Revision: April 24, 2023, 9:25 a.m.
SB 235-FN - AS AMENDED BY THE SENATE
03/16/2023 0849s
2023 SESSION
23-0953
04/08
SENATE BILL 235-FN
AN ACT relative to services provided through a primary care behavioral health model.
SPONSORS: Sen. Chandley, Dist 11; Sen. Watters, Dist 4; Sen. Fenton, Dist 10; Sen. Rosenwald, Dist 13; Sen. Altschiller, Dist 24; Sen. Prentiss, Dist 5; Rep. Burroughs, Carr. 2
COMMITTEE: Health and Human Services
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ANALYSIS
This bill prohibits an insurer providing a health plan in this state to mental health and substance use disorder benefits from denying coverage on the sole basis that services are delivered through a primary care behavioral health model.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/16/2023 0849s 23-0953
04/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to services provided through a primary care behavioral health model.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Findings. The general court finds that:
I. New Hampshire is experiencing a significant lack of mental health service which is impacting New Hampshire’s population.
II. According to the National Alliance on Mental Illness (NAMI-NH) 2021 report, Nearly 38 percent of New Hampshire adults report increases in symptoms of anxiety and depression. Nearly 15,000 New Hampshire teens experience depression.
III. Nearly 57 percent of New Hampshire children and 17 percent of adults are unable to find mental health care. In addition, more than 50,000 New Hampshire residents reported thoughts of suicide during 2020 and 279 New Hampshire residents committed suicide.
IV. According to the New Hampshire Psychological Association (NHPA) 2021 mental health practice survey, 65 percent of respondents indicate they almost always have difficulty finding providers for mental health services and 31 percent of respondents report their waitlist runs 2 or more months.
V. This act is in furtherance of addressing New Hampshire’s significant work force issues in behavioral health treatment and providing effective interventions as the state educates the large number of new professionals needed to provide a robust behavioral health workforce.
2 New Chapter; New Hampshire Primary Care Behavioral Health Act. Amend RSA by inserting after chapter 415-J the following new chapter:
CHAPTER 415-K
NEW HAMPSHIRE PRIMARY CARE BEHAVIORAL HEALTH ACT
415-K:1 New Hampshire Primary Care Behavioral Health Act. This chapter shall be known and may be cited as the New Hampshire primary care behavioral health act.
415-K:2 Definitions. In this chapter:
I. "Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, those contracts executed by the state of New Hampshire on behalf of state employees under RSA 21-I, by an insurer.
II. "Insurer" means an accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, health care corporation, health maintenance organization, preferred provider organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.
III. Primary care behavioral health model” (PCBH) means an evidence-based, integrated behavioral health care service delivery model delivered in primary or specialty care settings that recognizes licensed psychologists as consultants as well as direct service providers.
415-K:3 Coverage for Primary Care Behavioral Health Services.
I. An insurer providing a health plan in this state that provides mental health and substance use disorder benefits shall not deny coverage on the sole basis that services are delivered through primary care behavioral health models.
II. Primary care behavioral health shall involve expert consultation by a psychologist to assist a physician with the assessment of client needs relative to behavioral health. This shall include coordination of care, consultation with a physician and the use of outcomes measures, within the expertise of the psychologist. Appropriate CPT codes shall be added to psychologist contracts and outpatient licensed mental health providers working with the team to permit billing of PCBH services as covered in this section.
III. Nothing in this section shall be construed to prohibit an insurer from providing coverage for only those services that are medically necessary and subject to the terms and conditions of the covered person’s policy, provided that such medical necessity determinations are in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343), and that such determinations are made in accordance with the utilization review requirements found in RSA 420-E.
IV. When care is provided through a PCBH model, a health plan shall not impose more than one co-pay per day for individuals obtaining multiple related services.
3 New Subparagraph; Accident and Health Insurance; Coverage for Mental and Nervous Conditions and Treatment for Chemical Dependency Required. Amend RSA 415:18-a, III by inserting after subparagraph (d) the following new subparagraph:
(e) Benefits arising from consultation, coordination of care, diagnosis and the development of outcome measures for outpatient services under this paragraph, performed by psychologists as defined in this chapter, shall be subject to terms and conditions at least as favorable as those which apply to the benefits for the treatment provided by psychiatrists.
4 Application. Nothing in this act shall mandate that primary care physicians follow the primary care behavioral health model. The act shall only mandate insurance coverage of such care if a primary care provider were to choose to use the model.
5 Effective Date. This act shall take effect 60 days after its passage.
23-0953
Amended 4/21/23
SB 235-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2023-0849s)
AN ACT relative to services provided through a primary care behavioral health model.
FISCAL IMPACT: [ X ] State [ ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
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 - Insurance Premium Tax revenue | |||
METHODOLOGY:
This bill requires health insurers that provide mental health and substance abuse benefits to provide coverage for such benefits even when the services are provided through an entity that is organized according to a primary care behavioral health (PCBH) model. The bill requires health insurers to build into their contracts with PCB-model clinics the ability for the clinics to bill for specialized procedure codes for such services as "collaborative care," "medical consultation," and "medical team conferences." The Insurance Department states that to the extent these codes are not already included in provider contracts, the bill may increase claims costs, resulting in a corresponding increase in insurance premium tax revenue to the State. Alternatively, to the extent that this care model constitutes a more efficient delivery system, it may lower claims costs and, in turn, lower insurance premium tax revenue to the State. The Department states that it would need to conduct an external actuarial review in order to more precisely project the impacts on claims and state revenues.
The Department of Administrative Services states that the impact on the state's Retiree and Health Benefit Plan (HBP) is unclear, but notes that the bill requires that only one copayment per day be charged to members for multiple services, which would result in a cost shift to the State. The Department further notes that HBP benefits are collectively bargained.
The Department of Health and Human Services expects the bill will have no fiscal impact on the Department.
AGENCIES CONTACTED:
Departments of Insurance, Administrative Services, and Health and Human Services