HB1202: relative to third-party payment of covered services ordered by the juvenile court.

CHAPTER 117

HB 1202 – FINAL VERSION

17Mar2004… 0703h

04/22/04 1181s

2004 SESSION

03-2185

05/09

HOUSE BILL 1202

AN ACT relative to third-party payment of covered services ordered by the juvenile court.

SPONSORS: Rep. Bickford, Straf 68; Rep. McRae, Hills 48; Sen. O’Hearn, Dist 12

COMMITTEE: Commerce

AMENDED ANALYSIS

This bill provides that an insurance provider shall not consider the existence of a court order under RSA 169-B, 169-C, and 169-D for a covered service, placement, or program in determining qualification for third-party payment for the service, placement, or program, provided that the claimant meets certain criteria established by the insurance provider.

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

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

17Mar2004… 0703h

04/22/04 1181s

03-2185

05/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Four

AN ACT relative to third-party payment of covered services ordered by the juvenile court.

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

117:1 New Section; Accident and Health Insurance; Third-Party Payment of Covered, Court-Ordered Services. Amend RSA 415 by inserting after section 18-o the following new section:

415:18-p Third-Party Payment of Covered, Court-Ordered Services. The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:

I. The insurer’s receipt of the specified additional information; or

II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.

117:2 New Section; Health Service Corporations; Third-Party Payment of Covered, Court-Ordered Services. Amend RSA 420-A by inserting after section 15 the following new section:

420-A:15-a Third-Party Payment of Covered, Court-Ordered Services. The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:

I. The insurer’s receipt of the specified additional information; or

II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.

117:3 New Section; Health Maintenance Organizations; Third-Party Payment of Covered, Court-Ordered Services. Amend RSA 420-B by inserting after section 8-n the following new section:

420-B:8-o Third-Party Payment of Covered, Court-Ordered Services. The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:

I. The insurer’s receipt of the specified additional information; or

II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.

117:4 New Section; Managed Care Law. Amend RSA 420-J by inserting after section 6-b the following new section:

420-J:6-c Third-Party Payment of Covered, Court-Ordered Services. The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:

I. The insurer’s receipt of the specified additional information; or

II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.

117:5 Effective Date. This act shall take effect 90 days after its passage.

(Approved: May 17, 2004)

(Effective Date: August 15, 2004)