Revision: March 27, 2014, midnight
SB 308-FN – AS AMENDED BY THE SENATE
03/13/14 0856s
2014 SESSION
01/04
SENATE BILL 308-FN
AN ACT relative to innovation in the delivery of health care.
SPONSORS: Sen. Odell, Dist 8; Sen. Woodburn, Dist 1; Sen. Forrester, Dist 2; Sen. Hosmer, Dist 7; Sen. Pierce, Dist 5; Rep. Harding, Graf 13
COMMITTEE: Health, Education and Human Services
This bill establishes the Health Care Delivery Innovation Through Cooperation Act. Under this bill, the attorney general may issue certificates for cooperative agreements among health care providers and entities governing the sharing of personnel, facilities, and other assets. The attorney general is granted rulemaking authority for the purposes of the bill. The bill assesses an administrative fee on acute care hospitals for the purposes of paying for the development of the administrative rules governing the new chapter.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/13/14 0856s
14-2682
01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fourteen
AN ACT relative to innovation in the delivery of health care.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Findings.
I. The general court hereby declares it to be the public policy of the state of New Hampshire that:
(a) It is necessary and appropriate to encourage hospitals and other health care providers to cooperate and enter into agreements that will enhance innovation in the delivery of health care, increase access to health care services, reduce costs, improve quality of care and ensure continued local control of institutions that provide substantial community benefits.
(b) It is the intention of the general court to establish a process for review of the public benefits of cooperative agreements between health care providers, for approval through certificates of public advantage, and for the continuing supervision by the attorney general.
II. Therefore, the general court hereby establishes the Health Care Delivery Innovation Through Cooperation Act.
2 New Chapter; Health Care Delivery Innovation Through Cooperation Act. Amend RSA by inserting after chapter 151-H the following new chapter:
CHAPTER 151-I
HEALTH CARE DELIVERY INNOVATION THROUGH COOPERATION ACT
151-I:1 Definitions. In this chapter:
I. “Certificate of public advantage” or “certificate” means an approval of a cooperative agreement issued by the attorney general.
II. “Cooperative agreement” means an agreement between a health care provider and one or more persons or entities, including other health care providers, governing the sharing, allocation, or referral of patients or the sharing or allocation of personnel, instructional programs, support services and facilities, medical diagnostic or laboratory facilities, procedures, equipment, or other health care services traditionally offered by health care facilities or other health care providers, or the acquisition or merger of assets among or by 2 or more health care providers.
III. “Health care provider” means a health care professional licensed, certified, or registered under the laws of this state, or a facility licensed under RSA 151.
151-I:2 Application for Certificate.
I. Parties to a cooperative agreement, or a prospective cooperative agreement, may apply to the attorney general for a certificate of public advantage governing the cooperative agreement.
II. The application shall include the following:
(a) An executed written copy of the cooperative agreement or, in the case of a prospective cooperative agreement, an executed letter of intent;
(b) A description of how the cooperative agreement conforms to the standards established in this chapter;
(c) A copy of the public notice as required under this chapter; and
(d) An application fee of $5,000.
151-I:3 Public Comment.
I. There shall be a public comment period of 30 days from the date of application.
II. Upon submission of the application for certificate, the parties to a cooperative agreement shall publish in one or more newspapers of general circulation a notice of the application for a certificate of public advantage. The notice shall include a description of the application and the means by which to submit written comment.
III. The attorney general shall receive written comments on the application and may, after public notice, hold one or more hearings for receipt of public comment.
151-I:4 Standards for Approval.
I. The attorney general shall review applications submitted under this chapter. In reviewing applications, the attorney general shall consider, but not be limited to, the following standards and as further developed under rules adopted pursuant to RSA 151-I:10:
(a) Whether one or more of the following benefits are likely to result from the cooperative agreement:
(1) Enhancement of the quality of health care provided by the parties to the cooperative agreement;
(2) Lowered costs and improved efficiency of delivering health care services, including reductions in administrative and capital costs;
(3) Improved utilization of health care provider resources;
(4) Expansion of access to care;
(5) Preservation of necessary health care services in the relevant geographic area that would be at risk of elimination in the absence of a cooperative agreement;
(b) Whether one or more of the following disadvantages are likely to result from the cooperative agreement:
(1) Diminished quality of health care;
(2) Increased costs resulting from the cooperative agreement, after taking into consideration improvements in quality and outcomes;
(3) Decreased utilization of health care provider resources;
(4) Decreased access to care;
(5) Reduced competition among health care providers and the potential for adverse system quality, accessibility and cost consequences;
(c) The financial condition of the parties to the agreement, including whether either party to the cooperative agreement is experiencing financial distress and may be forced to cease operations or eliminate services in the absence of the cooperative agreement;
(d) The availability of arrangements that are less restrictive to competition and that are likely to achieve the same benefits attributable to a reduction in competition;
(e) Other benefits or disadvantages identified in the course of review; and
(f) The extent to which active review as provided in this chapter is likely to mitigate any disadvantages.
II. The attorney general may consider all other relevant information, including but not limited to the state health plan established under RSA 151-C:4-a. The attorney general shall consult with the commissioners of the department of health and human services and the insurance department as necessary relative to matters affecting the jurisdiction of those departments. The attorney general may provide the application and other information necessary to facilitate such consultation.
151-I:5 Issuance of Certificate.
I. The attorney general shall grant or deny an application within 90 days of the date of the filing. The attorney general’s decision shall be in writing, and shall set forth the basis for the decision.
II. The certificate shall be issued for a period of not less than 5 years, unless a period of shorter duration is specified by the parties to the agreement. The certificate may be renewed as provided in RSA 151-I:7.
