HB 647-FN - AS INTRODUCED
1999 SESSION
HOUSE BILL 647-FN
AN ACT relative to health care providers and provider agreements with health insurers.
This bill adds certain requirements to the insurance laws relative to provider agreements.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
99-0680
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord One Thousand Nine Hundred and Ninety-Nine
AN ACT relative to health care providers and provider agreements with health insurers.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Sections; Insurers; Providers. Amend RSA 400-A by inserting after section 15-a the following new sections:
400-A:15-b Insurers; Providers; General Provisions.
I. Notwithstanding any provision of law to the contrary, health insurers, health maintenance organizations and health service corporations shall offer to and accept as providers any provider who is in good standing with the state licensing board whose specialty of practice is within the scope of services covered by the health plan. Health insurers shall not terminate a provider without cause and due process. Any such termination may be appealed to the health insurance review board, then through the courts.
II. Providers may withdraw from insurance rosters at any time. They shall be reinstated voluntarily, if they desire, upon re-application, at the next fiscal year renewal. Insurers shall not include "gag" clauses or exclusivity requirements. Clauses of the provider agreement shall in no way alter or limit the ownership of records, the professional conduct, and communications of the provider.
III. Health insurers which currently use the term "managed care" shall be prohibited from using the term "care" in the description of their own services. Insurers who participate in remote direction of care, without licenses or without seeing the patient in person shall be guilty of practicing medicine without a license or malpractice, respectively.
IV. Insurers may require either provider or patient to notify the company at the onset of care. The insurance company shall indicate any cost limitations if applicable to coverage for that incident/episode. 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 care plan and the patient's right to choose or refuse 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. The members of the board shall be as follows:
(a) The insurance commissioner, or designee.
(b) Five representatives of health insurers, appointed by the insurance commissioner.
(c) Five public consumer members, appointed by the governor and council.
(d) Two physicians licensed under RSA 329, appointed by the board of medicine.
(e) One licensed mental health practitioner, appointed by the board of mental health practice.
(f) A chiropractor, appointed by the board of chiropractic examiners.
(g) One licensed pharmacist, appointed by the board of pharmacy.
II. The members appointed under subparagraphs I(b)-(g) shall serve 3-year terms; provided that initially 2 members under subparagraph I(b), 2 members under subparagraph I(c) and one member under subparagraph I(d) shall serve for one year; 2 members under subparagraph I(b), 2 members under subparagraph I(c), the member under subparagraph I(e) and the member under subparagraph I(g) shall serve 2 years; and one member under subparagraph I(b), one member under subparagraph I(c), one member under subparagraph I(d), and the member under subparagraph I(f) shall serve 3 years. The insurance commissioner shall serve a term coterminous with the commissioner's term of office.
III. The board shall hear appeals under RSA 400-A:15-b, I in accordance with RSA 541-A and consider review procedures under RSA 400-A:15-b, IV, upon petition by the insurance company, or a petition by a minimum of one percent of the providers, or 50 patient signatures. The board shall also generally advise the commissioner of concerns about the administration of health insurance.
2 Effective Date. This act shall take effect 60 days after its passage.
LBAO
99-0680
2/16/99
HB 647-FN - FISCAL NOTE
AN ACT relative to health care providers and provider agreements with health insurers.
FISCAL IMPACT:
The Legislative Budget Assistant has determined that this legislation has a total fiscal impact of less than $10,000 in each of the fiscal years 1999 through 2003.