SB531 (2020) Detail

Relative to prior authorizations under group health insurance policies and managed care.










AN ACT relative to prior authorizations under group health insurance policies and managed care.


SPONSORS: Sen. Morgan, Dist 23; Sen. Kahn, Dist 10; Sen. Watters, Dist 4; Sen. Rosenwald, Dist 13; Sen. Fuller Clark, Dist 21; Sen. Hennessey, Dist 5; Sen. Sherman, Dist 24; Sen. Bradley, Dist 3; Sen. Cavanaugh, Dist 16; Sen. Gray, Dist 6; Rep. Knirk, Carr. 3; Rep. Marsh, Carr. 8; Rep. Woods, Merr. 23; Rep. Indruk, Hills. 34








This bill clarifies the prior authorization procedures under group health insurance policies and managed care.


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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.






In the Year of Our Lord Two Thousand Twenty


AN ACT relative to prior authorizations under group health insurance policies and managed care.


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


1  Coverage for Emergency Services; Prior Authorization.  Amend RSA 417-F:3 to read as follows:

417-F:3  Prior Authorization.

I.  A participating provider or other authorized representative of the plan that gives prior authorization shall not rescind or modify the authorization after the health care provider has rendered the authorized emergency services care in good faith and the enrollee's, insured's, or subscriber's coverage was effective on the date of service.

II.  When emergency services are a covered benefit under a health plan subject to this chapter, no prior authorization shall be required for emergency health care services necessary to screen and stabilize an individual.

2  Managed Care Law; Access to Enhanced 911 System.  Amend RSA 420-J:3-a, IV to read as follows:

IV.  No health benefit plan shall require a prior authorization for medically necessary interfacility transports by emergency medical services.

V.  No person who issues a health benefit plan subject to this chapter shall use false or misleading language in its enrollment sales materials or in any other materials provided to covered persons to discourage or prohibit covered persons from accessing the enhanced 911 system for response and/or transportation for emergency services.

3  Managed Care Law; Substance Use Disorders.  Amend RSA 420-J:17, IV and V to read as follows:

IV.  When substance use disorder services are a covered benefit under a health benefit plan, no prior authorization shall be required for medication-assisted treatment for treatment of opioid use disorders.

V.  If an insurance policy does not require prior authorization for short-term inpatient withdrawal management services or clinical stabilization services, paragraphs II [and], III and IV shall not apply.

[V] VI.  Nothing in this section shall be construed to require coverage for services provided by a non-participating provider.

4  New Section; Exceptions to Prior Authorizations.  Amend RSA 420-J by inserting after section 19 the following new section:

420-J:20  Exceptions to Prior Authorizations.  When prior authorizations are required under a health benefit plan:

I.  There shall be no revocation, limitation, condition or restriction of prior authorizations, if care is provided within 45 days from the date the health care provider received prior authorization.

II.  The authorization shall be valid for one year from the date the health care provider receives the prior authorization.

III.  Additional medically necessary services or procedures required during the course of an otherwise authorized service or services shall not be denied or require additional authorization.

IV.  All notifications and disclosures of prior authorization requirements and written notices of new or amended requirements shall be provided to all impacted health care providers within 60 days of the effective date.

5  Repeal.  RSA 420-J:18, relative to authorization for medication-assisted treatment, is repealed.

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


SB531 at GenCourtMobile
SB531 Discussion

Action Dates

Date Body Type
March 10, 2020 Senate Hearing

Bill Text Revisions

SB531 Revision: 7747 Date: Dec. 24, 2019, 9:59 a.m.


Date Status
Jan. 8, 2020 To Be Introduced 01/08/2020 and Referred to Commerce; SJ 1
March 10, 2020 Hearing: 03/10/2020, Room 100, SH, 01:45 pm; SC 10
June 16, 2020 Vacated from Committee and Laid on Table, MA, VV; 06/16/2020 SJ 8
June 16, 2020 No Pending Motion; 06/16/2020 SJ 8