Revision: Dec. 4, 2017, 1:18 p.m.
HB 1784-FN - AS INTRODUCED
2018 SESSION
18-2559
01/10
HOUSE BILL 1784-FN
AN ACT relative to cost comparison for certain health care procedures.
SPONSORS: Rep. Kurk, Hills. 2
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill establishes procedures for cost comparison for certain health care procedures. Under this bill, insurance carriers shall establish an incentive program for its enrollees who undergo comparison shopping for such procedures. The bill grants rulemaking authority to the insurance commissioner for the purposes of the bill.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
18-2559
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eighteen
AN ACT relative to cost comparison for certain health care procedures.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Comparison Shopping for Health Care Procedures. Amend RSA 151 by inserting after section 12-b the following new section:
151:12-c Comparison Shopping for Certain Health Care Procedures. Beginning January 1, 2019, at the time a referral or recommendation is made for a comparable health care service, as defined in RSA 415-K:1, II during an in-person visit, the health care provider making the referral or recommendation shall notify a patient who has private health insurance coverage of the patient's right to obtain services from a different provider. A health care provider shall also provide a written notice at the time the health care provider recommends or refers a patient for a health care service or procedure that may qualify as a comparable health care service. A written notice provided under this section shall include a notification that, prior to obtaining the recommended service, the patient may review the health care price transparency tool provided by the patient's insurance carrier or contact the patient's carrier directly via a toll-free telephone number so that the patient may consider whether the recommended provider of the comparable health care service represents the best value for the patient. The written notice provided under this paragraph shall also include a description of the service or the applicable standard medical codes or current procedural terminology codes used by the American Medical Association sufficient to allow the insurance carrier to assist the patient in comparing prices for the comparable health care service.
2 New Chapter; Comparison Shopping for Health Care Procedures. Amend RSA by inserting after chapter 415-J the following new chapter:
CHAPTER 415-K
COMPARISON SHOPPING FOR HEALTH CARE PROCEDURES
415-K:1 Definitions. In this chapter:
I. "Commissioner" means the insurance commissioner.
II. "Comparable health care services" means the nonemergency outpatient health care services in the following categories:
(a) Physical and occupational therapy services.
(b) Radiology and imaging services.
(c) Laboratory services.
(d) Infusion therapy services.
III. "Department" means the insurance department.
IV. "Program" means the comparable health care services incentive program established by an insurance carrier pursuant to this chapter.
415-K:2 Health Care Price Transparency Tools.
I. A health carrier offering health insurance plans in New Hampshire shall develop and make available a website and a toll-free telephone number accessible to enrollees which enable enrollees to obtain information on the estimated costs for obtaining a comparable health care service, from network providers, as well as quality data for those providers, to the extent available. A carrier may comply with the requirements of this paragraph by directing enrollees to the publicly accessible health care costs website of the insurance department under RSA 415-K:8.
II. A carrier shall make available to the enrollee the ability to obtain an estimated cost that is based on a description of the service or the applicable standard medical codes or current procedural terminology codes used by the American Medical Association provided to the enrollee by the provider. Upon an enrollee's request, the carrier shall request additional or clarifying code information, if needed, from the provider involved with the comparable health care service. If the carrier obtains specific code information from the enrollee or the enrollee's provider, the carrier shall provide the anticipated charge and the enrollee's anticipated out-of-pocket costs based on that code information, to the extent such information is made available to the carrier by the provider.
III. A carrier shall notify an enrollee that the amounts are estimates based on information available to the carrier at the time the request is made and that the amount the enrollee will be responsible to pay may vary due to unforeseen circumstances that arise out of the proposed comparable health care service. This paragraph shall not prohibit a carrier from imposing cost-sharing requirements disclosed in the enrollee's certificate of coverage for unforeseen health care services that arise out of the proposed comparable health care service or for a procedure or service that was not included in the original estimate. This paragraph shall not preclude an enrollee from contacting the carrier to obtain more information about a particular admission, procedure or service with respect to a particular provider.
IV. Notwithstanding the provisions of this section and at the request of a carrier, the commissioner may grant an additional year to comply with the provisions of this section if the carrier has demonstrated a good faith effort to comply with the provisions of this section and has provided the commissioner with an action plan detailing the steps to be taken by the carrier to comply with this section.
415-K:3 Comparable Health Care Services Incentive Program. A carrier offering a health plan shall establish, at a minimum, for small group plans under RSA 420-G a health plan design in which enrollees are directly incentivized to shop for low-cost, high-quality participating providers for comparable health care services. Incentives may include, but are not limited to, cash payments, gift cards or credits or reductions of premiums, copayments or deductibles. A small group health plan design created under this section shall remain available to enrollees for at least 2 consecutive years, except that any changes made to the program after 2 years, including, but not limited to, ending the incentive, may not be construed as a change to the small group health plan design for the purpose of guaranteed renewability under RSA 420-G. A multiple-employer welfare arrangement is not considered a carrier for the purposes of this section.
415-K:4 Filing Requirements. A carrier subject to this chapter shall file its incentive plan to the commissioner. Plans filed with the commissioner pursuant to this section shall disclose, in the summary of benefits and explanation of coverage, a detailed description of the incentives available to a plan enrollee. The description shall clearly detail any incentives that may be earned by the enrollee, including any limits on such incentives, the actions that must be taken in order to earn such incentives and a list of the types of services that qualify under the program. This section shall not be construed to prevent a carrier from directing an enrollee to the carrier's website or toll-free telephone number for further information on the program in the summary of benefits and explanation of coverage. The commissioner shall review the filing made by the carrier to determine if the carrier's program complies with the requirements of this section.
