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1 New Subparagraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8, VIII by inserting after subparagraph (f) the following new subparagraph:
(g)(1) A health carrier shall provide a participating provider or facility with 60 days notice of a proposed change to a contract, including any attachment, exhibit, and provider manual, only 4 times per calendar year effective on January 1, April 1, July 1, and October 1, except that at any time:
(A) The carrier and the participating provider or facility may mutually agree to waive the 60 day notice requirement;
(B) A carrier may file a notice of a proposed change in response to a requirement of the state or federal government; or
(C) A carrier may file a notice of a proposed change due to a change in current procedural terminology codes used by the American Medical Association.
(2) As part of the notice requirement under this subparagraph, a health carrier shall provide to the participating provider or facility, printed or electronically, a copy of the contract, including any attachment, exhibit, and provider manual, without the changes and a copy of the revised contract, attachment, exhibit, and/or provider manual with changes indicated by underlining and bolding added language and by visually striking through deleted language.
(3) If the change to a contract, attachment, exhibit, or provider manual results in an aggregate change in provider reimbursement of more than $500,000 per calendar year across all participating providers or facilities in the state with whom the carrier has a provider contract, the carrier shall submit to each participating provider or facility a good faith estimate of the total annual aggregate financial impact of the changes to their contract. The estimate and an explanation for all financial impacts as a result of the change under this subparagraph shall be submitted annually to the commissioner of insurance to be published annually on the insurance department's official website or be made publicly available upon request of the department.
2 Effective Date. This act shall take effect 60 days after its passage.
Text to be added highlighted in green.
1 New Subparagraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8, VIII by inserting after subparagraph (f) the following new subparagraph:
(g)(1) A health carrier shall provide a participating provider or facility with 60 days notice of a proposed change to a contract, including any attachment, exhibit, and provider manual, only 4 times per calendar year effective on January 1, April 1, July 1, and October 1, except that at any time:
(A) The carrier and the participating provider or facility may mutually agree to waive the 60 day notice requirement;
(B) A carrier may file a notice of a proposed change in response to a requirement of the state or federal government; or
(C) A carrier may file a notice of a proposed change due to a change in current procedural terminology codes used by the American Medical Association.
(2) As part of the notice requirement under this subparagraph, a health carrier shall provide to the participating provider or facility, printed or electronically, a copy of the contract, including any attachment, exhibit, and provider manual, without the changes and a copy of the revised contract, attachment, exhibit, and/or provider manual with changes indicated by underlining and bolding added language and by visually striking through deleted language.
(3) If the change to a contract, attachment, exhibit, or provider manual results in an aggregate change in provider reimbursement of more than $500,000 per calendar year across all participating providers or facilities in the state with whom the carrier has a provider contract, the carrier shall submit to each participating provider or facility a good faith estimate of the total annual aggregate financial impact of the changes to their contract. The estimate and an explanation for all financial impacts as a result of the change under this subparagraph shall be submitted annually to the commissioner of insurance to be published annually on the insurance department's official website or be made publicly available upon request of the department.
2 Effective Date. This act shall take effect 60 days after its passage.