HB508 (2019) Detail

(Second New Title) relative to direct primary care.


CHAPTER 330

HB 508 - FINAL VERSION

 

14Feb2019... 0130h

4Apr2019... 1184h

05/15/2019   1863s

27Jun2019... 2586-CofC

27Jun2019... 2659-EBA

 

2019 SESSION

19-0197

01/03

 

HOUSE BILL 508

 

AN ACT relative to direct primary care and establishing a committee to study direct primary care.

 

SPONSORS: Rep. Marsh, Carr. 8; Rep. Guthrie, Rock. 13; Rep. Edwards, Rock. 4; Rep. Kotowski, Merr. 24; Rep. Yokela, Rock. 33; Rep. Stapleton, Sull. 5; Rep. Warden, Hills. 15; Sen. Reagan, Dist 17; Sen. Gray, Dist 6

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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AMENDED ANALYSIS

 

This bill declares that primary care providers providing direct primary care pursuant to a primary care agreement are not subject to the insurance laws, provided that certain conditions are met.  

 

This bill also establishes a committee to study direct primary care.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

14Feb2019... 0130h

4Apr2019... 1184h

05/15/2019   1863s

27Jun2019... 2586-CofC

27Jun2019... 2659-EBA 19-0197

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Nineteen

 

AN ACT relative to direct primary care and establishing a committee to study direct primary care.

 

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

 

330:1  New Section; Direct Primary Care.  Amend RSA 329 by inserting after section 1-d the following new section:

329:1-e  Direct Primary Care.

I.  In this section:

(a)  "Direct primary care agreement" means a written agreement between a primary care provider and a patient, a patient's legal representative, or a patient's employer, which meets the requirements of paragraph II.

(b)  "Primary care provider" means a health care provider licensed under RSA 329, RSA 326-B, or RSA 328-D, or a primary care group practice, who provides primary care services to patients.

(c)  "Primary care services" mean medical services in family practice, general practice, internal medicine, pediatrics, obstetrics, or gynecology including the screening, assessment, diagnosis, and treatment of a patient conducted within the competency and training of the primary care provider for the purpose of promoting health or detecting and managing disease or injury.

II.  Primary care services resulting from a primary care provider entering a direct primary care agreement is not insurance and the primary care provider shall not be subject to the requirements of RSA 415, RSA 420, or the jurisdiction of the commissioner when the following conditions are met:

(a)  The agreement is in writing and signed by the primary care provider, or agent, and the individual patient or his or her legal representative.

(b)  The agreement specifies the periodic fee required and any additional fees for services not covered by the periodic fee, and may allow the periodic fee and any additional fees to be paid by a third party.

(c)  The agreement describes the health care services that are covered by the periodic fee.

(d)  The agreement describes the duration of the agreement and any automatic renewal periods.

(e)  The agreement allows either party to terminate the agreement in writing, without penalty or payment of a termination fee, at any time or after notice as specified in the agreement which shall not exceed 90 days.

(f)  The agreement prominently states that the agreement is not health insurance and the primary care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any primary care services covered by the agreement.

(g)  The agreement prominently states that the agreement is not workers' compensation insurance and does not replace an employer's obligations under RSA 281-A.

III.  The direct primary care practice shall not decline to accept new direct primary care patients solely because of the patient's health status.  A direct primary care practice may decline to accept a patient for cause, including, but not limited to:

(a)  The practice has reached a maximum capacity;

(b)  The patient has previously contracted for services for which they have not paid; or

(c)  The patient’s medical condition is such that the provider is unable to provide the appropriate type of primary care services.

IV.  If the direct primary care practice provides the patient with notice and opportunity to obtain care from another physician, the direct primary care practice may discontinue care for a patient for cause, including, but not limited to:

(a)  The patient fails to pay the periodic fee.

(b)  The patient has performed an act of fraud.

(c)  The patient repeatedly fails to adhere to the recommended treatment plan.

(d)  The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice.

(e)  The primary care provider discontinues operation as a direct primary care practice.

V.  A direct primary care agreement may authorize a primary care provider to serve as a patient's authorized representative and as a claimant's representative as defined in RSA 420-J:3 and participate in grievance procedures under RSA 420-J:5 and request external review under RSA 420-J:5-a, 420-J:5-b, and 420-J:5-c.

