SB 448-FN - AS INTRODUCED
2016 SESSION
\t16-2898
\t01/05
SENATE BILL\t448-FN
AN ACT\trelative to rates for self-pay patients and notice of allowable benefits.
SPONSORS:\tSen. Stiles, Dist 24; Sen. Reagan, Dist 17; Sen. Fuller Clark, Dist 21; Rep. LeBrun, Hills. 32; Rep. M. Smith, Straf. 6; Rep. Bates, Rock. 7
COMMITTEE:\tCommerce
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ANALYSIS
\tThis bill clarifies billing rates for self-pay patients and requires claims to be cross accumulated against insurance deductibles.
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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\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2898
\t01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to rates for self-pay patients and notice of allowable benefits.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 Rates for Self-Pay Patients. Amend RSA 151:12-b to read as follows:
\t151:12-b [Hospital] Rates for Self-Pay Patients
\t\tI. When billing self-pay patients for a service rendered, a hospital or provider of health care shall accept as payment in full an amount no greater than the average amount [generally billed and] received [by the hospital] for that service for patients covered by health insurance. A hospital or provider of health care 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] to bill the self-pay patient by taking the average total amount the hospital or provider received for the same procedure using the most current public use data set values as provided by the New Hampshire Comprehensive health care information system (CHIS) having removed any records showing a zero payment. A hospital or provider of health care 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.
\t\tII. [For the purposes of] In this section:
\t\t\t(a) "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.
\t\t\t(b) "Provider of health care'' means a person who is a direct provider of health care, including a physician, dentist, nurse, podiatrist, optometrist, physician assistant, or ancillary personnel employed under the supervision of a physician, in that the individual's primary current activity is the provision of health care to individuals or the administration of facilities or institutions, including hospitals, long-term care facilities, rehabilitation facilities, alcohol and drug abuse treatment facilities, outpatient facilities, and health maintenance organizations, in which such care is provided and, when required by the laws of this state, who has received professional training in the provision of such care or in such administration and is licensed or certified for such provision or administration.
\t2 Accident and Health Insurance; Notification of Allowable Benefit. Amend RSA 415:22-b to read as follows:
\t415:22-b Notification of Allowable Benefit.
\t\tI. All individual and group health insurers providing benefits for medical and hospital expenses shall provide to each certificate holder, on request, a written statement of the dollar amount of allowable benefit for any procedure which is requested by the appropriate procedure code.
\t\tII. Within 30 days of submission by insured individuals of properly prepared claim forms and proof of direct payment to hospitals or providers of health care, as defined in RSA 151:12-b, II, all individual and group health insurers providing benefits for medical and hospital expenses shall apply to such payments, up to the dollar amount of allowable benefit for that procedure as defined by the appropriate procedure code, to any remaining individual and family policy deductible as if that hospital or provider of health care was included in the insurer's network.
\t3 Effective Date. This act shall take effect 60 days after its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2898
\t\t\t\t\t\t\t\t\t\t\t12/16/15
SB 448-FN- FISCAL NOTE
AN ACT\trelative to rates for self-pay patients and notice of allowable benefits.
FISCAL IMPACT:
The Department of Health and Human Services and Insurance Department state this bill, as introduced, will increase state expenditures and have an indeterminable impact on state revenue and on county and local expenditures in FY 2017 and each year thereafter. There will be no impact on county or local revenue.
METHODOLOGY:
The Department of Health and Human Services (DHHS) states this bill requires a hospital or provider of health care services to bill self-pay patients no more than the average amount received for that service for patients covered by health insurance. The bill also requires health insurers to apply out of pocket costs incurred by a consumer to the consumer’s deductible. The Department indicates the bill would require the providers to calculate the average amount received for a service using data from the Comprehensive Health Care Information System (CHIS). The Department states under RSA 420-G:11-a, the Insurance Department collects data from providers and the DHHS is responsible for releasing the data and ensuring the data is compliant with federal privacy laws. The Department is not able to determine the fiscal impact of the bill but assumes the following:
The Department states, according to the Insurance Department, the requirement that health insurers apply out of pocket expenses paid by consumers to their deductible would not apply to the Medicaid fee for service or managed care. Although Medicaid coverage for those newly eligible under the New Hampshire Health Protection Program will be through the marketplace, enrollees have co-payment requirements and not deductibles.
The Insurance Department states the bill limits what a health care provider can charge a self-pay patient not privileged to a negotiated provider discount. The Department states previously the law applied such limits only to hospitals. The Department indicates provider/insurer negotiations can be fairly involved and it is uncertain what, if any, impact such a limit would have on such negotiations, premiums, or premium tax revenue. The Department states the requirement that insurers consider all self-payments made by insured individuals to apply to the individual deductible would not apply to Health Maintenance Organizations (HMOs) according to RSA 420-B:20. The requirement would apply to non-HMOs with point-of-service plans that vary deductibles depending on whether services were provided in-network verses out-of-network. The Department assumes the bill would require all out-of-network self-payments to apply to the in-network deductible. The Department states it is uncertain what impact this provision would have on the market or insurance premiums.