HB 725-FN - AS AMENDED BY THE HOUSE
HOUSE BILL 725-FN
SPONSORS: Rep. Knirk, Carr. 3; Rep. Williams, Hills. 4; Rep. Marsh, Carr. 8; Rep. Woods, Merr. 23; Sen. Sherman, Dist 24
COMMITTEE: Commerce and Consumer Affairs
This bill establishes certain credentialing standards and claims quality assurance standards for managed care organizations for the purposes of the Medicaid program.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
7Mar2019... 0487h 19-0737
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
(j)(1) Managed care organizations shall process credentialing applications from all types of providers within the following prescribed time frames:
(A) For primary care physicians, within 30 calendar days of receipt of clean and complete credentialing applications.
(B) For specialty care providers, within 45 calendar days of receipt of clean and complete credentialing applications.
(2) For the purposes of subparagraph (1), the start time begins when the managed care organization has received a provider’s clean and complete application, and ends on the date of the provider’s written notice of network status.
(3) For the purposes of this subparagraph, a “clean and complete” application is a claim that is signed and appropriately dated by the provider, and includes:
(A) Evidence of the provider’s New Hampshire Medicaid identification; and
(B) Other applicable information to support the provider application, including provider explanations related to quality and clinical competence satisfactory to the managed care organization.
(4) If the managed care organization does not process a provider’s credentialing application within the time frames set forth in this subparagraph, the managed care organization shall pay the provider retroactive to 30 calendar days or 45 calendar days after receipt of the provider’s clean and complete application, depending on the prescribed time frame for the appropriate provider.
(5) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to credentialing standards under this subparagraph.
(k)(1) For the purposes of this subparagraph regarding claims quality assurance standards, the commissioner shall adopt the claims definitions established by the Centers for Medicare and Medicaid Services under the Medicaid program which are as follows:
(A) “Clean claim” means a claim that does not have any defect, impropriety, lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment.
(B) “Incomplete claim” means a claim that is denied for the purpose of obtaining additional information from the provider. The managed care organization shall pay or deny 95 percent of clean claims within 30 days of receipt, or receipt of additional information. The managed care organization shall pay 99 percent of clean claims within 90 days of receipt.
(2) Nothing in this subparagraph shall preclude the commissioner from administering the applicable contract requirements with the managed care organization as necessary to allow for exceptions to claims quality assurance standards under this subparagraph.
HB 725-FN- FISCAL NOTE
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
Estimated Increase / (Decrease)
[ X ] General [ ] Education [ ] Highway [ ] Other
This bill amends RSA 420-J:3, XXIII by adding Medicaid managed care organizations (MCO) to the definition of a "health carrier," thereby subjecting such organizations to state insurance laws and rules.
The Department of Health and Human Services states the fiscal impact is indeterminable as the bill could impose new or additional obligations on Medicaid MCOs that are in addition to their existing responsibilities or that result in MCOs being in violation of federal or state Medicaid regulations or contract provisions.
The Department of Administrative Services states the State Health Benefit Plan for Employees and Retirees is a governmental self-insured plan, and therefore is not governed by managed care laws. There will be no fiscal impact to the Department as a result of this bill.
Department of Administrative Services and Department of Health and Human Services
|Jan. 3, 2019||Introduced 01/03/2019 and referred to Commerce and Consumer Affairs HJ 3 P. 28|
|Jan. 30, 2019||Public Hearing: 01/30/2019 10:45 am LOB 302|
|Feb. 6, 2019||Subcommittee Work Session: 02/06/2019 09:30 am LOB 104|
|Feb. 6, 2019||==RECESSED== Executive Session: 02/06/2019 02:00 pm LOB 302|
|Feb. 13, 2019||Subcommittee Work Session: 02/13/2019 10:00 am LOB 302|
|Feb. 13, 2019||==CONTINUED== Executive Session: 02/13/2019 02:00 pm LOB 302|
|Retained in Committee|
|Committee Report: Ought to Pass with Amendment # 2019-0487h (Vote 19-1; CC)|
|March 7, 2019||Committee Report: Ought to Pass with Amendment # 2019-0487h (NT) for 03/07/2019 (Vote 19-1; CC) HC 14 P. 4|
|March 7, 2019||Amendment # 2019-0487h (NT): AA VV 03/07/2019|
|March 7, 2019||Ought to Pass with Amendment 2019-0487h (NT): MA VV 03/07/2019|
|March 14, 2019||Introduced 03/14/2019 and Referred to Commerce; SJ 9|
|Jan. 30, 2019||House||Hearing|
|Feb. 6, 2019||House||Exec Session|
|Feb. 13, 2019||House||Exec Session|
|March 7, 2019||House||Floor Vote|