330:2  New Subparagraph; Discount Medical Plan Organizations; Direct Primary Care Plan.  Amend RSA 415-I:3, III by inserting after subparagraph (c) the following new subparagraph:

(d)  A plan that provides direct primary care meeting the requirements of RSA 329:1-e.

330:3  Discount Medical Plan Organizations; Definitions; Direct Primary Care.  Amend RSA 415-I:3, IV to read as follows:

IV.  "Discount medical plan organization" means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount.  "Discount medical plan organization" is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or ancillary services at a discount and determines the charge to discount medical plan members.  "Discount medical plan organization" does not include a provider that offers discounts to its own patients without any cost or fee of any kind to the patient.  "Discount medical plan organization" shall not include providers of direct primary care meeting the requirements of RSA 329:1-e.

330:4  Prohibition of Exclusive Arrangement With Managed Care Insurers.  Amend RSA 420-I:1, III to read as follows:

III.  "Managed care" means any arrangement for the provision of physician services which is characterized by some measure of risk-sharing through capitated or other shared-risk compensation formulae, and which are characterized by the establishment and maintenance of a provider network available to subscribers or participants, and which provides incentives for subscribers or participants to use that network for covered services, and which ordinarily limit coverage or the extent of such coverage to physician services provided by that network.  "Managed care" shall include any managed care products or services or similar products including but not limited to those governed by RSA 415, RSA 419, RSA 420, RSA 420-A, RSA 420-B, and RSA 420-C.  "Managed care" shall not include direct primary care services which meet the requirements of RSA 329:1-e.  

330:5  Committee Established.  There is established a committee to study direct primary care.

330:6  Membership and Compensation.

I.  The members of the committee shall be as follows:

(a)  Three members of the house of representatives, appointed by the speaker of the house of representatives.

(b)  One member of the senate, appointed by the president of the senate.

II.  Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.

330:7  Duties.  

I.(a)  The committee shall study:

(1)  How direct primary care is being offered and delivered in New Hampshire and in the United States.

(2)  Whether direct primary care (DPC) is being regulated in other states and how it should be regulated in New Hampshire.

(3)  How oversight of this segment of health care should occur and whether regular reporting should be required.

(4)  The applicability of DPC fees and charges to cost sharing and coverage provisions of policy holder insurance plans and HSAs.

(5)  The implementation and impact of DPC on the insurance market and health care coverage costs.

(b)  The committee may solicit information from any person or entity the committee deems relevant to its study.

330:8  Chairperson; Quorum.  The members of the study committee shall elect a chairperson from among the members.  The first meeting of the committee shall be called by the first-named house member.  The first meeting of the committee shall be held within 45 days of the effective date of this section.  Four members of the committee shall constitute a quorum.

330:9  Report.  The committee shall make an interim report which shall include the impact of cost-sharing issues on the insurance market on or before November 1, 2019 and a final report which shall include an analysis of how DPC has been formalized in statute in other states, with any other findings and recommendations for proposed legislation, to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, the executive director of the board of medicine, and the state library on or before November 1, 2020.

330:10  Effective Date.

I.  Sections 1-4 of this act shall take effect 60 days after its passage.

II.  The remainder of this act shall take effect upon its passage.

 

Approved: August 16, 2019

Effective Date:

I. Sections 1-4 shall take effect October 15, 2019.

II. Remainder shall take effect August 16, 2019.

Links

HB508 at GenCourtMobile
HB508 Discussion

Action Dates

Date Body Type
Jan. 23, 2019 House Hearing
Jan. 29, 2019 House Exec Session
House Floor Vote
Feb. 14, 2019 House Floor Vote
March 5, 2019 House Hearing
March 20, 2019 House Exec Session
April 4, 2019 House Floor Vote
April 23, 2019 Senate Hearing
May 15, 2019 Senate Floor Vote
June 27, 2019 Senate Floor Vote
June 27, 2019 Senate Floor Vote
June 27, 2019 House Floor Vote

Bill Text Revisions

HB508 Revision: 6701 Date: Dec. 4, 2019, 9:38 a.m.
HB508 Revision: 6448 Date: July 12, 2019, 2:18 p.m.
HB508 Revision: 5957 Date: May 15, 2019, 12:48 p.m.
HB508 Revision: 5700 Date: April 4, 2019, 10:17 a.m.
HB508 Revision: 5701 Date: April 4, 2019, 10:10 a.m.
HB508 Revision: 4790 Date: Jan. 15, 2019, 11:35 a.m.

