HB247 (2021) Detail

Relative to treatment alternatives to opioids.


HB 247  - AS INTRODUCED

 

 

2021 SESSION

21-0164

08/05

 

HOUSE BILL 247

 

AN ACT relative to treatment alternatives to opioids.

 

SPONSORS: Rep. Lundgren, Rock. 5; Rep. Dolan, Rock. 5; Rep. Crawford, Carr. 4; Rep. Massimilla, Graf. 1; Rep. Lascelles, Hills. 20; Rep. Love, Rock. 6

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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ANALYSIS

 

This bill requires the department of health and human services to create a voluntary nonopioid directive form which may be used for nonopioid treatment options for pain.  This bill also establishes insurance coverage for such treatment options.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

21-0164

08/05

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT relative to treatment alternatives to opioids.

 

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

 

1  New Subdivision; Nonopioid Directives.  Amend RSA 126-A by inserting after section 88 the following new subdivision:

Nonopioid Directives

126-A:89  Definitions.  In this subdivision:

I.  "Health care facility" means a facility licensed under RSA 151.

II.  "Health care practitioner" or "prescribing practitioner" means a person who is lawfully entitled to prescribe, administer, dispense, or distribute controlled drugs.

126-A:90  Treatment of Chronic Pain.

I.  When patients seek treatment for any of the myriad conditions that cause pain, a health care practitioner shall refer or prescribe to a patient any of the following treatment alternatives, based on the practitioner's clinical judgment and the availability of the treatment, before starting a patient on an opioid; chiropractic, physical therapy, occupational therapy, acupuncture, massage therapy, and/or osteopathic manipulation.

II.  The health care practitioner shall honor the nonopioid directive first, by administering less addictive, nonopioid medications or nonpharmacological modalities as a first line of treatment, whenever possible.

III.  Nothing in this section shall be construed to require that all of the treatment alternatives set forth in paragraph I shall be required to be exhausted prior to the patient receiving a prescription for an opioid.

IV.  Nothing in this section shall preclude a health care practitioner from simultaneously prescribing an opioid and prescribing or recommending any of the procedures set forth in paragraph I.

126-A:91  Rulemaking.  The commissioner shall adopt rules, pursuant to RSA 541-A, relative to:

I.  A standard form for the recording and transmission of the voluntary nonopioid directive form, which shall include verification by the patient's practitioner and which shall comply with the appropriate confidentiality requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as amended, and shall include, the basic procedures necessary to revoke the voluntary nonopioid directive form.

II.  Procedures to record the voluntary nonopioid directive form in the patient's medical record or, if available, the patient's interoperable electronic medical record in the system.

III.  Requirements and procedures for a patient to appoint a duly authorized guardian or health care proxy to override a previously filed voluntary nonopioid directive form and circumstances under which an attending practitioner may override a previously filed voluntary nonopioid directive form based on documented medical judgment which shall be recorded in the patient's medical record.

IV.  Procedures to ensure that any recording, sharing, or distributing of data relative to the voluntary nonopioid directive form complies with all federal and state confidentiality laws.

V.  Procedures for yearly continuing education for health care practitioners which shall include proof that they have completed no less than 4 hours of continuing education relating to effective alternatives to the use of opioids which focus on the use of nonpharmacological modalities for pain management, specifically chiropractic, acupuncture, osteopathic manipulation, and massage.

126-A:92  Protections.

I.  A written prescription which is presented at an outpatient pharmacy or a prescription that is electronically transmitted to an outpatient pharmacy shall be presumed to be valid for the purposes of this subdivision, and a pharmacist in an outpatient setting shall not be held in violation of this subdivision for dispensing a controlled substance containing an opioid or other controlled substance in contradiction to a voluntary nonopioid directive form, except upon evidence that the pharmacist acted knowingly against the voluntary nonopioid directive form.

II.  No health care practitioner or employee of a health care practitioner acting in good faith shall be subject to criminal or civil liability or be considered to have engaged in unprofessional conduct for failing to offer or administer a prescription or medication order for a controlled substance containing an opioid under the voluntary nonopioid directive form.

III.  No person acting as a representative or an agent under a health care proxy shall be subject to criminal or civil liability for making a decision under RSA 126-A:90 in good faith.

