SB320: relative to health care provider contract standards.

SB 320 - AS INTRODUCED

2022 SESSION

22-3051

11/10

SENATE BILL 320

AN ACT relative to health care provider contract standards.

SPONSORS: Sen. Soucy, Dist 18; Sen. Whitley, Dist 15; Sen. Watters, Dist 4; Sen. Cavanaugh, Dist 16; Sen. Rosenwald, Dist 13; Sen. Prentiss, Dist 5; Sen. Sherman, Dist 24; Sen. Bradley, Dist 3; Sen. Perkins Kwoka, Dist 21; Sen. Gannon, Dist 23; Sen. Hennessey, Dist 1; Sen. Kahn, Dist 10; Sen. D'Allesandro, Dist 20; Sen. Gray, Dist 6; Rep. Knirk, Carr. 3; Rep. Marsh, Carr. 8; Rep. Weston, Graf. 8; Rep. Bartlett, Merr. 19

COMMITTEE: Health and Human Services

ANALYSIS

This bill modifies provider contract standards for purposes of the managed care law.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

22-3051

11/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty Two

AN ACT relative to health care provider contract standards.

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

1 New Paragraph; Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8 by inserting after paragraph XVII the following new paragraph:

XVIII.(a) Each health care provider contract with a health carrier shall refer to the provider manual only as an administrative tool and use such provider manual only for administrative purposes. The provider manual shall not contain, nor shall it be used to effectuate changes that conflict with, health benefit plan member certificates that impact consumer health care coverage or the economic arrangement between a health care provider and health carrier. Further, a health carrier is prohibited from engaging in any practice, either through notice to consumers or health care providers or by amending a provider manual, which results in any of the following:

(1) Disruption of coverage or site of care chosen by the policy holder for health care services during a health benefit plan year; or

(2) Uniliteral changes to the terms, including economic terms, of a health care provider contract for health care services contemplated pursuant to a current agreement for which a payment rate has already been established in the health care provider contract.

(b) A health carrier seeking to make such changes must enter into good faith negotiations with the health care provider; provided, however, that such carrier is prohibited from removing a health care provider from its network for covered services already agreed upon in an existing health care provider contract until the termination or renewal of such health care provider contract occurs.

(c) Failure to adhere to the standards of this paragraph shall result in the following, as applicable:

(1) An assessment of damages to either the policy holder or to the health care provider;

(2) Policy holders harmed shall be able to access covered health care services at the highest level of benefit offered under their respective health benefit plan;

(3) Health care providers harmed by a health carriers’ failure to meet the standards outlined in this section shall be entitled to reimbursement for health care services at the rates contemplated in the existing health care provider contract until such contract expires or is terminated in accordance with the termination provisions of such contract and within the constraints of RSA 420-J; and

(4) Any other remedy deemed appropriate by the commissioner.

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