HB 1600-FN-A - AS AMENDED BY THE HOUSE
19Feb2020... 0418h
2020 SESSION
20-2021
01/10
HOUSE BILL 1600-FN-A
SPONSORS: Rep. Marsh, Carr. 8; Rep. Merchant, Sull. 4; Rep. P. Schmidt, Straf. 19; Rep. Salloway, Straf. 5; Rep. Bartlett, Merr. 19; Rep. Campion, Graf. 12; Rep. M. Pearson, Rock. 34; Rep. Woods, Merr. 23; Sen. Bradley, Dist 3; Sen. Rosenwald, Dist 13
COMMITTEE: Health, Human Services and Elderly Affairs
─────────────────────────────────────────────────────────────────
AMENDED ANALYSIS
This bill authorizes pharmacists to provide smoking cessation therapy pursuant to a standing order from a physician or APRN and to be reimbursed under Medicaid. This bill also provides insurance coverage for pharmacist cognitive services under certain circumstances.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19Feb2020... 0418h
20-2021
01/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Department of Health and Human Services; General Provisions. Amend RSA 126-A:3 by inserting after paragraph III the following new paragraph:
III-a. Pharmacists shall be considered providers under RSA 126-A:3, III for the purpose of billing for providing cognitive services performed within the scope of a person’s license including, but not limited to, RSA 318:1, XXVIII, RSA 318:16-a, RSA 318:47-l, II, and RSA 318:47-m. The commissioner shall submit a Title XIX Medicaid state plan amendment to the federal Centers for Medicare and Medicaid Services to implement this paragraph, if necessary.
2 Managed Care Program; Dental Benefits. Amend RSA 126-A:5, XIX(a) to read as follows:
XIX.(a) The commissioner shall employ a managed care model for administering the Medicaid program and its enrollees to provide for managed care services for all Medicaid populations throughout New Hampshire consistent with the provisions of 42 U.S.C. section 1396u-2. Models for managed care may include, but not be limited to, a traditional capitated managed care organization contract, an administrative services organization, an accountable care organization, or a primary care case management model, or a combination thereof, offering the best value, quality assurance, and efficiency, maximizing the potential for savings, and presenting the most innovative approach compared to other externally administered models. Services to be managed within the model shall include all mandatory Medicaid covered services and may include, but shall not be limited to, care coordination, utilization management, disease management, pharmacy benefit management, provider network management, quality management, and customer services. The model shall reimburse pharmacists for cognitive services enumerated in RSA 126-A:3, III-a. The commissioner shall enter into contracts with the vendors that demonstrate the greatest ability to satisfy the state's need for value, quality, efficiency, innovation, and savings. The commissioner shall establish rates based on the appropriate model for the contract that is full risk to the vendors. The rates shall be established in rate cells or other appropriate units for each population or service provided including, but not limited to, persons eligible for temporary assistance to needy families (TANF), aid for the permanently and totally disabled (APTD), breast and cervical cancer program (BCCP), home care for children with severe disabilities (HC-CSD), and those residing in nursing facilities. The rates and/or payment models for the program shall be presented to the fiscal committee of the general court on an annual basis. The managed care model or models' selected vendors providing the Medicaid services shall emphasize patient-centered, value-based care and include enhanced care management of high-risk populations as identified by the department. In contracting for the managed care program, the department shall ensure no reduction in the quality of care of services provided to enrollees in the managed care model and shall exercise all due diligence to maintain or increase the current level of quality of care provided. The commissioner may, in consultation with the fiscal committee, adopt rules, if necessary, to implement the provisions of this paragraph. The department shall seek, with the approval of the fiscal committee, all necessary and appropriate waivers to implement the provisions of this paragraph.
3 New Paragraph; Pharmacists and Pharmacies; Definitions. Amend RSA 318:1 by inserting after paragraph XVIII the following new paragraph:
XVIII-a. “Smoking cessation therapy” means patches, gums, lozenges, inhalers, and nasal sprays which the United States Food and Drug Administration (FDA) classifies as available by prescription for the purpose of smoking cessation.
4 New Section; Pharmacists and Pharmacies; Smoking Cessation Therapy. Amend RSA 318 by inserting after section 47-l the following new section:
318:47-m Smoking Cessation Therapy.
I. In this section, "standing order" means a written and signed protocol authored by a physician licensed under RSA 329:12 or an advanced practice registered nurses licensed under RSA 326-B:18. The agreement shall specify a protocol allowing a licensed pharmacist to provide smoking cessation therapy under the delegated prescriptive authority of the physician or APRN, a mechanism to document screening performed and the prescription in the patient's medical record, and include a plan for evaluating and treating adverse events. The prescriptions shall be considered a legitimate medical purpose in the usual course of professional practice.
