Revision: March 21, 2018, 3:51 p.m.
HB 1769-FN - AS AMENDED BY THE HOUSE
HOUSE BILL 1769-FN
AN ACT relative to maintenance of certification by physicians or applicants for a license to practice medicine in New Hampshire.
SPONSORS: Rep. W. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. Kotowski, Merr. 24; Rep. Fothergill, Coos 1; Rep. J. MacKay, Merr. 14; Sen. Gray, Dist 6; Sen. Bradley, Dist 3
COMMITTEE: Health, Human Services and Elderly Affairs
This bill prohibits discrimination against physicians based on maintenance of certification.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
6Mar2018... 0713h 18-2034
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
I. The general court hereby finds that:
(a) Maintenance of certification (MOC) or national specialty board re-certification can be a useful tool to encourage continued proficiency for physicians over time; however, it is not and should not be the only means to maintain proficiency and can decrease access to care by preventing well-qualified physicians from practicing in institutional settings or being reimbursed by insurance carriers.
(b) Maintenance of certification requirements vary greatly from specialty to specialty and has not demonstrated a positive impact on continuous professional development or meaningful improvements in patient care.
(c) Maintenance of certification can be very costly and time consuming, reducing access to specialists while they engage in testing and other certification activities or when they choose to retire sooner to avoid these costs.
(d) Maintenance of certification requirements are often unrelated to a physician’s clinical practice and could lead to disqualification of the best, most specialized physicians and cause access to care issues in important critical specialties.
(e) Dependence on maintenance of certification eliminates local control over the quality of physician care and puts it solely in the hands of entities that profit from its existence.
(f) Access to specialty care is already limited in many specialties and geographic regions of the state; therefore, multiple pathways to ensuring clinical competency should be available to maximize workforce capacity without jeopardizing patient safety.
(g) Maintenance of certification has made it more difficult for small rural hospitals to recruit physicians nearing retirement age who intend to eventually retire in our state which is a traditional recruitment pool for these hospitals.
II. The purpose of this act is to ensure that well-qualified, licensed physicians are able to continue practicing in hospitals and other licensed health care facilities and to be reimbursed by insurers for the care they provide without being disqualified solely on the basis of standards and testing established as part of a specialty board’s maintenance of certification program.
III. This act is also intended to facilitate greater utilization of more meaningful and local continuing medical education, and not to eliminate initial national specialty board exams or state continuing medical education requirements or the ability of facilities and insurers to require that physicians engage in activities that maintain their proficiency over time.
2 New Paragraph; Managed Care Law; Definitions. Amend RSA 420-J:3 by inserting after paragraph XXIV the following new paragraph:
XXIV-a. "Maintenance of certification" means a process of physician certification maintenance through one of the 24 approved boards of the American Board of Medical Specialties (ABMS) or the 18 approved medical specialty boards of the American Osteopathic Association (AOA).
3 Managed Care Law; Definitions. Amend RSA 420-J:3, XXVIII-b to read as follows:
XXVIII-b. "Physician" means a person licensed to practice medicine under RSA 329.
XXVIII-c. "Pre-service claim'' means any claim for a benefit under a health plan with respect to which the terms of the plan condition receipt of the benefit, in whole or in part, on approval of the benefit in advance of obtaining medical care. "Pre-service claim'' shall not include a request for reimbursement made by a provider pursuant to the terms of an agreement between the provider and the health carrier.
4 New Section; Discrimination Based on Maintenance of Certification Prohibited. Amend RSA 420-J by inserting after section 7-e the following new section:
420-J:7-f Discrimination Based on Maintenance of Certification Prohibited.
I. Except as provided in paragraph II, a health benefit plan issuer shall not differentiate between physicians based on a physician's maintenance of certification relative to:
(a) Paying the physician;
(b) Reimbursing the physician; or
(c) Directly or indirectly contracting with the physician to provide services to enrollees.
II. A health benefit plan issuer may differentiate between physicians based on a physician's maintenance of certification only if certification or accreditation by a national certifying or accrediting organization of an entity is a requirement of physicians seeking staff privileges or credentialing at the health care facility where the managed care plan contracts for patient care and no alternative health care facility is also under contract by the managed care plan without such requirement where the physician in question has staff privileges or credentials and could reasonably provide similar services.
