Bill Text - HB1516 (2016)

Relative to balance billing.

Revision: March 8, 2016, midnight

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AN ACT\trelative to balance billing.


SPONSORS:\tRep. Luneau, Merr. 10; Rep. Myler, Merr. 10; Rep. Butler, Carr. 7; Sen. Feltes, Dist 15; Sen. Bradley, Dist 3


COMMITTEE:\tCommerce and Consumer Affairs






\tThis bill prohibits balance billing from out-of-network providers who provide services at an in-network facility.


\tThis bill is a request of the insurance department.


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Explanation:\tMatter added to current law appears in bold italics.

\t\tMatter removed from current law appears [in brackets and struckthrough.]

\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.






In the Year of Our Lord Two Thousand Sixteen


AN ACT\trelative to balance billing.


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


\t1  New Paragraph; Managed Care Law; Provider Contract Standards.  Amend RSA 420-J:8 by inserting after paragraph I the following new paragraph:

\t\tI-a.  When contracting with a hospital, a health carrier shall require that the hospital include in its contract with any person performing services within the hospital, but not employed by the hospital, the following provisions:

\t\t\t(a)  An agreement that if the non-employed person performs a service with respect to a patient for whom the hospital is in-network, but the non-employed person is not, the non-employed person shall accept as payment in full an amount no greater than the amount generally billed and received by a provider for that service for patients covered by health insurance in the state, as calculated by the insurance department based on claims data received pursuant to RSA 420-G:11-a; and

\t\t\t(b)  An agreement to hold the covered person harmless, consistent with the language in paragraph I of this section, upon payment by the health carrier of the amount described in subparagraph (a).

\t2  Effective Date.  This act shall take effect 60 days after its passage.








AN ACT\trelative to balance billing.




The New Hampshire Insurance Department states this bill, as introduced, will increase state expenditures by approximately $50,000 and have an indeterminable fiscal impact on state revenue in FY 2017 and in each year thereafter.  There will be no fiscal impact on county or local revenue or expenditures.



The Insurance Department states this bill eliminates the ability of a non-network provider providing services in a network facility to bill insured patients as if the service is a non-covered or out-of-network service.  The bill mandates that insurers include certain provisions in their network provider contracts.  The Department indicates the requirements specify that non-employed, non-network providers providing services at the contracted provider’s facility must accept reimbursement at an amount determined by the Department to be consistent with amounts generally billed for the service and further agree not to balance bill.  The Department assumes the bill requires the issuer to pay for the service provided by the non-employed, non-network provider.  The Department does not have information regarding this type of activity, but suspects it is not a significant problem and assumes the impact on premium tax revenue would be indeterminable and insignificant.  The Department anticipates using consultants to determine the acceptable payment rates required by the bill and estimates that cost would be approximately $50,000 per year.   


The Department of Health and Human Services states this bill would not apply to Medicaid managed care organizations and that federal Medicaid law (42 CFR 447.15) already prohibits balance billing of Medicaid recipients.  The Department indicates the bill would have no fiscal impact on its revenue or expenditures.


The Department of Administrative Services states the State of New Hampshire administers a self-insured health benefit plan not subject to the provisions of RSA 420-J and the bill would have no fiscal fiscal impact on the Department’s revenue or expenditures.


The New Hampshire Association of Counties states this bill would have no significant fiscal impact on county revues and expenditures.