Revision: April 20, 2018, 3:39 p.m.
HB 1809-FN - AS AMENDED BY THE HOUSE
6Mar2018... 0135h
2018 SESSION
18-2860
01/10
HOUSE BILL 1809-FN
AN ACT relative to balance billing under the managed care law.
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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ANALYSIS
This bill prohibits balance billing under the managed care law.
This bill is the result of the committee established in 2017, 20.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.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 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.
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 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.
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 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 the act on health insurance premium rates to the chairpersons of the house and senate committees having jurisdiction over insurance issues.
6 Effective Date. This act shall take effect July 1, 2018.
18-2860
Amended 3/23/18
HB 1809-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2018-0135h)
AN ACT relative to balance billing under the managed care law.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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| Estimated Increase / (Decrease) | ||||
STATE: | FY 2019 | FY 2020 | FY 2021 | FY 2022 | |
Appropriation | $0 | $0 | $0 | $0 | |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable | |
Expenditures | $0 | $0 | $0 | $0 | |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | ||||
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 prohibits balance billing in the commercial insurance market for certain services provided by out-of-network providers at an in-network facility. The bill further states that fees for such services shall be limited to a commercially reasonable value, based on payments for similar services from NH insurance carriers to NH health care providers. In the event of a dispute between carriers and providers, the bill charges the commissioner of the Insurance Department with determining whether a fee is commercially reasonable. The bill also charges the Insurance Department with granting waivers under certain circumstances, as well as with issuing a report on health insurance premium rates. The Department states that it will be able to absorb the cost of these additional responsibilities within its existing budget. The Department also states that it assumes the bill will have some impact on negotiations between providers and carriers but is unable to determine the extent of this impact on county or local expenditures or how it might affect insurance premium tax collections.
The Department of Health and Human Services states this bill will have no fiscal impact.
AGENCIES CONTACTED:
Insurance Department and Department of Health and Human Services