2  New Section; Coverage for Nonopioid Treatment for Pain; Individual.  Amend RSA 415 by inserting after section 6-aa the following new section:

415:6-bb  Coverage for Nonopioid Treatment for Pain; Individual.  Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for the costs of options to patients for evidenced-based nonopioid treatment for pain, including but not limited to, yoga therapy, chiropractic care, osteopathic manipulative treatment and acupuncture treatment.  Policies issued pursuant to this section shall provide coverage for at least 20 visits per event of yoga therapy, physical therapy, occupational therapy, osteopathic manipulation, a chronic pain management program, and chiropractic services when ordered by a health care practitioner to treat conditions that cause chronic pain.  Reimbursement, coinsurance, copayment, and deductible amounts for pain management care utilizing yoga therapy, chiropractic, acupuncture, and/or osteopathic manipulation shall be determined as a service under the Patient Protection and Affordable Care Act of 2009, as amended, definition of rehabilitation and habilitation, but in no case shall be greater than the deductible, coinsurance, or co-pay required for a primary care visit.

3  New Section; Coverage for Nonopioid Treatment for Pain; Group.  Amend RSA 415 by inserting after section 18-ee the following new section:

415:18-ff  Coverage for Nonopioid Treatment for Pain.  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 each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the costs of options to patients for evidenced-based nonopioid treatment for pain, including but not limited to, yoga therapy, chiropractic care, osteopathic manipulative treatment and acupuncture treatment.  Policies issued pursuant to this section shall provide coverage for at least 20 visits per event of yoga therapy, physical therapy, occupational therapy, osteopathic manipulation, a chronic pain management program, and chiropractic services when ordered by a health care practitioner to treat conditions that cause chronic pain.  Reimbursement, coinsurance, copayment, and deductible amounts for pain management care utilizing yoga therapy, chiropractic, acupuncture, and/or osteopathic manipulation shall be determined as a service under the Patient Protection and Affordable Care Act of 2009, as amended, definition of rehabilitation and habilitation, but in no case shall be greater than the deductible, coinsurance, or co-pay required for a primary care visit.  

4  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, 415:6-z, 415:6-aa, RSA 415:6-bb, 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, 415:18-dd, 415:18-ee, RSA 415:18-ff, 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.

5  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 415:6-z, RSA 415:6-aa, RSA 415:6-bb, 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 415:18-dd, 415:18-ee, RSA 415:18-ff, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.

6  Effective Date.  This act shall take effect July 1, 2021.

Links

HB247 at GenCourtMobile
HB247 Discussion

Action Dates

Date Body Type
Jan. 26, 2021 House Hearing
Oct. 26, 2021 House Exec Session
Jan. 26, 2021 House Hearing
Oct. 26, 2021 House Exec Session

Bill Text Revisions

HB247 Revision: 31585 Date: Jan. 9, 2021, 4:14 p.m.

Docket


: Committee Report: Refer for Interim Study HB247 10/26/2021 (Vote 21-0; CC)


Nov. 3, 2021: Committee Report: Refer for Interim Study HB247 10/26/2021 (Vote 21-0; CC)


Oct. 26, 2021: Executive Session: 10/26/2021 09:30 am LOB 205-207


Oct. 13, 2021: Executive Session: 10/26/2021 09:30 am LOB 205-207


Sept. 21, 2021: Subcommittee Work Session: 10/06/2021 10:00 am LOB 205-207


Oct. 6, 2021: Subcommittee Work Session: 10/06/2021 10:00 am LOB 205-207


: Retained in Committee


Feb. 9, 2021: Retained in Committee


Jan. 26, 2021: Public Hearing: 01/26/2021 11:00 am Members of the public may attend using the following link: To join the webinar: https://www.zoom.us/j/94852322897 / Executive session on pending legislation may be held throughout the day (time permitting) from the time the committee is initially convened.


Jan. 20, 2021: Public Hearing: 01/26/2021 11:00 am Members of the public may attend using the following link: To join the webinar: https://www.zoom.us/j/94852322897 / Executive session on pending legislation may be held throughout the day (time permitting) from the time the committee is initially convened.


Jan. 9, 2021: Introduced (in recess of) 01/06/2021 and referred to Health, Human Services and Elderly Affairs HJ 2 P. 40


Jan. 6, 2021: Introduced (in recess of) 01/06/2021 and referred to Health, Human Services and Elderly Affairs HJ 2 P. 40