Revision: Jan. 20, 2023, 9:40 a.m.
SB 177-FN - AS INTRODUCED
2023 SESSION
23-1041
05/04
SENATE BILL 177-FN
SPONSORS: Sen. Prentiss, Dist 5; Sen. Perkins Kwoka, Dist 21; Sen. Watters, Dist 4; Sen. Soucy, Dist 18; Sen. Whitley, Dist 15; Sen. Fenton, Dist 10; Sen. Carson, Dist 14; Rep. Bolton, Graf. 8; Rep. Palmer, Sull. 2; Rep. Morse, Graf. 9
COMMITTEE: Health and Human Services
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ANALYSIS
This bill creates orthotics and prosthetics parity and requires health insurance providers to cover prosthetic and orthotic devices for the performance of physical activities for children 18 years of age and younger.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-1041
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Accident and Health Insurance; Coverage for Prosthetic and Orthotic Devices; Individual Coverage. Amend RSA 415 by inserting after section 6-a1 the following new section:
415:6-bb Coverage for Prosthetic and Orthotic Devices for Children. 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 coverage for prosthetic and orthotic devices for children and youth up to 18 years plus 365 days, who are residents of this state and covered by such insurance. This coverage shall at least equal the coverage and payment for prosthetic and orthotic devices provided under federal laws and regulations for the aged and disabled pursuant to 42 U.S.C. Sections 1395k, 1395l and 1395m and 42 C.F.R. Sections 414.202, 414.210, 414.228 and 410.100 and be no less favorable than the terms and conditions for the medical and surgical benefits in the policy. Covered benefits shall be provided for:
I. A prosthetic or orthotic device determined by the enrollee’s provider to be the most appropriate model that adequately meets the medical needs of the enrollee;
II. In addition to coverage of a prosthetic device required by paragraph I, a prosthetic or orthotic device determined by the enrollee’s provider to be the most appropriate model that meets the medical needs of the enrollee for purposes of performing physical activities, as applicable, such as running, biking, and swimming, and to maximize the enrollee’s upper limb function;
III. All materials and components necessary to use the device;
IV. Instruction to the enrollee on using the device; and
V. The repair or replacement of a prosthetic or orthotic device that is determined medically necessary or is necessary for maximizing the enrollee’s ability to ambulate, run, bike, and swim and for maximizing upper limb function, as determined by the treating provider.
2 New Section; Accident and Health Insurance; Coverage for Prosthetic and Orthotic Devices; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Prosthetic and Orthotic Devices for Children. 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 coverage for prosthetic and orthotic devices for children and youth up to 18 years plus 365 days, who are residents of this state and covered by such insurance. This coverage must at least equal the coverage and payment for prosthetic and orthotic devices provided under federal laws and regulations for the aged and disabled pursuant to 42 United States Code, Sections 1395k, 1395l and 1395m and 42 C.F.R. Sections 414.202, 414.210, 414.228 and 410.100 and be no less favorable than the terms and conditions for the medical and surgical benefits in the policy. Covered benefits shall be provided for:
I. A prosthetic or orthotic device determined by the enrollee’s provider to be the most appropriate model that adequately meets the medical needs of the enrollee;
II. In addition to coverage of a prosthetic device required by paragraph I, a prosthetic or orthotic device determined by the enrollee’s provider to be the most appropriate model that meets the medical needs of the enrollee for purposes of performing physical activities, as applicable, such as running, biking, and swimming, and to maximize the enrollee’s upper limb function;
III. All materials and components necessary to use the device;
IV. Instruction to the enrollee on using the device; and
V. The repair or replacement of a prosthetic or orthotic device that is determined medically necessary or is necessary for maximizing the enrollee’s ability to ambulate, run, bike, and swim and for maximizing upper limb function, as determined by the treating provider.
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 No Addition to State’s Essential Health Benefits. The requirements of this act shall not constitute an addition to the state's essential health benefits that requires defrayal of costs by the state pursuant to 42 U.S.C. Section 18031(d)(3)(B).
6 Application. The requirements of this act shall apply to all policies, contracts, and certificates executed, delivered, issued for delivery, continued or renewed in this state on or after the effective date of this section. For the purposes of this act, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
I. The provisions of this act are not intended to conflict with existing provisions of New Hampshire law.
II. To the extent that this act conflicts with other state laws, those laws in conflict are declared null and void.
7 Effective Date. This act shall take effect 60 days after its passage.
23-1041
1/11/23
SB 177-FN- FISCAL NOTE
AS INTRODUCED
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:
The Insurance Department indicates there already exists in New Hampshire law at RSA 415:6-j and RSA 415:8-n a mandate for individual and group accident and health insurance coverage for certain prosthetic devices. In addition, New Hampshire’s Essential Health Benefits requirements, which apply to the individual and small group market, also require some coverage for prosthetic and orthotic devices. The Medicare definition of prosthetic and orthotic devices appears to be broader than the definition of prosthetic devices in RSA 415:6-j and RSA 415:8-n. However, because of the 80% coverage limitation in the Medicare regulations, the Insurance Department is unable to determine whether this new coverage requirement would expand or contract mandated benefits for prosthetics. To the extent this bill would require coverage at a level greater than current plan designs offer, the Department assumes there would be a corresponding and indeterminable increase in claims costs and premiums, and therefore premium tax revenues. To the extent that the coverages required in this bill are applicable to health benefits offered by state, county, and local government entities, this could represent an increase in expenditures. Similarly, to the extent that this bill would require coverage at a level lower than current plan designs offer, the Insurance Department assumes that there would be a corresponding and indeterminable decrease in claims costs and premiums, and therefore premium tax revenues.
This new coverage requirement could be subject to cost defrayal of state-mandated requirements pursuant to 45 CFR §155.170. Under this federal regulation, passage of this bill could be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits (EHB) offered in the Exchange Marketplace. This could be the case even though the specific coverage required is already subsumed under existing categories of EHB coverage. Under this regulation, the state must make payments to defray the cost of the additional required benefits to Qualified Health Plan (QHP) enrollees or to QHP issuers. This would represent a general fund expense which is indeterminable at this time.
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 Serves (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.
It is assumed that any fiscal impact would occur after FY 2023.
AGENCIES CONTACTED:
Insurance Department