Senate Health and Human Services Committee
Sophie Walsh 271-3469
HB 732-FN, to enhance informed consent and accountability in psychotropic drug prescriptions for children under Medicaid.
Hearing Date: April 2, 2025
Time Opened: 11:41 a.m. Time Closed: 12:08 p.m.
Members of the Committee Present: Senators Rochefort, Birdsell, Prentiss and Long
Members of the Committee Absent: Senator Avard
Bill Analysis: This bill requires medical care providers to review FDA medication guides with the parent, guardian, or state-designated caregiver before prescribing a psychotropic drug for a minor under Medicaid.
Sponsors:
Rep. Cordelli | Rep. Layon | Rep. M. Pearson |
Rep. Mazur | Sen. Gannon | Sen. Sullivan |
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Who supports the bill: Rep. Glenn Cordelli, Sen. Gannon, Sen. Sullivan, Linda Cyr, Cindy Kudlik, Linda Allard, Deborah Lussier, Cheryl Hinckley, Vivian Johnson, Becki Lynn, Carrie Navaroli, Julie Le Doux, Paul Connolly, John Rider, Diane Rider, Debra Beland, Jane Cheeseman, Nancy Greenwood, Renee Werner, Mary Jarry, and Daniel Richardson.
Who opposes the bill: Rep. Janet Lucas, Cathy Stratton (NH Medical Society), Nancy Husarik, Megan Carey, Gillian Sowden (NH Psychiatric Society), Mary Brunette, Lyn Lindpaintner, William Copeland Jr., Stephanie Osborne, Lisa Day-Copeland, Sheila Donahue, Carol Lenahan, Renee Plourde, Jane Smith, and Patrick Miller.
Who is neutral on the bill: Dr. Jonathan Ballard (DHHS), David Chorney (DHHS), and Rob Berry (DHHS).
Summary of testimony presented:
Representative Glenn Cordelli, Carroll – District 7
- Representative Cordelli explained that this is a simple bill requiring that the U.S. Food and Drug Administration (FDA) medication guides be provided to parents when their child receives a psychotropic prescription under Medicaid and that informed consent be obtained to ensure awareness of potential risks and benefits.
- This bill is specific to Medicaid because it is partially state-funded.
- He emphasized that parents should be aware of the risks and benefits associated with the psychotropic drugs prescribed to their minor children.
- This bill defines psychotropic drugs as a drug prescribed by a licensed medical practitioner to treat illnesses that affect psychological functioning, perception, behavior, and mood.
- Representative Cordelli explained that the bill’s effective date will give time for awareness and implementation of necessary guidelines, which are accessible through the FDA online.
- Senator Prentiss referenced lines 25 and 26 of the bill and asked if parents of minors are not being properly consented before medical treatment and prescription. She noted that it is standard medical practice to obtain consent unless someone is unconscious.
- Representative Cordelli explained that he does not have firsthand examples of this occurring, but this aims to ensure that parents are fully informed of potential risks and benefits their child may experience while taking a medication.
- He noted that a human rights organization initially came to him with this proposal.
- Senator Long asked if adding this requirement would impose additional costs. He noted that the guidelines would have to be physically printed and reviewed by physicians with parents.
- Representative Cordelli said he does not believe there would be an additional cost, as the guidelines are available for free on the FDA website.
- Senator Long referenced his own experience in a similar scenario when his son was diagnosed with ADHD and was prescribed medication. He noted that at the time, he may not have been interested in reviewing that information with the physician. He confirmed that a medication cannot be prescribed if the parent chooses not to review the information.
- Representative Cordelli confirmed.
- Senator Birdsell noted that the Department of Health and Human Services (DHHS) estimates the bill’s costs to be $1-2.5 million, primarily due to potential investigations and provider disenrollment for those who choose not to take Medicaid patients because of these requirements. She asked for Representative Cordelli’s thoughts.
- Representative Cordelli said he believes the estimate may be overstated.
- Senator Rochefort noted that the FDA medication guides distributed to the Committee are very similar to what pharmacies distribute when they dispense medications. He asked if there is concern about people not getting this information when the medication is dispensed or if the intent is to focus on the informed consent aspect.
