HB1809 (2018) Detail

(New Title) relative to balance billing under the managed care law and relative to coverage for emergency services.


CHAPTER 356

HB 1809-FN - FINAL VERSION

 

6Mar2018... 0135h

05/03/2018   1638s

23May2018... 2091-EBA

2018 SESSION

18-2860

01/10

 

HOUSE BILL 1809-FN

 

AN ACT relative to balance billing under the managed care law and relative to coverage for emergency services.

 

SPONSORS: Rep. Kurk, Hills. 2; Rep. Byron, Hills. 20; Rep. Luneau, Merr. 10; Sen. French, Dist 7

 

COMMITTEE: Commerce and Consumer Affairs

 

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AMENDED ANALYSIS

 

This bill prohibits balance billing under the managed care law.

 

This bill also clarifies coverage for emergency services.

 

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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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... 0135h

05/03/2018   1638s

23May2018... 2091-EBA 18-2860

01/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Eighteen

 

AN ACT relative to balance billing under the managed care law and relative to coverage for emergency services.

 

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

 

356:1  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 service is performed in a hospital or ambulatory surgical center 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.  The department of insurance may require the parties to engage in mediation prior to rendering a decision.

356:2  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.  The department may require the parties to engage in mediation prior to rendering a decision.

356:3  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.

356:4  New Paragraph; Network Adequacy; Report Required.  Amend RSA 420-J:7 by inserting after paragraph IV the following new paragraph:

V.  The commissioner shall provide a report annually on the findings associated with network adequacy review to the chairpersons of the house and senate committees having jurisdiction over insurance issues.

356:5  Coverage for Emergency Services; Definitions.  Amend the introductory paragraph of RSA 417-F:1, I to read as follows:

I.  "Emergency services" means health care services that are provided to an enrollee, insured, or subscriber in a licensed hospital emergency facility by a provider after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson with average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention could be expected to result in any of the following:

356:6  Managed care Law; Emergency Medical Condition.  RSA 420-J:3, XV is repealed and reenacted to read as follows:

XV.  "Emergency medical condition" means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention such that a prudent layperson with average knowledge of health and medicine could reasonably expect that failure to provide medical attention could result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or could place the person's health in serious jeopardy.

356:7  Managed Care Law; Emergency Services.  Amend the introductory paragraph of RSA 420-J:3, XVI to read as follows:

XVI.  "Emergency services" means health care services that are provided to an enrollee, insured, or subscriber in a licensed hospital emergency facility by a provider after the sudden onset of a medical condition that manifests itself by symptoms of sufficient severity that a prudent layperson with average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention could [be expected to] result in any of the following:

356:8  Report.  The insurance commissioner shall make a report on or before July 1, 2020 detailing the impact of RSA 329:31-b as inserted by section 1 of this act and RSA 420-J:8-e as inserted by section 2 of this act on health insurance premium rates to the chairpersons of the house and senate committees having jurisdiction over insurance issues.  

356:9  Effective Date.  This act shall take effect July 1, 2018.

 

Approved: July 02, 2018

Effective Date: July 01, 2018

 

 

Links

HB1809 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
April 12, 2018 Senate Hearing
April 12, 2018 Senate Hearing
April 12, 2018 Senate Hearing
April 17, 2018 Senate Hearing
April 26, 2018 Senate Floor Vote
April 26, 2018 Senate Floor Vote
May 2, 2018 Senate Floor Vote
May 2, 2018 Senate Floor Vote
May 3, 2018 Senate Floor Vote

Bill Text Revisions

HB1809 Revision: 4285 Date: July 5, 2018, 8:29 a.m.
HB1809 Revision: 3850 Date: May 25, 2018, 10:51 a.m.
HB1809 Revision: 3752 Date: May 4, 2018, 12:42 p.m.
HB1809 Revision: 3216 Date: April 20, 2018, 3:39 p.m.
HB1809 Revision: 2540 Date: Dec. 14, 2017, 1:38 p.m.

Docket

Date Status
Jan. 3, 2018 Introduced 01/03/2018 and referred to Commerce and Consumer Affairs HJ 1 P. 24
Jan. 16, 2018 Public Hearing: 01/16/2018 10:15 AM LOB 302
Jan. 30, 2018 Subcommittee Work Session: 01/30/2018 01:15 PM LOB 302
Feb. 20, 2018 Executive Session: 02/20/2018 LOB 302
March 6, 2018 Committee Report: Ought to Pass with Amendment # 2018-0135h for 03/06/2018 (Vote 18-2; RC) HC 9 P. 37
Committee Report: Ought to Pass with Amendment # 2018-0135h (Vote 18-2; RC)
March 6, 2018 Amendment # 2018-0135h: AA VV 03/06/2018 HJ 6 P. 71
March 6, 2018 Ought to Pass with Amendment 0135h: MA RC 326-5 03/06/2018 HJ 6 P. 72
March 8, 2018 Introduced 03/08/2018 and Referred to Health and Human Services; SJ 7
April 12, 2018 Hearing: 04/12/2018, Room 101, LOB, 02:00 pm; SC 16
April 12, 2018 Hearing: 04/12/2018, Room 101, LOB, 02:00 pm; SC 16
April 12, 2018 Hearing: 04/12/2018, Room 101, LOB, 01:00 pm or 10 minutes following the end of Session; SC 16
April 17, 2018 Hearing: 04/17/2018, Room 101, LOB, 01:00 pm; SC 17
April 26, 2018 Committee Report: Ought to Pass with Amendment # 2018-1638s, 04/26/2018; SC 18
May 2, 2018 Special Order to 05/02/2018, Without Objection, MA; 04/26/2018 SJ 14
May 2, 2018 Committee Report: Ought to Pass with Amendment # 2018-1638s, 05/02/2018; SC 19
May 3, 2018 Special Order to 05/03/2018, Without Objection, MA; 05/02/2018 SJ 15
May 3, 2018 Committee Report: Ought to Pass with Amendment # 2018-1638s, 05/03/2018;
May 3, 2018 Committee Amendment # 2018-1638s, AA, VV; 05/03/2018; SJ 16
May 3, 2018 Ought to Pass with Amendment 2018-1638s, RC 24Y-0N, MA; OT3rdg; 05/03/2018; SJ 16
May 10, 2018 House Concurs with Senate Amendment 1638s (Rep. Hunt): MA VV 05/10/2018
May 23, 2018 Enrolled Bill Amendment # 2018-2091e Adopted, VV, (In recess of 05/23/2018); SJ 18
May 23, 2018 Enrolled Bill Amendment # 2018-2091e: AA VV 05/23/2018
May 23, 2018 Enrolled (In recess 05/23/2018); SJ 18
May 23, 2018 Enrolled 05/23/2018
Signed by Governor Sununu 07/02/2018; Chapter 356; Eff. 07/01/2018