Revision: March 8, 2016, midnight
\t \t\tSB 532-FN - AS INTRODUCED
2016 SESSION
\t16-2878
\t01/03
SENATE BILL\t532-FN
AN ACT\trelative to prior authorization for substance abuse treatment.
SPONSORS:\tSen. Stiles, Dist 24; Sen. Birdsell, Dist 19; Sen. Boutin, Dist 16; Sen. Carson, Dist 14; Sen. Cataldo, Dist 6; Sen. Feltes, Dist 15; Sen. Fuller Clark, Dist 21; Sen. Hosmer, Dist 7; Sen. Kelly, Dist 10; Sen. Lasky, Dist 13; Sen. Little, Dist 8; Sen. Pierce, Dist 5; Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Sen. Woodburn, Dist 1; Rep. Sherman, Rock. 24; Rep. J. Ward, Rock. 19
COMMITTEE:\tHealth and Human Services
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ANALYSIS
\tThis bill authorizes coverage for medically necessary substance abuse treatment without prior authorization for a certain period of time.
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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\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
\t16-2878
\t01/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Sixteen
AN ACT\trelative to prior authorization for substance abuse treatment.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 Standards for Accident and Health Insurance; Definitions Added. Amend RSA 415-A:1, I and I-a to read as follows:
\t\tI. "Accident and health insurance'' means insurance written under RSA 415 and coverages written under RSA 415-E, RSA 420-A, RSA 420-B, and RSA 420-C. For purposes of this chapter, multiple-employer welfare arrangements, nonprofit health service corporations, health maintenance organizations, and preferred provider agreements subject to RSA 420-C shall be deemed to be engaged in the business of insurance.
\t\tI-a. "Acute treatment services" means 24-hour medically supervised addiction treatment for adults or adolescents provided in medically-managed or medically-monitored inpatient facilities that provide evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychological educational groups, and discharge planning.
\t\tI-aa. "Claim denial'' means any of the following: a denial, reduction, or termination of, or a failure to provide or make payment (in whole or in part) for, a benefit, including any such denial, reduction, termination, or failure to provide or make payment that is based on a determination of a participant's or beneficiary's eligibility to participate in a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment [(in whole or in part)] for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate.
\t2 New Paragraph; Accident and Health Insurance; Definitions Added. Amend RSA 415-A:1 by inserting after paragraph I-c the following new paragraph:
\t\tI-cc. "Clinical stabilization services" mean 24-hour clinically managed post detoxification treatment for adults or adolescents usually following acute treatment services for substance abuse, which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and aftercare planning, for individuals beginning to engage in recovery from addiction.
\t3 New Section; Prior Authorization for Substance Abuse Treatment. Amend RSA 415-A by inserting after section 6 the following new section:
\t415-A:7 Prior Authorization. All policies issued or renewed after July 1, 2016 shall provide coverage for medically necessary acute treatment services and medically necessary clinical stabilization services without prior authorization prior to obtaining such acute treatment services or clinical stabilization services for up to 72 hours; provided, that the facility shall provide the carrier notification of admission within 48 hours of the admission. Medical necessity shall be determined by the treating clinician.
\t4 Effective Date. This act shall take effect 60 days after its passage.
\t\t\t\t\t\t\t\t\t\t\t16-2878
\t\t\t\t\t\t\t\t\t\t\tRevised 2/10/16
SB 532-FN- FISCAL NOTE
AN ACT\trelative to prior authorization for substance abuse treatment.
FISCAL IMPACT:
The Department of Health and Human Services and the Insurance Department state this bill, as introduced, will have an indeterminable impact on state, local, and county expenditures in FY 2017 and each year thereafter. There will be no impact on state, county, or local revenue.
METHODOLOGY:
The Department of Health and Human Service states this bill requires all healthcare policies issued on or after July 1, 2016 include coverage for acute treatment services and clinical services without prior authorization for up to 72 hours, provided the facility notifies the health carrier within 48 hours of admission. The Department notes this requirement would apply to the managed care organizations (MCO) that administer Medicaid benefits on the Department's behalf. Currently, MCOs provide substance use disorder (SUD) benefits only to those Medicaid recipients eligible under the New Hampshire Health Protection Program (NHHPP). Chapter 276:231, Laws of 2015 directed the Department to provide SUD services to all Medicaid recipients, and the Department anticipates this benefit will be offered beginning July 1, 2016. Under the State's existing contract with MCOs for the provision of SUD benefits, MCOs require prior authorization for the service types identified by this bill. The Department notes that altering the prior authorization requirement may increase utilization of SUD services, and may necessitate a contract change with the MCOs as well as an increase in the rates paid to MCOs for SUD services. Were this to happen, it would result in an increase in state expenditures beginning in FY 2017 when SUD benefits are offered to the general Medicaid population.
The Insurance Department states it is unclear what impact the bill will have on insurance benefits and premiums. Any impact may affect expenditures for state, county, and local governments to the extent that they are employers providing health benefits for employees.