HB471: relative to cost containment practices and establishing an insurance review and advisory board.

HB 471 - AS INTRODUCED

2003 SESSION

03-0751

01/09

HOUSE BILL 471

AN ACT relative to cost containment practices and establishing an insurance review and advisory board.

SPONSORS: Rep. Gilman, Graf 9; Rep. Ingbretson, Graf 13; Rep. Buhlman, Hills 66; Rep. Sorg, Graf. 11; Sen. Martel, Dist 18

COMMITTEE: Commerce

ANALYSIS

This bill authorizes an insurance company to require either the patient or the health care provider to notify it at the onset of care. The insurance company may then indicate any cost limitations that are applicable to the coverage of the care required by the patient.

This bill also establishes a health insurance review board to advise the insurance commissioner on health insurance issues.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03-0751

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

AN ACT relative to cost containment practices and establishing an insurance review and advisory board.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Sections; Insurance; Cost Containment Practices. Amend RSA 400-A by inserting after section 15-a the following new sections:

400-A:15-b Cost Containment Practices. Health insurers may require either the provider or the patient to notify the company at the onset of care. The insurance company shall indicate any cost limitations if applicable to coverage for the required care. Procedures eligible for coverage shall be any of those which are reasonably related to the care of the patient's condition and which the practitioner is licensed to perform. Review procedures for determining reasonable cost containment for particular patients shall in no way impede the practitioner's professionally competent care plan and the patient's right to choose or refuse any such care. Periodic reviews for extended care patients shall be spaced according to reasonable practice expectations of recovery and patient change. For most diagnoses, the review period shall correspond to the average duration of care for each diagnostic grouping as determined by the insurance commissioner. The health insurance review board, established in RSA 400-A:15-c, may consider changes in the spacing of reviews.

400-A:15-c Review Board Established.

I. There is hereby established a health insurance review board to advise the commissioner of insurance relative to health insurance matters and other matters as the commissioner so designates. The board shall provide an annual state of insurance report, beginning on or before December 31, 2005, to the governor and council. The board shall represent 3 parties of interest equally: consumers; providers of care and medicines; and the third party payers. The members of the board shall be as follows:

(a) The insurance commissioner, or designee.

(b) Three representative of health insurers, appointed by the insurance commissioner.

(c) One representative of a government third party payer such as Medicare or medicaid, appointed by the insurance commissioner.

(d) One representative of an Employee Assistance Company, appointed by the insurance commissioner.

(e) Five public members, appointed by the governor and council.

(f) One physician licensed under RSA 329, appointed by the board of medicine.

(g) One licensed mental health practitioner, appointed by the board of mental health practice.

(h) One chiropractor, appointed by the board of chiropractic examiners.

(i) One licensed pharmacist, appointed by the board of pharmacy.

(j) One hospital administrator, appointed by the governor and council.

II. The members appointed under subparagraphs I(b)-(g) shall serve 3-year terms; provided that initially one member under subparagraph I(b), one member under subparagraph I(c), one member under subparagraph I(e), the member under subparagraph I(f), and one member under subparagraph I(i) shall serve for one year; one member under subparagraph I(b), the member under subparagraph I(d), 2 members under subparagraph I(e) and the member under subparagraph I(g) shall serve 2 years; and one member under subparagraph I(b), 2 members under subparagraph I(e), one member under subparagraph I(f), the member under subparagraph I(h), and the member under subparagraph I(j) shall serve 3 years. The insurance commissioner shall serve a term coterminous with the commissioner's term of office.

2 Effective Date. This act shall take effect 60 days after its passage.