- Representative Cordelli said the goal is to ensure informed consent at the time of prescribing.
- Senator Rochefort asked if the Medical Society has weighed in on this bill, and Representative Cordelli said nothing came up during the House hearing.
Rob Berry, David Chorney, and Jonathan Ballard, MD, Department of Health and Human Services
- Dr. Ballard stated that DHHS is not taking a position on this bill.
- Medicaid covers approximately one in four children in New Hampshire.
- This bill imposes additional requirements on medical providers specifically for patients who are children on Medicaid.
- This is different from anything done before in New Hampshire for the Medicaid program, as the treatment of Medicaid beneficiaries has been approached as agnostic to payer.
- Dr. Ballard stated that psychotropic drugs are prescribed for psychiatric diagnoses that have medical indications. There is a consent-to-treat document required by the Medicaid program, all insurers, and Centers for Medicare & Medicaid Services (CMS) to providers that patients must consent to treat. If the patient is a minor, it would be a parent or guardian.
- Senator Rochefort confirmed that while consent-to-treat is more of a blanket consent that is usually administered when care is initiated, this bill requires consent each time a prescription is written. Dr. Ballard confirmed.
- Senator Rochefort noted that if a consent-to-treat is signed years before a prescription is written, a lot could have changed in that time.
- Dr. Ballard clarified that the consent-to-treat is signed annually. He noted that standard medical practice requires risk-benefit discussions between providers and patients each time a medication is prescribed.
- Dr. Ballard explained that the bill’s definition of psychotropic medication is broader than the standard medical definition and could potentially encompass any medications that could affect mood, such as allergy or gastrointestinal medications.
- Dr. Ballard noted that providers may not have access to payer information at the time of prescribing.
- Dr. Ballard explained that there are patients who receive retrospective coverage through Medicaid. Thus, there is an issue of whether the statute applies to the payer at the moment of prescription or the payer determined later on as responsible for coverage.
- Dr. Ballard noted that the bill does not provide any description of setting, which could delay urgent medication administration in emergencies or psychiatric crises.
- Dr. Ballard noted that the bill includes medically inaccurate references regarding ADHD treatment, as not all the listed psychotropic medications are used for ADHD.
- Mr. Chorney explained that two main cost factors were considered for the fiscal note: the resources needed to oversee the bill’s implementation and the potential increased medical costs due to reduced access to care, as some providers may choose to not treat Medicaid patients under these new requirements.
- Delays in prescribing medically necessary medications due to enhanced consent requirements in emergency situation could result in higher, more costly settings of care being needed.
- Enforcing this would require manual chart reviews and claims auditing to verify parental consent compliance, increasing administrative costs.
- Mr. Berry explained that any action taken against a Medicaid provider requires detailed written documentation, formal notification, and an appeals process. This makes enforcement complex and time consuming.
- Mr. Berry noted that the bill lacks clarity on when provider suspensions would be lifted, if at all, and whether new rulemaking would be required.
- Mr. Berry suggested that explicit rulemaking authority be incorporated into the legislation to clarify enforcement mechanisms.
Cathy Stratton, New Hampshire Medical Society
- Ms. Stratton explained that the New Hampshire Medical Society has not previously weighed in on this bill due to recent transitions, but they are in opposition to it.
- Physicians have expressed concerns about using FDA medication guides as the standard for informed consent because they are lengthy and complex.
- Informed consent discussions already occur in standard medical practice. They allow for a tailored, personalized conversation.
- This also introduces an administrative burden on providers. Furthermore, there is no accessibility accommodations provided for those who may need them.
- Ms. Stratton expressed concern about legislating penalties, as physicians do their best to comply with all laws. There are concerns about the ethical and logistical challenges associated with legislating penalties against providers.
- This bill creates a separate standard for Medicaid and non-Medicaid patients, requiring providers to track insurance status before prescribing. Ms. Stratton noted this is not standard practice in their roles.
SW
Date Hearing Report completed: April 8, 2025