HB265: relative to the health care delivery system.

HB 265 - AS AMENDED BY THE HOUSE

15Jan2004... 2430h

2003 SESSION

03-0766

01/09

HOUSE BILL 265

AN ACT relative to the health care delivery system.

SPONSORS: Rep. Hunt, Ches 28; Sen. Flanders, Dist 7

COMMITTEE: Commerce

AMENDED ANALYSIS

This bill establishes a pilot program to allow health benefit plans which offer better alignment of financial incentives with health care quality improvement to apply to the commissioner for a waiver of certain requirements. The pilot program is repealed on July 1, 2007.

This bill is a request of the insurance department.

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

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

15Jan2004... 2430h

03-0766

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

AN ACT relative to the health care delivery system.

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

1 New Chapter; Aligning Health Care Payment Policies With Quality Improvement. Amend RSA by inserting after chapter 420-J the following new chapter:

CHAPTER 420-K

ALIGNING HEALTH CARE PAYMENT POLICIES WITH QUALITY IMPROVEMENT

420-K:1 Purpose of Chapter. The purpose of this chapter is to reduce waste, medical errors, inconsistent care, and misallocation of resources in the state's health care delivery system by instituting a pilot program that encourages health carriers to develop health benefit plans and provider payment policies that promote a better alignment of financial incentives with health care quality improvement and efficiency.

420-K:2 Applicability and Scope of Chapter. This chapter shall apply to all health carriers offering health benefit plans in this state.

420-K:3 Definitions. In this chapter:

I. "Commissioner" means the insurance commissioner.

II. "Consumer" means someone in the general public who may or may not be a covered person or a purchaser of health care including employers.

III. "Covered benefits" or "benefits" means those health care services to which a covered person is entitled under the terms of a health benefit plan.

IV. "Covered person" means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.

V. "Facility" means an institution providing health care services or a health care setting, including but not limited to hospitals, and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.

VI. "Health benefit plan" means a policy, contract, certificate or agreement entered into, offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

VII. "Health care professional" means a physician or other health care practitioner licensed, accredited, or certified to perform specified health services consistent with state law.

VIII. "Health care provider" or "provider" means a health care professional or facility.

IX. "Health care services" or "health services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease.

X. "Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.

XI. "Purchaser" means the purchaser of a health benefit plan and may include employers, employees or other persons.

XII. "Quality improvement" means the effort to improve the processes and outcomes related to the provision of health care services.

420-K:4 Eligibility for Waiver of Statutory or Regulatory Requirements. A health carrier seeking to offer a health benefit plan that will promote a better alignment of financial incentives with health care quality improvement and efficiency shall be eligible, pursuant to RSA 420-K:5, to apply to the commissioner for a waiver or modification of specified statutory or regulatory requirements relating to such health benefit plan. To be eligible for the waiver, the carrier shall demonstrate to the commissioner that the design of the health benefit plan and the provider payment policies associated with the health benefit plan will meet at least 4 of the following standards:

I. Encourages providers to actively manage the care of patients with chronic health conditions or more complicated conditions and to treat such patients in accordance with evidence-based best practice guidelines.

II. Provides an opportunity for providers to share in the benefits of quality improvement and efficiency enhancements.

III. Provides the opportunity and incentive for covered persons and purchasers to recognize cost and quality differences in health care and make their decisions accordingly.

IV. Aligns financial incentives with the implementation of care processes based on evidence-based best practices and the achievement of better patient outcomes.

V. Aligns financial incentives with the implementation of programs for reducing medical errors and improving patient safety that are based on evidence-based best practices.

VI. Enables providers to coordinate care for patients across settings and over time.

VII. Creates financial incentives for providers to make resource allocation decisions based on established practice benchmarks.

420-K:5 Waiver Authority.

I. A health carrier offering or intending to offer a health benefit plan that meets the requirements of RSA 420-K:4 may apply to the commissioner for a waiver or modification of specified statutory or regulatory provisions concerning mandatory coverage requirements or network adequacy standards as they apply to such health benefit plan. The commissioner shall hold a public hearing on the proposed plan and after public hearing may grant such waiver or modification request upon a determination that:

(a) The health benefit plan and associated provider payment policies meet the requirements of RSA 420-K:4;

(b) The waiver or modification is a significant component of, and integral to, the effort to better align financial incentives with health care quality improvement and efficiency; and

(c) The health benefit plan establishes qualitative and quantitative benchmarks for measuring provider performance and the success of the payment mechanism in increasing compliance with evidenced-based practice guidelines.

II. The authority to grant waivers under this section on newly issued policies shall cease on July 1, 2007.

420-K:6 Rulemaking Authority. The commissioner may, in accordance with RSA 541-A, adopt rules as are necessary or proper to implement the waiver provisions of RSA 420-K:5.

2 Repeal. RSA 420-K, relative to aligning health care payment policies with quality improvement, is repealed.

3 Effective Date.

I. Section 2 of this act shall take effect July 1, 2007.

II. The remainder of this act shall take effect 60 days after its passage.