5 New Paragraph; Physicians and Surgeons; Board; Duties. Amend RSA 329:2 by inserting after paragraph IV the following new paragraph:
V.(a) The board shall not require maintenance of certification, as defined in RSA 329:16-i, by an applicant for the applicant to be eligible for a license under paragraph II. Continuing medical education shall remain a requirement under RSA 329:16-g and RSA 318-B:40.
(b) The board shall not adopt a rule requiring maintenance of certification by a license holder for the license holder to be eligible for a license to practice medicine, a special training license, a courtesy license, a temporary license, or a license to practice administrative medicine.
6 New Section; Discrimination Based on Maintenance of Certification Prohibited. Amend RSA 329 by inserting after section 16-h the following new section:
329:16-i Discrimination Based on Maintenance of Certification Prohibited.
I. In this section "maintenance of certification" means the satisfactory completion of periodic recertification requirements that are required for a physician to maintain certification after initial certification from:
(a) A medical specialty member board of the American Board of Medical Specialties;
(b) A medical specialty member board of the American Osteopathic Association Bureau of Osteopathic Specialists;
(c) The American Board of Oral and Maxillofacial Surgery; or
(d) Any other certifying board that is recognized by the board.
II.(a) Except as otherwise provided under this section, the following entities shall not differentiate between physicians based on a physician's maintenance of certification:
(1) A health facility licensed under RSA 151;
(2) A hospital that is owned or operated by this state;
(3) An institution or program that is owned, operated, or licensed by this state, including an institution or program that directly or indirectly receives state financial assistance, if the institution or program has an organized medical staff or a process for credentialing physicians on its staff; and
(A) Is not a medical school, an academic medical center, or other site which is involved in the training of residents; or
(B) An institution or program that is owned, operated, or licensed by a political subdivision of this state, if the institution or program has an organized medical staff or a process for credentialing physicians on its staff.
(b) An entity described under subparagraph (a) may differentiate between physicians based on a physician's maintenance of certification if:
(1) The physician is making an initial application to the medical staff; or
(2) The entity's designation under law or certification or accreditation by a national certifying or accrediting organization is contingent on the entity requiring a specific maintenance of certification by physicians seeking staff privileges or credentialing at the entity; and
(3) The differentiation is limited to those physicians whose maintenance of certification is required.
(c) An entity described under subparagraph (a) may differentiate between physicians based on a physician's maintenance of certification if the voting physician members of the entity's organized medical staff vote to authorize the differentiation and that vote is recommended to and approved by the entity's governing body.
(d) An authorization under subparagraph (c) shall:
(1) Subject to subparagraph (e), establish terms applicable to the entity's differentiation, including:
(A) Appropriate grandfathering provisions; and
(B) Limiting the differentiation to certain medical specialties; and
(2) Be rescinded at any time by a vote of the voting physician members of the entity's organized medical staff.
(e) Terms established under subparagraph (d)(1) shall not conflict with a maintenance of certification requirement applicable to the entity's designation under law or certification or accreditation by a national certifying or accrediting organization.
HB 1769-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2018-0713h)
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
Estimated Increase / (Decrease)
[ X ] General [ X ] Education [ X ] Highway [ X ] Other
This bill prohibits insurance carriers from discriminating against physicians in terms of contracting or reimbursement, based on the physician's maintenance of certification, except when such certification is a requirement for staff privileges at a health care facility under contract with the insurance carrier. The Insurance Department states to the extent insurers do vary provider reimbursement based on maintenance of a certain certification, this bill may have an impact on claim costs and associated premiums, which could impact the premium tax base by an indeterminable amount. The Department states this bill may have an indeterminable fiscal impact on local and county expenditures to the extent insurers vary provider reimbursement based on the maintenance of a certain certification and claim costs are impacted.
The Department of Administrative Services indicates the changes in this bill apply to the laws governing managed care and the self-funded State Employee and Retiree Health Benefit Plan (HBP) is not governed by these laws. However the HBP's Third Party Administrator (Medical TPA) is subject to those legal requirements. Thus the HBP would be indirectly affected by associated administrative costs and HBP claim costs resulting from altered certification requirements and potential patient safety concerns. Such impact is indeterminable.
The Department of Health and Human Services and the Office of Professional Licensure and Certification state this bill will have no fiscal impact upon their respective agencies.
Insurance Department, Department of Administrative Services, Department of Health and Human Services, and Office of Professional Licensure and Certification