III. Issuance of the certificate shall be conditioned on the reporting and review requirements under RSA 151-I:6. The attorney general may impose additional conditions.
151-I:6 Reporting and Review.
I. On the first anniversary of the issuance of a certificate under this chapter and every year thereafter, the parties to a cooperative agreement shall file a report of activities with the attorney general. Such report shall include the following:
(a) A statement of activities conducted under the cooperative agreement.
(b) A statement of activities to be conducted under the cooperative agreement over the next 2 years.
(c) A statement of the benefits achieved or the benefits expected to be achieved under the cooperative agreement, including data regarding utilization of services, costs, quality of care, and population health.
(d) A statement addressing measures taken to comply with any conditions imposed on the issuance of the certificate.
(e) Any additional information requested by the attorney general.
II. If, upon review of the annual report, the attorney general determines that the parties to the cooperative agreement have failed to comply with any condition imposed on the issuance of the certificate or that the benefits of the cooperative agreement no longer outweigh the disadvantages, the attorney general shall notify the parties and request any additional information deemed necessary. The attorney general may, after notification to the parties, alter or amend any conditions imposed on the certificate.
151-I:7 Renewal.
I. The parties to a cooperative agreement covered by a certificate of public advantage issued for a definite term shall, no later than 120 days prior to the expiration of the certificate, submit to the attorney general an application to renew the certificate.
II. Unless waived by the attorney general, the application for renewal shall be in the same form as the application for certificate. The application for renewal shall be accompanied by a fee of $5,000.
III. The attorney general shall make a determination on the application for renewal under the standards for issuance of a certificate as provided in this chapter.
151-I:8 Revocation.
I. The attorney general may revoke a certificate issued under this chapter upon a finding that the benefits resulting from such a certificate no longer outweigh the disadvantages.
II. Upon a decision to revoke a certificate issued under this chapter, the attorney general shall notify the parties to the cooperative agreement in writing, and the parties shall have 90 days to respond. After review of the responses, the attorney general shall make a final decision regarding revocation.
151-I:9 No Requirement to Seek Approval; Effect of Approval.
I. Nothing in this chapter shall obligate health care providers to enter into cooperative agreements or to submit a request for approval of a cooperative agreement as set forth under the provisions of this chapter.
II. Any person who implements a cooperative agreement without securing the approval of the attorney general under the provisions of this section is subject to any enforcement action that otherwise might apply.
III. It is the intent of this chapter that cooperative agreements that are approved and subject to the review and supervision of the attorney general shall provide state action immunity under federal antitrust laws to health care providers who participate in discussions or negotiations leading to a cooperative agreement and to parties to cooperative agreements approved by the attorney general.
151-I:10 Rules. The attorney general shall adopt rules, pursuant to RSA 541-A, relative to:
I. Application procedures for the issuance of a certificate under this chapter.
II. Renewal of certificate procedures and requirements.
III. Content and format of all forms required under this chapter.
IV. Conduct of public comment period and hearings under RSA 151-I:3.
V. Other matters the attorney general deems necessary for the proper administration of this chapter.
151-I:11 Assessed Expenses.
I. The attorney general shall employ independent experts, including consultants, financial advisors, and counsel, which are reasonably necessary to review the application, application for renewal, and periodic monitoring required under this chapter. These expenses shall be assessed to the parties to the agreement and shall be in addition to any other fees required under this chapter.
II. For the purposes of developing the rules required under RSA 151-I:10, the attorney general shall assess each acute care hospital licensed under RSA 151 an administrative fee. The total amount collected shall be equal to the amount actually expended for the development of the administrative rules or $300,000, whichever is less. The amount to be collected shall be prorated as of the fiscal year ending on June 30, 2014, among all acute care hospitals licensed under RSA 151. Funds collected under this section shall be deposited in the general fund.
151-I:12 Application of Other Laws. The requirements of this chapter shall be in addition to the requirements in RSA 7:19-b and RSA 151-C, if otherwise applicable.
3 Effective Date.
I. RSA 151-I:10 and RSA 151-I:11, II, as inserted by section 2 of this act, shall take effect 60 days after its passage.
II. The remainder of this act shall take effect July 1, 2015.
LBAO
14-2682
12/03/13
SB 308-FN - FISCAL NOTE
AN ACT relative to innovation in the delivery of health care.
FISCAL IMPACT:
The Departments of Justice states this bill, as introduced, will increase state revenue and expenditures by an indeterminable amount in FY 2015 and each year thereafter. There will be no fiscal impact on county and local revenue and expenditures.
METHODOLOGY:
The Department of Justice states this bill would create a new law allowing parties to a health care cooperative agreement to apply to the Attorney General for a certificate of public advantage governing the agreement. The Department states after an application is filed with a fee of $5,000, there would be a 30 day public comment period, an option to hold public hearings, and a final decision issued within 90 days of receipt of the filing. In addition, parties to the cooperative agreement would be required to file annual reports with the Attorney General. The Department assumes each request would be unique, some would be relatively simple while others would be complex. The Department anticipates review of the applications would require various experts to provide technical assistance such as: health care providers with knowledge of health services within the relevant service areas; health insurance experts with knowledge of health care costs; and economists and business analysts with knowledge of utilization, health care cost controls and efficiency. The Department expects each application review and subsequent annual review would require the services of an assistant attorney general and a paralegal. The Department is not able to predict the number or the complexity of cooperative agreement reviews or project the associated fiscal impact. In addition, the Department states the bill authorizes the Attorney General to promulgate rules necessary to implement the law. The Department assumes the rules would require 200-500 hours of an assistant attorney general’s time to draft the rules, hold one or more public hearings, prepare the rules for review by the Joint Legislative Committee on Administrative Rules, and take other necessary measures to implement the rules.