HB 0301

AN ACT requiring that the department of corrections be charged the lowest rate for inmates who need medical services within the community.

SPONSORS: Rep. C. Bouchard, Merr 22; Rep. Francoeur, Rock 22; Rep. E. Smith, Ches 6; Sen. Larsen, Dist 15; Sen. Gordon, Dist 2

This bill requires that the department of corrections be charged the lowest rate for inmates who need medical services within the community.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

AN ACT requiring that the department of corrections be charged the lowest rate for inmates who need medical services within the community.

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

1 New Paragraphs; Reimbursement Rate for Medical Care for Inmates Incarcerated in the State Prison System Established. Amend RSA 623:1 by inserting after paragraph II the following new paragraphs:

IV.(a) Notwithstanding any provision of law to the contrary, and notwithstanding any fee, rate, or payment schedule established under the medical assistance program pursuant to RSA 161 and RSA 167 or any other fee, rate, or payment schedule for any other program, no provider of health care services to the department shall bill or charge the department more than the provider's usual and customary charge, as defined in this paragraph.

(b) Except as specified in subparagraph (c), the term "usual and customary" means the lowest charge, fee, or rate charged by a provider for any product or service at the time such product or service was provided. For the purpose of determining the lowest charge, fee, or rate:

(1) If the provider offers discounts or rebates, then the amount after applying discounts or rebates shall be utilized;

(2) If the provider offers a sale for a limited period of time on any goods or service, then the sale price shall be utilized during the sale period;

(3) If the provider regularly accepts less than its full charge from any customer, then the amount accepted shall be utilized;

(4) If any good or service is offered free of charge by the provider, then no charge shall be made to the department for the provision of the product or service to the department or a client of the department who satisfies the terms of the offer;

(5) If any good or service is covered under any warranty or guarantee offered by the provider, then the amount charged to the department shall not exceed the amount which would otherwise be payable solely by the customer; and

(6) If a provider structures or packages its goods or services in a manner which is exclusively or primarily used for medicaid, medicare, or other third-party payors, then the charge for the most similar good or service offered to any other consumer shall be utilized.

(1) Discounts offered solely to bona fide employees or family members of employees;

(2) Discounts offered solely on the basis of age shall be utilized in determining the usual and customary charge only when the client of the department satisfies the age requirement;

(3) Free goods or services or discounts provided to a limited number of persons on the basis of financial hardship;

(4) Charges by an organization on a sliding fee scale for a good or service where the organization's charge is based on ability to pay;

(5) Charges not collected as a result of bad debts incurred by the provider. A bad debt exists where sound business judgment indicates that there is no reasonable likelihood of recovery of the amount owed; and

(d) The commissioner may waive the application of this paragraph if the commissioner determines such action is necessary to ensure a continuum of care to avert serious economic hardships to the health care provider.

V. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the department of corrections, including the medicaid program, unless the prescribing practitioner specifies that the brand name drug product is medically necessary. Such notification shall be in the practitioner's own handwriting and shall be retained in the pharmacist's file. The commissioner may waive the application of paragraph IV if the commissioner determines such action is necessary to ensure the availability of prescription and other pharmaceutical services to persons served by the department or to avert serious economic hardship in the provision of prescriptions and other pharmaceutical services. The commissioner shall adopt rules, under RSA 541-A, relative to a waiver of the application. The commissioner, in consultation with pharmacy providers, may develop a new methodology for medical assistance reimbursement for legend and non-legend drugs.

AN ACT requiring that the department of corrections be charged the lowest rate for inmates who need medical services within the community.

The Department of Corrections has determined this bill will decrease state expenditures by $1,200,000 in FY 2002 and each year thereafter. There will be no fiscal impact on county and local expenditures or state, county and local revenues.

The Department stated that outside medical services for FY 2000 and FY 2001 averaged approximately $3,000,000 per year. The Department assumed the first year of impact would be FY 2002 and that the lowest rate for medical services within the community will be approximately 40% less than what the Department is currently paying. A 40% savings would result in decreased state expenditures of approximately $1,200,000 per year.