Revision: June 7, 2016, midnight
\t \t\tSB 532-FN - VERSION ADOPTED BY BOTH BODIES
03/10/2016 0857s
03/24/2016 1065s
03/24/2016 1132s
11May2016... 1778h
11May2016... 1920h
06/01/2016 2027EBA
2016 SESSION
\t16-2878
\t01/03
SENATE BILL\t532-FN
AN ACT\trelative to prior authorization for substance use 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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AMENDED ANALYSIS
This bill clarifies prior authorization requirements under the managed care law for substance use services.
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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\t\tMatter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/10/2016 0857s
03/24/2016 1065s
03/24/2016 1132s
11May2016... 1778h
11May2016... 1920h
06/01/2016 2027EBA\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 use treatment.
Be it Enacted by the Senate and House of Representatives in General Court convened:
\t1 Substance Use Disorders; Definitions. Amend RSA 420-J:15 to read as follows:
\t420-J:15 Definitions. In this subdivision:
\t\tI. “ASAM criteria” means the latest edition of the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, developed by the American Society of Addiction Medicine.
\t\tII. “Clinical stabilization services” means 24-hour clinically-managed post-withdrawal management treatment for adults or adolescents which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and after-care planning, for individuals beginning to engage in recovery from addiction.
\t\tIII. “Short-term inpatient withdrawal management” 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\tIV. “Substance use disorder services” means health care services that are provided to a covered person as treatment for an addictive substance-related condition, not including treatment for any condition related to tobacco use.
\t2 Substance Use Disorders; Prior Authorization. Amend RSA 420-J:17 to read as follows:
\t420-J:17 Prior Authorization.
\t\tI. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for the first 2 routine outpatient visits of an episode of care by an individual for assessment and care with respect to a substance use disorder.
\t\tII. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for short-term inpatient withdrawal management and clinical stabilization services for up to 24 hours, when prescribed by a clinician trained in the use and application of the ASAM criteria; provided, that the facility notifies the patient’s health carrier as soon as practicable after admission of the patient. If the facility fails to notify the patient’s health carrier as soon as practicable after admission of the patient, the facility shall be financially responsible for the costs of any services provided by the facility to the patient.
\t\tIII. Alternatively, a carrier may require prior authorization for the services described in paragraph II, but only if the carrier has a medical clinician or licensed alcohol and drug counselor available on a 24-hour hotline to make the medical necessity determination and assist with placement at the appropriate level of care, and the carrier provides a prior authorization decision as soon as practicable after receipt from the treating clinician of the clinical rationale consistent with the ASAM criteria, but in no event more than 6 hours of receiving such information; provided that until such hotline determination is made, coverage for substance use disorder services shall be provided at an appropriate level of care consistent with the ASAM criteria, as defined in RSA 420-J:15, I.
\t\tIV. If an insurance policy does not require prior authorization for short-term inpatient withdrawal management services or clinical stabilization services, paragraphs II and III shall not apply.
\t\tV. Nothing in this section shall be construed to require coverage for services provided by a non-participating provider.
\t3 Effective Date. This act shall take effect January 1, 2017 at 12:01 a.m.
\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 use 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.