Revision: Jan. 15, 2019, 12:13 p.m.
HB 528-FN - AS INTRODUCED
2019 SESSION
19-0302
01/10
HOUSE BILL 528-FN
AN ACT relative to insurance reimbursement for emergency medical services.
SPONSORS: Rep. Marsh, Carr. 8; Rep. Knirk, Carr. 3; Rep. MacDonald, Carr. 6; Rep. Camarota, Hills. 7; Rep. DesMarais, Carr. 6; Sen. Bradley, Dist 3
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill requires insurers to consider the presenting symptoms rather than the final diagnosis when determining whether to cover and pay 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0302
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to insurance reimbursement for emergency medical services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Coverage for Emergency Services. Amend RSA 417-F:2 to read as follows:
417-F:2 Claims Processing. When processing a claim for reimbursement for emergency services, the insurer shall consider the presenting symptoms rather than the final diagnosis as well as the health care services provided when determining whether to cover and pay for emergency services.
2 Managed Care Law; Definitions. Amend RSA 420-J:3, XV 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. For this chapter, the prudent layperson definition of emergency medical condition shall be focused on the patient's presenting symptoms rather than the final diagnosis when insurers are determining whether to cover and pay emergency medical claims.
3 Effective Date. This act shall take effect 60 days after its passage.
19-0302
1/14/19
HB 528-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to insurance reimbursement for emergency medical services.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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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 requires insurers to consider the presenting symptoms rather than the final diagnosis when determining whether to cover and pay for emergency services.
The Insurance Department assumes that this emphasis will put inflationary pressure on claims. To the extent there is an increase in claim amounts, there would be an increase in premiums and premium tax revenue.
The Department of Administrative Services does not believe this bill would have significant impact on the processing or payment for claims for emergency room services related to the State Health Benefit Plan for employees and retirees. The Department states the impact to the Plan is indeterminable as the volume of future emergency room medical care claims is unknown.
The Department of Health and Human Services indicates the bill would have no fiscal impact on the Medicaid program as the changes in the bill are not applicable to Medicaid managed care organizations.
AGENCIES CONTACTED:
Departments of Insurance, Administrative Services and Health and Human Services