Revision: Dec. 4, 2019, 10:56 a.m.
HB 1600-FN-A - AS INTRODUCED
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
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ANALYSIS
This bill authorizes pharmacists to dispense smoking cessation therapy pursuant to a standing order from a physician or APRN and to be reimbursed under Medicaid.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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 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.
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, and pills which the United States Food and Drug Administration (FDA) classifies as available by prescription for the purpose of smoking cessation.
4 New Paragraph; Pharmacists and Pharmacies; Standards for Collaborative Pharmacy Practice. Amend RSA 318:16-a by inserting after paragraph VI the following new paragraph:
VII. Pharmacists dispensing hormonal contraceptives by standing order pursuant to RSA 318:47-l, II and pharmacists dispensing smoking cessation therapy by standing order pursuant to RSA 318:47-m, II shall be considered to be in a collaborative practice agreement with the physician or APRN who signed the standing order.
5 New Section; Pharmacists and Pharmacies; Smoking Cessation Therapy; Dispensing. Amend RSA 318 by inserting after section 47-l the following new section:
318:47-m Smoking Cessation Therapy; Dispensing.
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 dispense 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 dispense nicotine replacement 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 dispensing 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.
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.
6 New Subparagraph; Managed Care Law; Network Adequacy. Amend RSA 420-J:7, II by inserting after subparagraph (e) the following new subparagraph:
(f) Standards for accessing contraceptive counseling services provided by a pharmacist that are at least as stringent as those for accessing a retail pharmacy.
7 New Subparagraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8, XV(a) by inserting after subparagraph (2) the following new subparagraph:
(3) For a New Hampshire pharmacy, a provision that recognizes pharmacists as health care providers and includes distinct reimbursement rates for contraceptives counseling services provided to a member by a pharmacist pursuant to RSA 318:47-l.
8 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.
9 Effective Date. This act shall take effect June 30, 2020.
20-2021
12/4/19
HB 1600-FN-A- FISCAL NOTE
AS INTRODUCED
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $100,000 | $0 | $0 | $0 |
Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Federal Medicaid Funds | |||
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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 amends the required provider contract standards under RSA 420-J:8 to include a provision recognizing pharmacists as health care providers and including distinct reimbursement rates for contraceptive counseling services provided by a pharmacist. The bill contains a General Fund appropriation of $100,000 for the FY 2020/21 biennium.
The Department of Health and Human Services projects that 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. Additional costs may result from reimbursements to pharmacists for cognitive services provided in conjunction with smoking cessation services or contraceptive counseling. The Department states that the extent of any such cost increase is indeterminable, but that the cost will be offset by the $100,000 appropriation contained in the bill. The Department further assumes that the $100,000 general fund appropriation will be matched by federal Medicaid funds.
AGENCIES CONTACTED:
Department of Health and Human Services, Insurance Department, and Office of Professional Licensure and Certification