Revision: Jan. 20, 2023, 9:39 a.m.
SB 176-FN - AS INTRODUCED
2023 SESSION
23-1039
05/07
SENATE BILL 176-FN
AN ACT relative to insurance coverage for pelvic floor therapy.
SPONSORS: Sen. Perkins Kwoka, Dist 21; Sen. Watters, Dist 4; Sen. Fenton, Dist 10; Sen. Altschiller, Dist 24; Sen. Whitley, Dist 15; Sen. Carson, Dist 14; Rep. Cannon, Straf. 12; Rep. Grote, Rock. 24
COMMITTEE: Health and Human Services
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ANALYSIS
This bill requires individual and group health insurance providers to cover pelvic floor therapy.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-1039
05/07
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to insurance coverage for pelvic floor therapy.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Accident and Health Insurance; Coverage for Pelvic Floor Therapy; Individual Coverage. Amend RSA 415 by inserting after section 6-a1 the following new section:
415:6-bb Coverage for Pelvic Floor Therapy. 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 pelvic floor therapy. Benefits provided under this section shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
2 New Section; Accident and Health Insurance; Coverage for Pelvic Floor Therapy; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Pelvic Floor Therapy. Each insurer that issues or renews a policy of group or blanket 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 pelvic floor therapy. Benefits provided under this section shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.
3 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 415:6-z, RSA 415:6-a1, 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, RSA 415:18-dd, RSA 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.
4 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-a1, 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, RSA 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.
5 Effective Date. This act shall take effect 60 days after its passage.
23-1039
1/13/23
SB 176-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to insurance coverage for pelvic floor therapy.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Various Government Funds | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill requires individual and group health insurance providers to cover pelvic floor therapy.
The Insurance Department assumes that, under one reading of this bill, the coverage this bill requires is likely to be something that would already be covered or substantially covered under the health plans affected by this bill. The coverage is likely to already exist under more general categories of coverage such as coverage for physical therapy, surgery, and durable medical equipment. However, the Department indicates the bill could be read to prohibit any sort of limitation on coverage for pelvic floor therapy, such as: a visit limitation per benefit period for physical therapy treatment of pelvic floor issues, or an exclusion of coverage for prophylactic pelvic floor treatment based on lack of medical necessity. This level of coverage would exceed the coverage provided in certain plans for physical therapy and would likely preclude some of the coverage limitations for pelvic floor therapy that are based on medical necessity. For example, the Essential Health Benefit coverage as provided in the New Hampshire Exchange Marketplace has a 20 visit limit for physical therapy. This would also apply to pelvic floor physical therapy.
The Department states that if the bill does represent an expansion of coverage, then there could be inflationary pressure on claim costs that may impact premium rates and/or benefit designs. This may also impact premium tax revenue. To the extent that the coverages required in this bill are applicable to health benefits offered by state, county, or local government entities, this would represent a possible increase in expenditures for coverage of state, county, or local employees.
In addition, under federal regulation at CFR Section 155.170, passage of this bill could possibly be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits offered in the Exchange Marketplace. This could be the case even though the specific coverage required is already subsumed under existing categories of coverage. Under this regulation, the state must make payments to defray the cost of the additional required benefits to Qualified Health Plan enrollees or to QHP issuers. This would represent a general fund expense which is indeterminable at this time.
However, the Department notes under RSA 400-A:39-b, the legislative committee having jurisdiction over this bill may refer the proposed mandated coverage to the Insurance Department which is authorized to retain an external actuarial review of the costs and benefits of the proposed mandate. In this manner, a qualified opinion of the cost could be obtained. In addition, the Centers for Medicare and Medicaid Services (CMS) encourages states to reach out to CMS concerning any state defrayal questions in advance of passing and implementing benefit mandates and to provide QHP issuers in the state ample time to quantify the cost attributable to each additional required benefit and report these calculations to the state.
AGENCIES CONTACTED:
Insurance Department