Bill Text - HB432 (2013)

Relative to health care costs for county and state inmates.


Revision: March 7, 2013, midnight

HB 432-FN – AS AMENDED BY THE HOUSE

6Mar2013… 0324h

2013 SESSION

13-0602

04/01

HOUSE BILL 432-FN

AN ACT relative to health care costs for county and state inmates.

SPONSORS: Rep. Pantelakos, Rock 25; Rep. Shurtleff, Merr 11; Rep. Charron, Rock 4

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill amends the procedures for reimbursement by the county and state departments of corrections for the costs of inmate medical care.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

6Mar2013… 0324h

13-0602

04/01

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Thirteen

AN ACT relative to health care costs for county and state inmates.

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

1 Medical Services for County Prisoners. Amend RSA 623-C:1, I to read as follows:

I.(a) Except as provided in subparagraphs (b) through [(f), no hospital or emergency room shall charge a county or its agent] (g) the department of corrections or its agent shall pay health care facilities and hospitals at no more than 110 percent of the Medicare allowable rate for inpatient or emergency room care provided for prisoners in county correctional facilities. In this chapter, “health care facilities” mean ambulatory and specialty-medical services centers licensed under RSA 151, and shall include but not be limited to surgical, rehabilitation, long-term care, oncology, radiology/imaging centers, and dialysis centers, and shall also include physician, nurse practitioner, dental, and allied health care practices, and community health care clinics operating under a licensed healthcare facility.

(b) Except as provided in subparagraphs (c) through (e), the department of corrections or its agent shall pay the following providers no more than 125 percent of the Medicare allowable rate for care provided for prisoners in county correctional facilities:

(1) Physicians and surgeons licensed pursuant to RSA 329.

(2) Podiatrists licensed pursuant to RSA 315.

(3) Dentists licensed pursuant to RSA 317-A.

(4) Optometrists licensed pursuant to RSA 327.

(5) Advanced practice registered nurses licensed pursuant to RSA 326-B:18.

(6) Physician assistants licensed pursuant to RSA 328-D.

(7) Physical therapists licensed pursuant to RSA 328-A.

(8) Athletic trainers licensed pursuant to RSA 326-G.

(9) Occupational therapists licensed pursuant to RSA 326-C.

(10) Speech and language pathologists licensed pursuant to RSA 326-F.

(11) Respiratory therapists licensed pursuant to RSA 326-E.

(12) Recreational therapists licensed pursuant to RSA 326-J.

(13) Dietitians licensed pursuant to RSA 326-H.

(14) Audiologists licensed pursuant to RSA 137-F.

(15) Pharmacies licensed pursuant to RSA 318.

(16) Durable medical equipment providers.

(c) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).

[(c)] (d) Hospitals reported by the department of health and human services as having a negative operating margin in the most recent year for which hospital-audited financial data is available shall charge no more than 125 percent of the Medicare rate.

[(d)] (e) Nothing in this section shall preclude the superintendent of a county correctional facility from negotiating and executing medical service rate agreements with hospitals, health care facilities, or other licensed medical providers for the provision of medical or dental services to prisoners at the lowest rate possible, or from utilizing rates in existing agreements.

(f) The superintendent of a county correctional facility may waive the application of subparagraph (a) if the superintendent determines such action is necessary to ensure prisoner access to medically necessary care.

[(e) The superintendent of a county correctional facility may waive the application of subparagraph (a) if the superintendent determines such action to be necessary for the efficient operations of the county correctional facility.

(f) Nothing in this paragraph shall require a hospital to admit any person]

(g) The superintendent of a county correctional facility may waive the application of subparagraph (a) if the superintendent determines such action to be necessary for the efficient operations of the county correctional facility.

(h) The superintendent of a county correctional facility may at any time audit any claim or seek clarification on any payment made pursuant to this section, or both. Upon request by the superintendent, the provider shall furnish information on pricing methodology and shall detail any internal process controls for ensuring accurate pricing of claims processed under this section. Claim information shall be provided in the industry standard format, including but not limited to the application of global surgery provisions, billing for surgical assistants, and bundling.

2 Medical Services for State Prisoners. Amend RSA 623-C:2, I to read as follows:

I. (a) Except as provided in subparagraphs (b) through [(d)] (f), the department of corrections or its agent shall pay health care facilities and hospitals at no more than 110 percent of the Medicare allowable rate for inpatient, outpatient, or emergency room care provided for prisoners in state correctional facilities. In this chapter, “health care facilities” mean ambulatory and specialty-medical services centers licensed under RSA 151, and shall include but not be limited to surgical, rehabilitation, long term care, oncology, radiology/imaging centers, and dialysis centers, [but shall not] and shall also include physician [practices and community health care clinics], nurse practitioner, dental, and allied health care practices, and community health care clinics operating under a licensed healthcare facility.

