1 New Paragraph; Pharmacy Rights During Audit; Response. Amend RSA 318:62 by inserting after paragraph VI the following new paragraph:

VI-a. To have the same number of days to respond to a claim in an audit that have passed since the origination of the claim.

2 Pharmacy Rights During Audit; Claims Period. Amend RSA 318:62, X to read as follows:

X. To have the period covered by an audit limited to 24 months from the date a claim was submitted to, or adjudicated by, a managed care company, an insurance company, a third-party payer, or any entity that represents responsible parties, unless a longer period is permitted by a federal plan under federal law.

3 Appeals Process. Amend RSA 318:63 to read as follows:

318:63 Mandatory Appeals Process.

I. Each entity that conducts an audit of a pharmacy shall establish an appeals process under which a pharmacy may appeal an unfavorable audit report to the entity.

II. If, following the appeal, the entity finds that an unfavorable audit report or any portion of the unfavorable audit report is unsubstantiated, the entity shall dismiss the unsubstantiated portion of the audit report without any further proceedings unless outlined in the contract.

III. Each entity conducting an audit shall provide a copy, if required under contractual terms, of the audit findings to the plan sponsor after completion of any appeals process.

4 Recoupment; Charges. Amend RSA 318:64, III to read as follows:

III. The entity conducting the audit may charge or assess the responsible party, directly or indirectly, based on amounts recouped *if both of the following conditions are met:

(a) The responsible party and the entity conducting the audit have entered into a contract that explicitly states the percentage charge or assessment to the responsible party.

(b) A commission or other payment to an agent or employee of the entity conducting the audit is not based, directly or indirectly, on amounts recouped*.

5 Audit Reports; Response. Amend RSA 318:65 to read as follows:

318:65 Audit Information and Reports. An audit report shall be delivered to the pharmacy within 75 days, unless otherwise agreed to, after the conclusion of the audit. A pharmacy shall be allowed at least 30 days, unless otherwise agreed to, following receipt of the audit report to appeal any discrepancy found in the audit. A final audit report shall be delivered to the pharmacy within 90 days, unless otherwise agreed to, after receipt of the appeal. A charge-back, recoupment, or other penalty may not be assessed until the appeal process has been exhausted and the final report issued except as specified in RSA 318:64. Except as provided by state or federal law or contract, audit information may not be shared. Auditors may have access only to previous audit reports on a particular pharmacy conducted by that same entity.

6 Effective Date. This act shall take effect 60 days after its passage.

1 New Paragraph; Pharmacy Rights During Audit; Response. Amend RSA 318:62 by inserting after paragraph VI the following new paragraph:

VI-a. To have the same number of days to respond to a claim in an audit that have passed since the origination of the claim.

2 Pharmacy Rights During Audit; Claims Period. Amend RSA 318:62, X to read as follows:

X. To have the period covered by an audit limited to 6 months from the date a claim was submitted to, or adjudicated by, a managed care company, an insurance company, a third-party payer, or any entity that represents responsible parties, unless a longer period is permitted by a federal plan under federal law.

3 Appeals Process. Amend RSA 318:63 to read as follows:

318:63 Mandatory Appeals Process.

I. Each entity that conducts an audit of a pharmacy shall establish an appeals process under which a pharmacy may appeal within 30 days after the report an unfavorable audit report to the entity.

II. If, following the appeal, the entity finds that an unfavorable audit report or any portion of the unfavorable audit report is unsubstantiated, the entity shall dismiss the unsubstantiated portion of the audit report without any further proceedings unless outlined in the contract.

III. Each entity conducting an audit shall provide a copy, if required under contractual terms, of the audit findings to the plan sponsor after completion of any appeals process.

IV. If any portion of an unfavorable audit report is not dismissed within 30 days after an appeal is made under paragraph I, the pharmacy may request a hearing from the insurance department pursuant to RSA 400-A:17.

4 Recoupment; Charges. Amend RSA 318:64, III to read as follows:

III. The entity conducting the audit shall not charge or assess the responsible party, directly or indirectly, based on amounts recouped .

5 Audit Reports; Response. Amend RSA 318:65 to read as follows:

318:65 Audit Information and Reports. An audit report shall be delivered to the pharmacy within 75 days, unless otherwise agreed to, after the conclusion of the audit. A pharmacy shall be allowed at least 30 days, unless otherwise agreed to, following receipt of the audit report to appeal any discrepancy found in the audit. A pharmacy shall be provided with a phone number for directly contacting the auditor. A final audit report shall be delivered to the pharmacy within 90 days, unless otherwise agreed to, after receipt of the appeal. A charge-back, recoupment, or other penalty may not be assessed until the appeal process has been exhausted and the final report issued except as specified in RSA 318:64. Except as provided by state or federal law or contract, audit information may not be shared. Auditors may have access only to previous audit reports on a particular pharmacy conducted by that same entity.

6 Effective Date. This act shall take effect 60 days after its passage.