415-K:5 Availability of Program; Notice to Enrollees. Annually at enrollment or renewal, a carrier shall provide notice about the availability of the program to an enrollee who is enrolled in a health plan eligible for the program under this chapter.
415-K:6 Additional Types of Nonemergency Health Care Services or Procedures. Nothing in this chapter precludes a carrier from including additional types of nonemergency health care services or procedures in its program.
415-K:7 No Administrative Expense. An incentive payment made by a carrier in accordance with this chapter is not an administrative expense of the carrier for rate development or rate filing purposes.
415-K:8 Interactive Website. The commissioner shall create and maintain a publicly accessible interactive website that presents reports related to payments for services rendered by health care facilities licensed under RSA 151 and practitioners to residents of New Hampshire. The services presented shall include, but not be limited to, imaging, preventative health, radiology, surgical services, comparable health care services and other services that are predominantly elective and may be provided to a large number of patients who do not have health insurance or are underinsured. The website shall also be constructed to display prices paid by individual commercial health insurance companies, third-party administrators and, unless prohibited by federal law, governmental payors. Price information posted on the website shall be posted semiannually, shall display the date of posting and, when posted, shall be current to within 36 months of the date of submission of the information. Payment reports and price information posted on the website shall include data submitted by payors with regard to all health care facilities and practitioners that provide comparable health care services or services for which the department reports data pertaining to the statewide median price pursuant to this section or Title XXXVII.
415-K:9 Study and Evaluation. Beginning November 1, 2020 and annually thereafter, the commissioner shall undertake a study and evaluation of the programs created by carriers as required by this chapter. The commissioner may request information on enrollment and use of incentives earned by enrollees of a carrier as necessary. On or before December 1, 2020 and annually thereafter, the commissioner shall submit an aggregate report relating to the performance of the programs, the use of incentives, the incentives earned by enrollees and the cumulative effect of the programs to the speaker of the house of representatives, the senate president, and the chairs of the house and senate committees having jurisdiction over health insurance issues.
415-K:10 Services From Out-of-Network Provider; Lower Prices. If an enrollee covered under a health plan other than a health maintenance organization plan elects to obtain a covered comparable health care service from an out-of-network provider at a price that is the same or less than the statewide median for the same covered health care service based on data reported on the publicly accessible health care costs website under RSA 415-K:8, the carrier shall allow the enrollee to obtain the service from the out-of-network provider at the provider's charge and, upon request by the enrollee, shall apply the payments made by the enrollee for that comparable health care service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the health care services had been provided by an in-network provider. A carrier may use the median price paid to a network provider for the covered comparable health care service under the enrollee's health plan in lieu of the statewide median price on the website established under RSA 415-K:8 if the carrier uses a reasonable method to calculate the median price paid and the information is available to enrollees through a website accessible to the enrollee and a toll-free telephone number that provide, at a minimum, information relating to comparable health care services. The enrollee is responsible for demonstrating to the carrier that payments made by the enrollee to the out-of-network provider should be applied toward the enrollee's deductible or out-of-pocket maximum pursuant to this section. The carrier shall provide a downloadable or interactive online form to the enrollee for the purpose of making such a demonstration and may require that copies of bills and proof of payment be submitted by the enrollee.
415-K:11 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the proper administration of this chapter.
3 Effective Date. This act shall take effect January 1, 2019.
18-2559
12/1/17
HB 1784-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to cost comparison for certain health care procedures.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2019 | FY 2020 | FY 2021 | FY 2022 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Insurance Department administrative fund | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill establishes procedures for cost comparison for certain health care procedures and requires insurance carriers to establish an incentive program for its enrollees who undergo comparison shopping for such procedures. The Insurance Department states the cost comparison and incentive programs may lead to lower claim costs as insureds are incentivized to select lower cost providers. However, the bill requires out-of-network services to be covered at the in-network cost sharing in certain circumstances. This may impact negotiated costs for certain services which may result in higher claim costs. Any changes in health insurance premiums may impact county and local health insurance expenditures by an indeterminable amount. The Department is required to perform periodic reporting starting on December 1, 2020. The Department estimates the first year report will cost $25,000 and each year thereafter the cost of the report will be $10,000.
The Department of Administrative Services states the State of New Hampshire employee and retiree health benefit plan (HBP) is not a "health carrier" and would not be directly impacted by this bill. The third party medical administrator is a health carrier with regard to its fully insured managed care business. To the extent this bill has a fiscal impact on the third party medical administrator, there may be an impact on the HBP.
However, the Department notes, through the third party medical administrator, the HBP already enables active members and non-Medicare eligible retiree members to comparison shop for non-emergent health care services and procedures. As part of this process, enrollees are eligible for cashback incentives when they choose a lower cost, high quality provider. The Department notes this program saved the HBP approximately $4.4 million in calendar year 2016.
The Department of Health and Human Services states this bill has no fiscal impact on the Department.
AGENCIES CONTACTED:
Insurance Department, Department of Health and Human Services, and Department of Administrative Services