Docket

Date Status
Jan. 3, 2019 Introduced 01/03/2019 and referred to Health, Human Services and Elderly Affairs HJ 3 P. 17
Jan. 23, 2019 Public Hearing: 01/23/2019 10:00 am LOB 205
Jan. 29, 2019 Executive Session: 01/29/2019 01:00 pm LOB 205
Committee Report: Ought to Pass with Amendment # 2019-0130h (Vote 20-0; CC)
Feb. 14, 2019 Committee Report: Ought to Pass with Amendment # 2019-0130h for 02/14/2019 (Vote 20-0; CC) HC 11 P. 7
Feb. 14, 2019 Amendment # 2019-0130h: AA VV 02/14/2019 HJ 5 P. 16
Feb. 14, 2019 Ought to Pass with Amendment 2019-0130h: MA VV 02/14/2019 HJ 5 P. 16
Feb. 14, 2019 Referred to Commerce and Consumer Affairs 02/14/2019 HJ 5 P. 16
March 5, 2019 ==TIME CHANGE== Public Hearing: 03/05/2019 01:15 pm LOB 302
March 20, 2019 Full Committee Work Session: 03/20/2019 12:00 pm LOB 302
March 20, 2019 Executive Session: 03/20/2019 01:00 pm LOB 302
April 4, 2019 Committee Report: Ought to Pass with Amendment # 2019-1184h (NT) for 04/04/2019 (Vote 14-1; CC) HC 18 P. 2
Committee Report: Ought to Pass with Amendment # 2019-1184h (NT) (Vote 14-1; CC)
April 4, 2019 Amendment # 2019-1184h (NT): AA VV 04/04/2019 HJ 12 P. 2
April 4, 2019 Ought to Pass with Amendment 2019-1184h (NT): MA VV 04/04/2019 HJ 12 P. 2
April 11, 2019 Introduced 04/11/2019 and Referred to Health and Human Services; SJ 13
April 23, 2019 Hearing: 04/23/2019, Room 101, LOB, 02:00 pm; SC 19
May 15, 2019 Committee Report: Ought to Pass with Amendment # 2019-1863s, 05/15/2019; Vote 5-0; CC; SC 22
May 15, 2019 Committee Amendment # 2019-1863s, AA, VV; 05/15/2019; SJ 16
May 15, 2019 Ought to Pass with Amendment 2019-1863s, MA, VV; OT3rdg; 05/15/2019; SJ 16
June 6, 2019 House Non-Concurs with Senate Amendment 1863s and Requests CofC (Rep. Weber): MA VV 06/06/2019 HJ 18 P. 44
June 6, 2019 Speaker Appoints: Reps. Butler, Indruk, Marsh, Campion 06/06/2019 HJ 18 P. 44
June 6, 2019 Sen. Sherman Accedes to House Request for Committee of Conference, MA, VV; (In recess 06/06/2019); SJ 20
June 6, 2019 President Appoints: Senators Sherman, Fuller Clark, Gray; (In Recess 06/06/2019); SJ 20
June 18, 2019 Conference Committee Meeting: 06/18/2019 01:30 pm LOB 302
June 27, 2019 Conference Committee Report Filed, # 2019-2586c; 06/27/2019
June 27, 2019 Conference Committee Report # 2019-2586c, Adopted, VV; 06/27/2019; SJ 21
June 27, 2019 Conference Committee Report 2586c: Adopted, VV 06/27/2019 HJ 20 P. 32
June 27, 2019 Enrolled Bill Amendment # 2019-2659e Adopted, VV, (In recess of 06/27/2019); SJ 21
June 27, 2019 Enrolled Bill Amendment # 2019-2659e: AA VV 06/27/2019 HJ 20 P. 56
June 27, 2019 Enrolled (In recess 06/27/2019); SJ 21
June 27, 2019 Enrolled 06/27/2019 HJ 20 P. 59
Aug. 16, 2019 Signed by Governor Sununu 08/16/2019; Chapter 330; I. Sec. 1-4 Eff: 10/15/2019 II. Rem. Eff: 08/16/2019