hb 1428

CHAPTER 251

HB 1428-FN – FINAL VERSION

AN ACT relative to the administration of the medical assistance program for home care for children with severe disabilities; establishing a commission to review the medical assistance program for home care for children with severe disabilities; and relative to the use of standardized health statements and renewals of certain insurance policies.

SPONSORS: Rep. Burling, Sull 19; Rep. Whalley, Belk 31; Rep. M. Smith, Straf 72; Rep. Wallner, Merr 40; Sen. Larsen, Dist 15; Sen. D’Allesandro, Dist 20

I. Establishes a position in the department of health and human services to assist recipients of home care for children with severe disabilities in obtaining reimbursement or payment from private insurers whenever possible, and appropriates $1 in each year of the biennium to fund the position.

II. Establishes program eligibility criteria for home care for children with severe disabilities and authorizes the department to loan specialized equipment to program participants.

III. Directs the department to adopt the expired rules regulating home care for children with severe disabilities as interim rules and provides that such rules shall remain in effect until July 1, 2005.

V. Expands the definition of health carrier for purposes of disclosing insurance information to the department of health and human services for medicaid reimbursement.

VI. Permits the department to seek reimbursement or payment from a health carrier for a medical assistance recipient if the claim is made within 5 years of the service.

VII. Prohibits a reduction in the appropriation to the home care program for children with severe disabilities for the biennium ending June 30, 2005.

VIII. Clarifies when standardized health statements are to be used for medical underwriting.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

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

251:1 Statement of Purpose. The general court recognizes the state’s obligation to assist in the provision of services to children with severe disabilities and their families. The general court hereby declares that, under federal law, medicaid is the obligor of last resort for services in this state to children with severe disabilities, but that every effort should be made by the state to ensure payment or reimbursement for such services by liable third party insurers. Therefore, the state must dedicate appropriate resources to ensure that liable third party insurers fulfill their obligation to families with children with severe disabilities without delaying the provision of services in order to avoid increased medical expenses which may become the responsibility of the state.

251:2 New Section; Public Assistance to the Blind, Aged, or Disabled Persons, and to Dependent Children; Home Care for Children With Severe Disabilities. Amend RSA 167 by inserting after section 3-d the following new section:

I. If a child is enrolled in the medical assistance program that provides home care for children with severe disabilities, the commissioner shall assist the child’s parent or guardian to recover costs for medical care and services under any private health insurance available to the child.

II. The department of health and human services may acquire adaptive equipment and other specialized home health care assets for the purpose of loaning such equipment to participants in the medical assistance program that provides home care for children with severe disabilities. The department shall have authority to contract for the refurbishment of such equipment, to reissue equipment returned to the department, and to dispose of any equipment that is no longer useful.

III. To be eligible for home care for children with severe disabilities, a child shall, at a minimum, have an impairment or combination of impairments that meets, medically equals, or functionally equals the criteria for an impairment as listed in 20 CFR, Part 404, Subpart P, App. 1.

IV. A child who has been determined to meet the requirements of institutional level of care shall receive services to the extent the estimated cost of care outside an institution is no higher than the estimated medicaid cost of appropriate institutional care.

251:3 Position Established; Funding. The department of health and human services shall establish a position of “program specialist III” to assist parents and guardians of children enrolled in the medical assistance program that provides home care for children with severe disabilities in recovering the costs of services from private health insurers. The commissioner of health and human services shall pursue all sources of funding, including the medicaid program, for the position of program specialist. In addition, the sum of $1 for the fiscal year ending June 30, 2004 and the sum of $1 for the fiscal year ending June 30, 2005 are hereby appropriated to the department of health and human services for the purpose of funding the program specialist position. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

251:4 Administrative Rules. The commissioner of health and human services shall adopt as interim rules under RSA 541-A the expired rules regulating home care for children with severe disabilities in He-W 508. The interim rules shall not contain changes, other than minor editorial changes, from the text of the expired rules. Notwithstanding any provision of RSA 541-A to the contrary, the interim rules adopted pursuant to this section shall not expire and shall not be amended by the commissioner until July 1, 2005.

251:5 Commission Established. There is established a commission to study the medical assistance program that provides home care for children with severe disabilities.

(a) Two members of the house of representatives, appointed by the speaker of the house of representatives.

(d) One representative of the Parent Information Center, appointed by that organization.

(e) One representative of a family participating in the medical assistance program for home care for children with severe disabilities appointed by the Council for Children and Adolescents with Chronic Health Conditions.

(f) One representative of The New Hampshire Pediatric Society, appointed by that organization.

