Revision: April 18, 2024, 10:59 a.m.
HB 1296-FN - VERSION ADOPTED BY BOTH BODIES
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
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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.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
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.
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
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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
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Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• 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 | ||||||
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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