HB1484 (2020) Detail

Relative to retroactive denials of previously paid claims.


HB 1484 - AS AMENDED BY THE HOUSE

 

11Mar2020... 0964h

2020 SESSION

20-2640

01/05

 

HOUSE BILL 1484

 

AN ACT relative to retroactive denials of previously paid claims.

 

SPONSORS: Rep. Read, Rock. 17; Rep. Abrami, Rock. 19; Rep. Luneau, Merr. 10; Rep. Ellison, Merr. 27; Sen. Fuller Clark, Dist 21; Sen. Hennessey, Dist 5; Sen. Reagan, Dist 17; Sen. Bradley, Dist 3

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill clarifies the law regarding retroactive denials of previously paid claims under accident and health insurance.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

11Mar2020... 0964h 20-2640

01/05

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT relative to retroactive denials of previously paid claims.

 

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

 

1  Accident and Health Insurance; Retroactive Denials.  RSA 415:6-i, II and III are repealed and reenacted to read as follows:

II.(a)  No insurer shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless:

(1)  The insurer has notified the health care provider at least 15 days in advance of the imposition of any retroactive denial and provided a written statement specifying the basis for any denial; and

(2)  The time which has elapsed since the date of payment of the challenged claim does not exceed 6 months.  The retroactive denial of a previously paid claim may be permitted beyond 6 months from the date of payment only for the following reasons:

(A)  The claim was submitted fraudulently;

(B)  The claim payment was incorrect because the health care provider or the insured was already paid for the health care services identified in the claim;

(C)  The health care services identified in the claim were not delivered by the health care provider;

(D)  The claim payment is the subject of legal action;

(E)  The claim payment is the subject of an adjustment with a different insurer, administrator, or payor and such adjustment is not affected by a contractual relationship, association, or affiliation involving claims payment, processing, or pricing; or

(F)  The claim payment was for services subject to coordination of benefits with another carrier or under Title XVIII, Title XIX, or Title XXI of the Social Security Act.

(b)  In those cases where the retroactive denials relate to coordination of benefits, the carrier shall furnish the provider with the name and address of the entity responsible for the denied claim.

(c)  When prior approval for a service or other covered item is granted, a carrier shall not retrospectively deny coverage or payment for the originally approved service unless fraudulent or materially incorrect information was provided at the time prior approval for the services was granted.

III.  The health care provider shall have 6 months from the date of notification under this paragraph to determine whether the insured had other appropriate insurance, which was in effect on the date of service.  Notwithstanding the contractual terms between the insurer and provider, the insurer shall allow for the submission of a claim that was previously denied by another insurer due to the insured's transfer or termination of coverage.

2  Effective Date.  This act shall take effect January 1, 2021.

 

LBAO

20-2640

Amended 3/25/20

 

HB 1484- FISCAL NOTE

AS AMENDED BY THE HOUSE (AMENDMENT #2020-0964h)

 

AN ACT relative to retroactive denials of previously paid claims.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [ X ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

Indeterminable

Indeterminable

Indeterminable

   Revenue

$0

$0

$0

$0

   Expenditures

$0

$0

$0

$0

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [    ] Other

 

 

 

 

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

This bill clarifies the law regarding retroactive denials of previously paid claims under accident and health insurance.  The Insurance Department indicates it has not studied retroactive denial of claims and has no knowledge about how existing practices compare to the practices permitted by the bill.  To the extent today’s practices permit more denials then what the bill would permit, there could be inflationary pressure on claim costs.  Inflationary pressures on claim costs may impact premium rates and plan designs.  The Department states it is difficult to determine how this would impact premium tax revenue, as purchasers may respond with buy-downs.  The bill only impacts fully insured plans.  Regulatory differences between fully insured products and self-insured designs may cause employers to shift from one segment to the other.  

 

AGENCIES CONTACTED:

Insurance Department

 

Links

HB1484 at GenCourtMobile
HB1484 Discussion

Action Dates

Date Body Type
Feb. 5, 2020 House Hearing
March 3, 2020 House Exec Session
House Floor Vote
March 11, 2020 House Floor Vote

Bill Text Revisions

HB1484 Revision: 8357 Date: March 31, 2020, 3:53 p.m.
HB1484 Revision: 7179 Date: Dec. 3, 2019, 10:21 a.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and referred to Commerce and Consumer Affairs HJ 1 P. 24
Feb. 5, 2020 Public Hearing: 02/05/2020 10:30 am LOB 302
Feb. 18, 2020 Subcommittee Work Session: 02/18/2020 09:30 am LOB 302
Feb. 24, 2020 ==TIME CHANGE== Subcommittee Work Session: 02/24/2020 09:00 am LOB 302
March 3, 2020 Executive Session: 03/03/2020 10:30 am LOB 302
Committee Report: Ought to Pass with Amendment # 2020-0964h (Vote 12-7; RC)
March 11, 2020 Committee Report: Ought to Pass with Amendment # 2020-0964h for 03/11/2020 (Vote 12-7; RC) HC 10 P. 39
March 11, 2020 Amendment # 2020-0964h: AA VV 03/11/2020 HJ 7 P. 122
March 11, 2020 Ought to Pass with Amendment 2020-0964h: MA VV 03/11/2020 HJ 7 P. 122
June 16, 2020 Introduced 06/16/2020, and Laid on Table, MA, VV; 06/16/2020; SJ 8
June 16, 2020 No Pending Motion; 06/16/2020 SJ 8