II. Licensed pharmacists following standing orders may provide smoking cessation therapy to persons in this state without a prior prescription.
III. A pharmacist, pharmacy, physician, or APRN issuing or following standing orders shall be prohibited from seeking personal financial benefit by participating in any incentive-based program or accepting any inducement that influences or encourages therapeutic or product changes or the ordering of tests or services.
IV. Prior to providing smoking cessation therapy under this section, a pharmacist shall complete an Accreditation Council for Pharmacy Education (ACPE) accredited educational training program related to smoking cessation.
V. The pharmacist shall provide each recipient of smoking cessation therapy with a standardized information sheet written in plain language, which shall include, but is not limited to, the indication for the use of the smoking cessation therapy, the importance of follow-up care, and health care referral information.
VI. The board shall adopt rules, pursuant to RSA 541-A, relative to:
(a) Education and training required under paragraph IV.
(b) Content and format of the information sheet required under paragraph V, in consultation with the commissioner of the department of health and human services.
(c) A model statewide protocol, with the consent of the board of medicine, the board of nursing, and the department of health and human services to be used for the purposes of paragraph I.
(d) Communication to the patient's primary care provider with the consent of the patient.
VII. The board of medicine shall not deny, revoke, suspend, or otherwise take disciplinary action against a physician based on a pharmacist's failure to follow standing orders provided the provisions of this section and the rules adopted under this section are satisfied. The board of nursing shall not deny, revoke, suspend, or otherwise take disciplinary action against an APRN based on a pharmacist's failure to follow standing orders provided the provisions of this section and the rules adopted under this section are satisfied. The board of pharmacy shall not deny, revoke, suspend, or otherwise take disciplinary action against a pharmacist who follows standing orders based on a defect in those standing orders provided the provisions of this section and the rules adopted under this section are satisfied.
5 New Section; Accident and Health Insurance; Coverage for Cognitive Services; Individual. Amend RSA 415 by inserting after section 6-x the following new section:
415:6-y Coverage for Pharmacist Cognitive Services. Each insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for providing pharmacist cognitive services, at a reimbursement rate established by contract between the pharmacy and the insurer, provided by a pharmacist in a collaborative practice agreement pursuant to RSA 318:16-a or under a standing order pursuant to RSA 318:47-m and RSA 318:47-l. Coverage shall be subject to terms and conditions of the policy.
6 New Section; Accident and Health Insurance; Coverage for Pharmacist Cognitive Services; Group. Amend RSA 415 by inserting after section 18-bb the following new section:
415:18-cc Coverage for Pharmacist Cognitive Services. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for providing pharmacist cognitive services, at a reimbursement rate established by contract between the pharmacy and the insurer, provided by a pharmacist in a collaborative practice agreement pursuant to RSA 318:16-a or under a standing order pursuant to RSA 318:47-m and RSA 318:47-l. Coverage shall be subject to terms and conditions of the policy.
7 Health Services Corporations; Applicable Statutes. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-i, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
8 Health Services Corporations; Applicable Statutes; Effective January 2021. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-i, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
9 Health Maintenance Organizations; Statutory Construction. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
10 Health Maintenance Organizations; Statutory Construction; Effective January 1, 2021. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
11 Appropriation; Department of Health and Human Services. The sum of $100,000 for the biennium ending June 30, 2021 is hereby appropriated to the department of health and human services for the purposes of this act. The governor is authorized to draw a warrant for said sum out of any money in the treasury not otherwise appropriated.
I. Sections 8 and 10 of this act shall take effect January 1, 2021 at 12:04 a.m.
II. The remainder of this act shall take effect June 30, 2020.
20-2021
Amended 5/18/20
HB 1600-FN-A- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2020-0418h)
AN ACT relative to smoking cessation therapy and pharmacist reimbursement under Medicaid and making an appropriation therefor and relative to insurance coverage for pharmacist cognitive services.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
|
| |||
| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $100,000 | $0 | $0 |
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable |
Expenditures | $0 | Approximately $100,000 | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Federal Medicaid Funds | |||
|
|
|
|
|
METHODOLOGY:
This bill authorizes pharmacists to dispense smoking cessation therapy upon order from a physician or advanced practice registered nurse (APRN), and allows for reimbursement by Medicaid. The bill also allows for Medicaid reimbursement for the dispensation by a pharmacist of hormonal contraceptives per RSA 318:47-l, II, and amends the state's Medicaid statute by requiring the managed care program to reimburse pharmacists for cognitive services as defined in the newly-established RSA 126-A:3, III-a. Finally, the bill establishes a new provision in RSA 415 and amends various provisions in RSA 420 to require insurers to provide coverage for pharmacist cognitive services. The bill contains a General Fund appropriation of $100,000 for the FY 2020/21 biennium.
