HB1643 (2018) Detail

Relative to balance billing.


HB 1643 - AS INTRODUCED

 

 

2018 SESSION

18-2609

01/10

 

HOUSE BILL 1643

 

AN ACT relative to balance billing.

 

SPONSORS: Rep. Luneau, Merr. 10

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill prohibits balance billing under the managed care law.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

18-2609

01/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Eighteen

 

AN ACT relative to balance billing.

 

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

 

1  New Section; Prohibition on Balance Billing; Payment for Reasonable Value of Services.  Amend RSA 329 by inserting after section 31-a the following new section:

329:31-b  Prohibition on Balance Billing; Payment for Reasonable Value of Services.

I.  When a commercially insured patient is covered by a managed care plan as defined under RSA 420-J:3, XXV, a health care provider performing anesthesiology, radiology, emergency medicine, or pathology services shall not balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance, if the patient received the service from a health care provider that is in-network under the patient’s health insurance plan.  This prohibition shall apply whether or not the health care provider is contracted with the patient’s insurance carrier.

II.  Pursuant to paragraph I, fees for health care services submitted to an insurance carrier for payment shall be limited to a commercially reasonable value, based on payments for similar services from New Hampshire insurance carriers to New Hampshire health care providers.  

III.  In the event of a dispute between a provider and an insurance carrier relative to the reasonable value of a service under this section, the insurance commissioner shall have exclusive jurisdiction under RSA 420-J:8-e to determine if the fee is commercially reasonable.  The provider and the insurance carrier shall each make best efforts to resolve any dispute prior to applying to the insurance commissioner for resolution, which shall include presenting to the other party evidence supporting its contention that the fee level it is proposing is commercially reasonable.

2  New Section; Reasonable Value of Health Care Services.  Amend RSA 420-J by inserting after section 8-d the following new section:

420-J:8-e  Reasonable Value of Health Care Services.  In the event of a dispute between a health care provider and an insurance carrier relative to the reasonable value of a service under RSA 329:31-b, the commissioner shall have exclusive jurisdiction to determine if the fee is commercially reasonable.  Either the provider or the insurance carrier may petition for a hearing under RSA 400-A:17.  The petition shall include the appealing party’s evidence and methodology for asserting that the fee is reasonable, and shall detail the efforts made by the parties to resolve the dispute prior to petitioning the commissioner for review.

3  New Subparagraph; Network Adequacy; Rulemaking.  Amend RSA 420-J:7, II by inserting after subparagraph (d) the following new subparagraph:

(e)  Standards for addressing in-network access to hospital based providers, such as anesthesiologists, radiologists, pathologists, and emergency medicine physicians.

4  New Paragraph; Network Adequacy; Waiver.  Amend RSA 420-J:7 by inserting after paragraph IV the following new paragraph:

V.  The commissioner shall grant a waiver from the requirements under this section pertaining to a specific health care service if the health care provider will not accept commercially reasonable reimbursement rates, based on historical and existing payments made by insurance carriers to health care providers.

5  Effective Date.  This act shall take effect July 1, 2018.

Links

HB1643 at GenCourtMobile

Action Dates

Date Body Type
Jan. 16, 2018 House Hearing
Feb. 20, 2018 House Exec Session
House Floor Vote
March 6, 2018 House Floor Vote

Bill Text Revisions

HB1643 Revision: 2369 Date: Nov. 13, 2017, 12:20 p.m.

Docket


March 6, 2018: Inexpedient to Legislate: MA VV 03/06/2018 HJ 6 P. 13


: Committee Report: Inexpedient to Legislate (Vote 20-0; CC)


March 6, 2018: Committee Report: Inexpedient to Legislate for 03/06/2018 (Vote 20-0; CC) HC 9 P. 8


Feb. 20, 2018: Executive Session: 02/20/2018 LOB 302


Feb. 21, 2018: Subcommittee Work Session: 02/21/2018 09:30 AM LOB 302


Feb. 20, 2018: Subcommittee Work Session: 02/20/2018 09:30 AM LOB 302


Jan. 30, 2018: Subcommittee Work Session: 01/30/2018 01:15 PM LOB 302


Jan. 16, 2018: Public Hearing: 01/16/2018 10:30 AM LOB 302


Jan. 3, 2018: Introduced 01/03/2018 and referred to Commerce and Consumer Affairs HJ 1 P. 18