Revision: Jan. 26, 2024, 1:42 p.m.
SB 177-FN - AS AMENDED BY THE SENATE
01/03/2024 2418s
2023 SESSION
23-1041
05/04
SENATE BILL 177-FN
AN ACT relative to health insurance coverage of prosthetics for children under 19 years of age.
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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AMENDED ANALYSIS
This bill requires group insurance policies, health service corporations, and health maintenance organizations to provide insurance coverage for prosthetic devices, including activity-specific devices, for children under 19 years of age.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
01/03/2024 2418s 23-1041
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to health insurance coverage of prosthetics for children under 19 years of age.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Accident and Health Insurance; Coverage for Prosthetic Devices; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Prosthetic 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 devices, including activity-specific prosthetic devices, for children under 19 years of age, who are residents of this state and covered by such insurance. The insurer may limit coverage for activity-specific prosthetic devices to one activity-specific prosthetic device per plan year. Medically necessary prosthetic devices shall not be subject to any annual limits. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply.
I. Covered benefits shall include:
(a) All materials and components necessary to use the device;
(b) Instruction to the enrollee on using the device; and
(c) The repair or replacement of a prosthetic device that is determined medically necessary or is necessary for maximizing the enrollee’s ability to engage in the specific activity.
II. In this section:
(a) “Prosthetic” means an artificial substitute for a body part for functional or therapeutic purposes.
(b) “Activity-specific prosthetic device” means a prosthetic device designed to allow an individual to participate in a specific activity that could damage the residual limb or everyday prosthesis, or when the everyday prosthesis would not function effectively to perform that specified activity.
III. This section shall not apply to plans available through the Small Business Health Options Program (SHOP).
2 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 415:18, 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.
3 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 415:18, 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.
4 Effective Date. This act shall take effect January 1, 2025.
23-1041
Amended 1/26/24
SB 177-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2023-2418s)
AN ACT relative to health insurance coverage of prosthetics for children under 19 years of age.
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 | Indeterminable Increase | Indeterminable Increase | ||
Revenue Fund(s) | General Fund
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Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Funding Source(s) | General Fund Various Government Funds | |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• Does this bill provide sufficient funding to cover estimated expenditures? [X] No • 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 | Indeterminable Increase | Indeterminable Increase | ||
Local Revenue | $0 | $0 | $0 | $0 | ||
Local Expenditures | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
METHODOLOGY:
This bill requires group insurance policies, health service corporations, and health maintenance organizations to provide insurance coverage for prosthetic devices, including activity-specific devices, for children under 19 years of age.
The Insurance Department assumes this bill would result in an increase in claims costs related to activity-specific prosthetic devices. The Department commissioned a mandate benefit review based on the bill as introduced which indicated a cost range from $0.07 Per Member Per Month (PMPM) to $0.21 PMPM and estimated the cost for an activity-specific prosthetic leg to be approximately $25,000 per user per year. The bill, as amended, would apply to large group products, limits the benefit to one activity-specific device per plan year, and provides that the device must be medically necessary. As a result, and without commissioning the cost of a revised benefit review and report, the Department believes these changes to the bill as amended are significant enough to drive the estimated cost above towards the lower end of the PMPM range. The estimated cost for one activity specific prosthetic leg of $25,000 remains the same. 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.
AGENCIES CONTACTED:
Insurance Department