensed as a nursing home under the laws of New Hampshire.
14 References Deleted. Amend RSA 281-A:2, XII-b to read as follows:
XII-b. “Health care provider” as used in this chapter includes doctors, chiropractors, rehabilitation providers, health services [as defined in RSA 151-C:2, XVIII], health care facilities [as defined in RSA 151-C:2, XV-a], and health maintenance organizations [as defined in RSA 151-C:2, XVI]. For the purposes of this paragraph:
(a) “Health services” means clinically related diagnostic, treatment, or rehabilitative services, as well as preventive services, and includes, without limitation, alcohol, drug abuse, and mental health services.
(b) “Health care facility” means hospitals, ambulatory surgical facilities, specialty hospitals and licensed nursing homes including all services and property owned by such. Health care facilities shall include facilities which are publicly or privately owned or for-profit or not-for-profit, and which are licensed or required to be licensed in whole or in part by the state.
(c) “Health maintenance organization” means a public or private organization, organized under the laws of any state or the federal government which:
(1) Provides or otherwise makes available to enrolled participants health care services, including at least the following basic health care services: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive services, and out-of-area coverage;
(2) Is compensated, except for co-payments, for the provision of the basic health care services listed in subparagraph (c)(1) to enrolled participants on a predetermined periodic basis without regard to the date on which health care services are provided; a predetermined periodic basis shall be fixed without regard to the frequency, extent, or kind of health care service actually provided; and
(3) Provides physician services primarily:
(A) Directly through physicians who are either employees or partners of such organization;
(B) Through arrangements with individual physicians or one or more groups of physicians organized in a group practice or individual basis; or
(C) A combination of (A) and (B), as provided herein.
15 Reference Changed. Amend RSA 318:29, V(i) to read as follows:
(i) Any ownership or control of an ownership interest of a pharmacy within the state by an individual licensed to prescribe medicine, or a corporation, professional association or partnership consisting of such prescriber or prescriber’s immediate family members, except such corporations as are expressly exempt from income taxation under section 501(c)(3) of the United States Internal Revenue Code. This shall not include ownership of investment securities purchased by the practitioner on terms available to the general public and which are publicly traded. This subparagraph shall not apply to the ownership or control of an ownership interest of an institutional pharmacy operated within the state by or for hospitals, as defined in RSA [151-C:2, XX] 151:2, I(a), licensed by the state pursuant to RSA 151.
16 References Deleted. Amend RSA 508:18 to read as follows:
508:18 Liability Limited; Health Care Facilities and Personnel.
I. No health care facility licensed under RSA 151, licensed physician, registered nurse, certified physician’s assistant or qualified medical technician or medical technologist ordered by a law enforcement officer to perform a test, medical examination or procedure on a person in the custody of such officer, shall be held liable for any damage arising out of the performance of such test, examination, or procedure, if the test, examination, or procedure is performed with ordinary care. Nothing in this section shall be construed to legalize an otherwise illegal test, examination or procedure insofar as the law enforcement agency and any employee thereof is concerned.
II. For purposes of this section, “health care facility” means [“health care facility” as defined in RSA 151-C:2, XV-a] hospitals, ambulatory surgical facilities, specialty hospitals, and licensed nursing homes including all services and property owned by such. Health care facilities shall include facilities which are publicly or privately owned or for-profit or not-for-profit, and which are licensed or required to be licensed in whole or in part by the state.
17 Repeal. The following are repealed:
I. RSA 126:25, II, relative to a plan developed by the health services planning and review board.
II. RSA 151-C, relative to certificate of need review of proposed new institutional health services.
18 Effective Date. This act shall take effect June 30, 2015.
LBAO
12-2486
11/15/11
HB 1617-FN - FISCAL NOTE
AN ACT repealing the certificate of need law and extending the moratorium on nursing home beds and rehabilitation beds.
FISCAL IMPACT:
The Department of Health and Human Services states this bill will reduce state revenue and expenditures and may increase county and local expenditures by indeterminable amounts in FY 2013 and in each year thereafter. The New Hampshire Association of Counties states this bill may increase county expenditures by an indeterminable amount in FY 2013 and in each year thereafter. This bill will have no fiscal impact on county and local revenues.
METHODOLOGY:
The Department of Health and Human Services states this bill repeals the certificate of need program which establishes regulations for the review of health care construction or renovation, the addition of hospital and nursing home beds, and the installation of certain diagnostic and therapeutic equipment. The Department indicated the budget for the Health Services Planning and Review Board, which administers the program, is statutorily limited to $500,000 and is funded by administrative fees paid by acute care hospitals, private nursing homes, and specialty hospitals. In addition, application fees of $500 to $12,000 are charged to facilities not paying an annual fee, and individuals may pay a fee of $1,000 for development of standard by the Board. These additional fees are deposited in the general fund, but they are rare. The Department states the Health Services Planning and Review Board also funds most of the contract for collection of health care data as required by RSA 126:25,I. The Department assumes the responsibility for the data collection and the associated annual cost of approximately $70,000 would be assumed by an existing agency or discontinued. The department states repeal of the program may lead to uncontrolled spending for additional healthcare facilities, programs, and equipment leading to higher healthcare costs for all payers.
The New Hampshire Association of Counties states the repeal could increase the number of nursing home beds and facilities which would in increase healthcare costs overall. The Association assumes, notwithstanding the statutory cap, the county share of long-term care Medicaid costs would increase. The Association is not able to estimate what the increase might be.