(b) Except as provided in subparagraphs (c) through (e), the department of corrections or its agent shall pay the following providers no more than 125 percent of the Medicare allowable rate for care provided for prisoners in state correctional facilities:

(1) Physicians and surgeons licensed pursuant to RSA 329.

(2) Podiatrists licensed pursuant to RSA 315.

(3) Dentists licensed pursuant to RSA 317-A.

(4) Optometrists licensed pursuant to RSA 327.

(5) Advanced practice registered nurses licensed pursuant to RSA 326-B:18.

(6) Physician assistants licensed pursuant to RSA 328-D.

(7) Physical therapists licensed pursuant to RSA 328-A.

(8) Athletic trainers licensed pursuant to RSA 326-G.

(9) Occupational therapists licensed pursuant to RSA 326-C.

(10) Speech and language pathologists licensed pursuant to RSA 326-F.

(11) Respiratory therapists licensed pursuant to RSA 326-E.

(12) Recreational therapists licensed pursuant to RSA 326-J.

(13) Dietitians licensed pursuant to RSA 326-H.

(14) Audiologists licensed pursuant to RSA 137-F.

(15) Pharmacies licensed pursuant to RSA 318.

(16) Durable medical equipment providers.

(c) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).

(d) Hospitals reported by the department of health and human services as having a negative operating margin in the most recent year for which hospital-audited financial data is available shall charge no more than 125 percent of the Medicare rate.

[(c)] (e) The commissioner of the department of corrections may waive the application of subparagraph (a) if the commissioner determines such action is necessary to ensure prisoner access to medically necessary care.

[(d)] (f) The commissioner of the department of corrections may waive the application of subparagraph (a) if the commissioner determines such action to be necessary for the efficient operations of the state correctional facility.

(g) The commissioner of the department of corrections may at any time audit any claim or seek clarification on any payment made pursuant to this section, or both. Upon request by the commissioner, the provider shall furnish information on pricing methodology and shall detail any internal process controls for ensuring accurate pricing of claims processed under this section. Claim information shall be provided in the industry standard format, including but not limited to the application of global surgery provisions, billing for surgical assistants, and bundling.

3 Effective Date. This act shall take effect July 1, 2013.

LBAO

13-0602

Revised 01/28/13

HB 432 FISCAL NOTE

AN ACT relative to health care costs for county and state inmates.

FISCAL IMPACT:

      The Department of Corrections states this bill, as introduced, will increase state expenditures by an indeterminable amount in FY 2014 and each year thereafter. The New Hampshire Association of Counties states this bill may decrease county expenditures by an indeterminable amount in FY 2014 and each year thereafter. There is no fiscal impact on local expenditures, or state, county and local revenue.

METHODOLOGY:

    The Department of Corrections states this bill amends the procedures for reimbursement by the county and the Department for the costs of inmate medical care. The Department states this bill will increase state expenditures by an indeterminable amount; however the Department is not able to determine the exact impact as the future medical needs of inmates cannot be determined. The Department does provide a couple of examples of where the bill may result in inmate medical care costs increasing as a result of this bill. The Department states the bill requires the Department to reimburse medical care providers at a rate of up to 70 percent of customary and usual charges. The base figure for customary and usual charges is unknown and varies with each provider dependent upon various factors. The Department uses a base figure of 110 percent of Medicare as mandated in RSA 623-C as a basis of negotiations for medical care contracts. Using the customary and usual charges as proposed by this bill may impact the Department’s ability to negotiate medical contracts effectively. The Department also states this bill attempts to utilize an equal distribution method in a region when using outside medical providers. The Department makes every effort to contain inmate medical costs by providing care within its facilities. If the Department has an inmate requiring care from an outside medical provider, the Department makes determinations of which outside medical provider to use based upon recommendations of its medical staff not based on the geographical location of a medical facility. Because medical facilities offer different levels of care and equipment within regions, the use of an equal distribution method for outside medical care may hinder the Department’s ability to place inmates in facilities based upon the level of services require by the inmates healthcare needs.

    The New Hampshire Association of Counties states this bill may decrease county expenditures. The Association is not able to determine the actual decrease on expenditures as it would depend on the contracts and/or arrangements made with outside entities and the number of inmates needing medical services.