(g) One service provider, appointed by the speaker of the house of representatives.

(h) Four public members, 2 of whom shall be appointed by the speaker of the house of representatives and 2 of whom shall be appointed by the senate president.

II. Legislative members of the commission shall receive mileage at the legislative rate when attending to the duties of the commission.

III. The commission shall review the current medical assistance program that provides home care for children with disabilities, including program eligibility criteria, service configurations, and the role of private health insurers in providing home care for children with severe disabilities. The commission shall also consider the effect of any proposed changes in the program on families, public schools, and public institutions.

IV. The members of the study commission shall elect a chairperson from among the members. The first meeting of the commission shall be called by the first-named house member. The first meeting of the commission shall be held within 45 days of the effective date of this section. Six members of the commission shall constitute a quorum.

V. The commission shall report its findings and any recommendations for proposed legislation to the speaker of the house of representatives, the president of the senate, the house clerk, the senate clerk, the governor, and the state library on or before November 1, 2004.

251:6 Health Carrier Disclosure of Third Party Liability. Amend RSA 167:4-b to read as follows:

I. In this section, “health carrier” means a health carrier as defined in RSA 420-G:2 and any entity that is a pharmacy benefit manager, third party administrator of health benefits, provider of health benefits under an ERISA plan, or provider of health benefits under a self-administered plan. Each health carrier[~~, as defined in RSA 420-G:2,~~] shall electronically cross-match claims data, policyholder, and subscriber information with the department of health and human services to provide health insurance coverage information, for third party liability purposes, regarding medical assistance recipients and applicants for medical assistance under RSA 167 in accordance with rules adopted by the commissioner of health and human services pursuant to RSA 167:3-c.

II. Such electronic cross-match shall be made by any health carrier upon certification by the department of health and human services that all persons identified on the electronic medium are applicants for or recipients of medical assistance for which the department seeks payment or reimbursement through third party liability. A health carrier shall limit the transfer of electronic cross-match information required under this section to a list of medical assistance recipients and applicants for medical assistance under RSA 167 provided to the health carrier by the department of health and human services.

III. Any health carrier who supplies information in accordance with this section and with rules adopted under RSA 167:3-c shall have immunity from any civil or criminal liability that might otherwise be imposed or incurred.

IV. Each health carrier shall provide to the department of health and human services upon request such information in the health carrier’s possession as the department determines necessary to assist in identifying third party liability for payments made by the state for services to medical assistance recipients.

251:7 New Paragraph; Financial Disclosure by Applicants and Recipients; Liability and Reimbursement by Health Carriers. Amend RSA 167:4-a by inserting after paragraph III the following new paragraph:

IV. Each health carrier, as defined in RSA 167:4-b, I, against which the department of health and human services seeks payment or reimbursement through third party liability for services provided to medical assistance recipients shall be liable for such payment or reimbursement, provided that the claim for payment or reimbursement by the department is made within 5 years following the date of service.

251:8 Public Assistance; Department of Health and Human Services Rulemaking; Age Limit for Medical Assistance Program Eligibility. Amend RSA 167:3-c, VI to read as follows:

VI. Establishing an optional state coverage group under RSA 167:6, VII to provide medical assistance for children under the age of [18] 19 years who are severely disabled.

251:9 Department of Health and Human Services; General Fund Appropriation Reduction. Notwithstanding the general fund appropriation reduction requirement in 2003, 318:9, II, and any action taken by the fiscal committee of the general court pursuant thereto, the department of health and human services shall not reduce the appropriation to the medical assistance program for home care for children with severe disabilities for the biennium ending June 30, 2005.

251:10 Medical Underwriting; Standardized Health Statements. Amend RSA 420-G:5, I to read as follows:

I. Health carriers providing health coverage for individuals or small employer groups may perform medical underwriting, including the use of health statements or screenings or the use of prior claims history, to the extent necessary to establish or modify premium rates as provided in RSA 420-G:4. [~~Such underwriting shall be limited to the use of a standardized health statement for use in adjustments to rating pursuant to RSA 420-G:4.~~] The commissioner [~~shall, by rule, require~~] may allow group carriers to use standardized health statements.

251:11 New Paragraph; Medical Underwriting; Standardized Health Statements. Amend RSA 420-G:5 by inserting after paragraph VI the following new paragraph:

VII. Health carriers and health insurance producers shall ensure that persons seeking coverage through a small employer group who are required to complete a health statement have an option to convey the required information directly to the carrier or the producer through a secure means and bypassing the employer.

251:12 Duplicate Amendment. Sections 12 and 13 of SB 371 from the 2004 legislative session shall not take effect.