SB 131-FN - AS INTRODUCED
2023 SESSION
23-0949
05/04
SENATE BILL 131-FN
AN ACT relative to health care provider contract standards.
SPONSORS: Sen. Soucy, Dist 18; Sen. Watters, Dist 4; Sen. Gannon, Dist 23; Sen. Rosenwald, Dist 13; Sen. Chandley, Dist 11; Sen. D'Allesandro, Dist 20; Rep. Tellez, Hills. 40; Rep. Ebel, Merr. 7; Rep. J. Murphy, Graf. 12; Rep. Nagel, Belk. 6
COMMITTEE: Health and Human Services
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ANALYSIS
This bill states that a health care provider manual is intended as an administrative tool and is not to be used to change the terms of the provider contract or benefit plan.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-0949
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to health care provider contract standards.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8 by inserting after paragraph XVIII the following new paragraph:
XIX.(a) Each health care provider contract with a health carrier shall refer to the provider manual only as an administrative tool and use such provider manual only for administrative purposes. The provider manual shall not contain, nor shall it be used to effectuate, material changes to, or provisions that conflict with, the prevailing provider contract or health benefit plan member certificates that impact consumer health care coverage or clinical care.
(b) Disputes regarding such changes shall be referred to the department, which shall establish rules under RSA 541-A to resolve such disputes, including any remedies deemed appropriate by the commissioner.
2 Effective Date. This act shall take effect 60 days after its passage.
23-0949
1/5/23
SB 131-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to health care provider contract standards.
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 Increase | Indeterminable Increase | Indeterminable Increase |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Insurance Department Operating Funds | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase |
METHODOLOGY:
This bill states that a health care provider manual is intended as an administrative tool and is not to be used to change the terms of the provider contract or benefit plan.
The Insurance Department indicates this bill seeks to amend provider contract standards within managed care entities by limiting the use of the provider manual to administrative purposes only and by prohibiting carriers from making material changes to existing provider contracts via revisions in the provider manual. The Department assumes the purpose or effect of this bill would be to limit a health carrier’s ability to seek out lower cost options for such services as specialty pharmacy, laboratory services, and diagnostic imaging services. To the extent that health carriers will be limited in pursuing lower cost options for health care services, there may be upward pressure on health care claims costs and on health insurance premiums. To the extent premiums increase, this would cause an increase in premium tax revenues. The Department is unable to determine to what extent these effects would occur. If there is an effect on premiums, this would potentially affect state, county, and local expenditures for health coverage for employees.
In addition, the bill requires the Insurance Commissioner to adjudicate contract disputes between health carriers and providers resulting from the changes in the bill. The Department is unable to estimate the number of hearing requests it may be required to resolve and therefore is unable to ascertain whether it can handle these administrative responsibilities within its existing operating budget.
AGENCIES CONTACTED:
Insurance Department
| Date | Body | Type |
|---|---|---|
| Feb. 15, 2023 | Senate | Hearing |
Jan. 3, 2024: Refer to Interim Study, MA, VV; 01/03/2024; SJ 1
Dec. 18, 2023: Committee Report: Referred to Interim Study, 01/03/2024; Vote 5-0; CC; SC 49
Nov. 7, 2023: Committee Report: Referred to Interim Study; Vote 5-0; CC
March 16, 2023: Rereferred to Committee, MA, VV; 03/16/2023; SJ 10
March 8, 2023: Committee Report: Rereferred to Committee, 03/16/2023; Vote 5-0; CC; SC 13
Feb. 8, 2023: Hearing: 02/15/2023, Room 101, LOB, 09:00 am; SC 10
Jan. 19, 2023: Introduced 01/19/2023 and Referred to Health and Human Services; SJ 5