The Department of Health and Human Services assumes the bill will result in increased access to and utilization of smoking cessation therapy, resulting in an indeterminable increase in costs to the Medicaid program in future years beyond FY 2021. In addition, the Department assumes there will be a one-time cost to the state general fund for system modifications to the Medicaid Management Information System (MMIS) to create a new provider type (“Pharmacist”) and coding to allow pharmacies to bill for the pharmacist’s time. The Department estimates that the general fund impact of this bill is $100,000 for the FY 2020/21 biennium. Two components will make up this cost: the modification to MMIS for the new provider type, and the actual service by pharmacists. The Department assumes that the modification to MMIS will be $50,000 in general funds, while the remaining $50,000 in general funds will be for implementation of the new benefit. All are projected to begin on April 1, 2021, due to the time needed to add the new service in MMIS, receive federal approval of a Medicaid state plan amendment, and effectuate changes in state administrative rules. Additional indeterminable costs may include reimbursement to pharmacists for cognitive services that are provided in conjunction with smoking cessation therapy or contraceptive counseling which have not previously been covered. The Department assumes that the state/federal cost share for the services provided will be 50/50, and further assumes there will be an indeterminable impact to the Granite Advantage Health Care Trust Fund.
The Insurance Department assumes that by mandating coverage for pharmacist cognitive services for certain therapies, the bill will cause inflationary pressure on claims costs. These pressures may result in increased premiums, changes in benefit designs to mitigate increased premiums, or some combination of the two. The Department states that the impact of these changes on state insurance premium tax revenues is uncertain, but assumes that the impact will be fairly small. Finally, the Department notes that the federal Affordable Care Act requires the cost of new coverage mandates to be borne by the state for coverage purchased through the exchange.
AGENCIES CONTACTED:
Department of Health and Human Services and Insurance Department
| Date | Body | Type |
|---|---|---|
| Jan. 14, 2020 | House | Hearing |
| Feb. 4, 2020 | House | Exec Session |
| House | Floor Vote | |
| Feb. 19, 2020 | House | Floor Vote |
| March 18, 2020 | House | Exec Session |
| March 18, 2020 | House | Exec Session |
| May 21, 2020 | House | Exec Session |
: Committee Report: Inexpedient to Legislate (Vote 22-0; CC) HC 23 P. 4
May 21, 2020: Executive Session: 05/21/2020 02:00 pm Members of the public may attend using this link: https://www.zoom.us/j/91769986281
March 18, 2020: ==CANCELLED== Executive Session: 03/18/2020 01:00 pm LOB 210-211
March 18, 2020: Executive Session: 03/18/2020 01:00 pm LOB 210-211
March 17, 2020: ==CANCELLED== Division III Work Session: 03/17/2020 10:00 am LOB 210-211
March 4, 2020: Divison II Work Session: 03/04/2020 01:00 pm LOB 210-211
Feb. 19, 2020: Referred to Finance 02/19/2020 HJ 4 P. 59
Feb. 19, 2020: Ought to Pass with Amendment 2020-0418h (NT): MA VV 02/19/2020 HJ 4 P. 59
Feb. 19, 2020: Amendment # 2020-0418h (NT): AA VV 02/19/2020 HJ 4 P. 59
: Minority Committee Report: Inexpedient to Legislate
Feb. 19, 2020: Majority Committee Report: Ought to Pass with Amendment # 2020-0418h (NT) for 02/19/2020 (Vote 16-5; RC) HC 7 P. 22
: Majority Committee Report: Ought to Pass with Amendment # 2020-0418h (Vote 16-5; RC)
Feb. 4, 2020: Executive Session: 02/04/2020 01:00 pm LOB 205
Jan. 30, 2020: Subcommittee Work Session: 01/30/2020 03:00 pm LOB 205
Jan. 23, 2020: Subcommittee Work Session: 01/23/2020 12:00 pm LOB 205
Jan. 14, 2020: Public Hearing: 01/14/2020 10:00 am LOB 205
Jan. 8, 2020: Introduced 01/08/2020 and referred to Health, Human Services and Elderly Affairs HJ 1 P. 28