HB1296 (2024) Detail

Relative to insurance coverage for diagnostic and supplemental breast examinations.


HB 1296-FN - AS AMENDED BY THE HOUSE

 

28Mar2024... 1133h

2024 SESSION

24-2186

05/10

 

HOUSE BILL 1296

 

AN ACT relative to insurance coverage for diagnostic and supplemental breast examinations.

 

SPONSORS: Rep. Rombeau, Hills. 2; Rep. W. Thomas, Hills. 12; Rep. Ming, Hills. 35; Rep. Simpson, Rock. 33; Rep. Bay, Straf. 21; Rep. L. Foxx, Hills. 2; Rep. McGhee, Hills. 35; Rep. Coker, Belk. 2; Rep. Bogert, Belk. 5; Sen. Perkins Kwoka, Dist 21; Sen. Soucy, Dist 18; Sen. Prentiss, Dist 5; Sen. Whitley, Dist 15

 

COMMITTEE: Commerce and Consumer Affairs

 

-----------------------------------------------------------------

 

ANALYSIS

 

This bill provides that certain insurers that provide diagnostic and supplemental breast examinations shall not impose co-payments, deductibles, or other cost-sharing requirements.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

28Mar2024... 1133h 24-2186

05/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty Four

 

AN ACT relative to insurance coverage for diagnostic and supplemental breast examinations.

 

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

 

1  New Section; Women's Health Care; Coverage for Diagnostic and Supplemental Breast Examinations.  Amend RSA 417-D by inserting after section 2-b the following new section:

417-D:2-c  Coverage for Diagnostic and Supplemental Breast Examinations.

I.  No group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening and diagnostic and supplemental breast examinations furnished to an individual enrolled under such plan or coverage, shall impose any cost-sharing requirements for such services.

II.  For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2), this requirement shall apply only after the enrollee has satisfied the minimum deductible under section 223 for the year, except with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case paragraph I shall apply regardless of whether the minimum deductible under section 223 has been satisfied.

III.  In this section:

(a)  "Cost-sharing requirements" mean a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.

(b)  "Diagnostic breast examination" means a medically necessary and appropriate examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:

(1)  Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or

(2)  Used to evaluate an abnormality detected by another means of examination.

(c)  "Supplemental breast examination" means a medically necessary and appropriate examination of the breast, including such an examination using breast magnetic resonance imaging, or breast ultrasound, that is:

(1)  Used to screen for breast cancer when there is no abnormality seen or suspected; and

(2)  Based on personal or family medical history, or additional factors that may increase the individual’s risk of breast cancer.

2  Effective Date.  This act shall take effect January 1, 2025.

 

LBA

24-2186

2/23/24

 

HB 1296-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT relative to insurance coverage for diagnostic and supplemental breast examinations.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [ X ] Local              [    ] None

 

 

Estimated State Impact - Increase / (Decrease)

 

FY 2024

FY 2025

FY 2026

FY 2027

Revenue

$0

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

Revenue Fund(s)

General Fund

Insurance Premium Tax

Expenditures

$0

$0

$0

$0

Funding Source(s)

None

 

Appropriations

$0

$0

$0

$0

Funding Source(s)

None

 

Does this bill provide sufficient funding to cover estimated expenditures? [X] N/A

Does this bill authorize new positions to implement this bill? [X] No

 

Estimated Political Subdivision Impact - Increase / (Decrease)

 

FY 2024

FY 2025

FY 2026

FY 2027

County Revenue

$0

$0

$0

$0

County Expenditures

$0

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

Local Revenue

$0

$0

$0

$0

Local Expenditures

$0

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

Indeterminable Increase                     (See below)

 

METHODOLOGY:

This bill provides that certain insurers that provide diagnostic and supplemental breast examinations shall not impose co-payments, deductibles, or other cost-sharing requirements.

 

The Insurance Department indicates preventative breast screenings are currently required to be covered without cost-sharing.  Diagnostic and supplemental examinations are covered benefits that are subject to cost sharing under most plans. The amount of cost sharing applicable depends on the plan design. Since preventative services are already covered, the Insurance Department assumes negligible increases in claims for preventative screenings.  However, placing cost-sharing limits on diagnostic and supplemental services would shift a portion of these costs from consumers to insurers which could increase the overall insurer spending on health services.  The amount of cost shifting would depend on the number of diagnostic or supplement examinations conducted as well as the benefit design of the consumers receiving such services, as the cost sharing amount will vary based on the consumer's plan and whether the particular patient has met their total out-of-pocket maximum for the plan year. If this bill were to become law, the Insurance Department assumes there would be the potential for upward premium pressure that is indeterminable at this time.  To the extent this bill results in increased premiums, state insurance premium tax revenue would increase along with county and local expenditures for health insurance.

 

The Department reviewed claims data for the three most commonly-billed diagnostic mammography services. 34,877 unique claims were submitted by commercial insurers, some self-insured commercial plans, and managed care organizations.  The median cost sharing amount was $0, however the Department noted that, for some diagnoses, there was a cost-share amount. However, this was the case in less than 100 claims out of 34,877, or <0.03% of the total diagnostic mammography claims.  Therefore, any fiscal impact on state revenue and state, county and local expenditures would likely be small.

 

AGENCIES CONTACTED:

Insurance Department

 

Amendments

Date Amendment
March 20, 2024 2024-1133h

Links


Date Body Type
Jan. 18, 2024 House Hearing
March 13, 2024 House Exec Session
March 20, 2024 House Exec Session
March 20, 2024 House Floor Vote
April 10, 2024 Senate Hearing
April 18, 2024 Senate Floor Vote

Bill Text Revisions

HB1296 Revision: 41450 Date: March 28, 2024, 2:23 p.m.
HB1296 Revision: 41327 Date: March 20, 2024, 5:12 p.m.
HB1296 Revision: 39804 Date: March 15, 2024, 2:50 p.m.

Docket


April 10, 2024: Committee Report: Ought to Pass, 04/18/2024, Vote 5-0; SC 15


April 4, 2024: Hearing: 04/10/2024, Room 101, LOB, 09:15 am; SC 14


April 2, 2024: Introduced 03/21/2024 and Referred to Health and Human Services; SJ 8


March 28, 2024: Ought to Pass with Amendment 2024-1133h: MA VV 03/28/2024 HJ 10


March 28, 2024: Amendment # 2024-1133h: AA VV 03/28/2024 HJ 10


March 20, 2024: Committee Report: Ought to Pass with Amendment # 2024-1133h 03/20/2024 (Vote 17-0; CC) HC 12 P. 7


March 13, 2024: Executive Session: 03/20/2024 10:00 am LOB 302-304


March 7, 2024: Executive Session: 03/13/2024 10:00 am LOB 302-304


Feb. 14, 2024: Subcommittee Work Session: 02/20/2024 10:00 am LOB 305


Feb. 7, 2024: Subcommittee Work Session: 02/14/2024 10:00 am LOB 302-304


Jan. 9, 2024: Public Hearing: 01/18/2024 01:45 pm LOB 302-304


Dec. 6, 2023: Introduced 01/03/2024 and referred to Commerce and Consumer Affairs HJ 1