Proposed Majority Committee Amendment for HB 309 - 1/4/12

Proposed Majority Committee Amendment for HB 309

http://www.gencourt.state.nh.us/legislation/amendments/2011-2815H.html

 

Notes for NH House Session

January 4, 2012

By Kirsten M. Murphy

 

ANALYSIS: The changes proposed to the existing consumer protections for early childhood intervention (the "Early Childhood Mandate") and the treatment of autism ("Connor’s Law") are limited to the addition of a required utilization review. This is a considerable improvement over the original bill, which would have rescinded both laws entirely. There is nothing in NH law that currently prohibits utilization review and carriers already routinely subject benefits under these laws to such review. Representative Hunt, who is the bill’s lead sponsor stated in committee on 10/18/11 that his intent here is to discourage consumers from spending up to the benefit caps without a medical justification for maximizing their benefit; it is the sponsor’s belief that caps, which he termed "evil," cause consumers to spend more than necessary. Note that in the case of Connor’s Law, NH’s mental health parity law already protects consumers from utilization review that is more frequent or burdensome than that placed upon any other medical service for a physical illness.

For these reasons, HB 309,

in its current form, is an acceptable compromise that does not present a barrier to obtaining the coverage that leadership groups are seeking for children with autism and other developmental disabilities.

It is also worth noting that future discussion regarding benefits that exceed minimal federal requirements will take place in the context of debating how NH will interpret the "essential benefits requirement" under the Patient Protection and Affordable Care Act (PPACA). Since HB 309 was amended in November, the federal Department of Health and Human Services has announced that it will grant states greater authority to define their own version of "essential benefits" than was originally contemplated by the PPACA.

For this reason, creation of a committee to review "current New Hampshire insurance mandates" that does not include representation from the public and stakeholder groups is concerning.

PROCEDURALLY, WHAT SHOULD ADVOCATES ANTICIPATE? HB 309 will be heard on the House Floor on

January 4, 2012. The bill will be debated by legislators; members of the public can watch the session from the gallery but will not be permitted to speak. Because of the complexity of the bill, amendment on the floor is a strong possibility.

 

ACTION STEPS:

Call your local representative and ask him/her how they intend to vote on HB 309. Emphasize that any floor amendment that would further qualify/limit benefits under the Early Childhood Mandate or Connor’s Law is unacceptable to you.

Briefly share why you and your family value early intervention and treatment: Services like these improve the lives of children who experience developmental challenges and reduce the long term cost of care.

Ask why members of the public and other stakeholders are not included in the all-important effort to define what benefits will be considered "essential" in New Hampshire’s changing health insurance market. Challenge your legislator to open up this process to greater public input and debate.

 

If you can, attend the January 4, 2012 House Session. Let our elected officials know that we are watching!

 

Rep. Hunt, Ches. 7

November 1, 2011

2011-2815h

01/10

NOTE: Italics indicated changes to the original bill. Highlights and boldface are provided to assist advocates for early childhood intervention (red) and the treatment of autism spectrum disorders (purple) and healthcare reform (orange).

Amendment to HB 309-FN

Amend the title of the bill by replacing it with the following:

AN ACT relative to certain insurance mandates and establishing a committee to study current insurance mandates.

Amend the bill by replacing all after the enacting clause with the following:

1 Coverage for Certified Midwives; Individual. Amend RSA 415:6-l to read as follows:

415:6-l Coverage for Certified Midwives; Individual. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing maternity benefits, [shall]

may also provide to certificate holders of such insurance, who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. Ifcoverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.

2 Coverage for Certified Midwives; Group. Amend RSA 415:18-q to read as follows:

415:18-q Coverage for Certified Midwives. Each insurer that issues or renews any policy of group accident or health insurance providing maternity benefits [shall]

may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.

3 Coverage for Certified Midwives; Health Service Corporations. Amend RSA 420-A:17-f to read as follows:

420-A:17-f Coverage for Certified Midwives. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group

 

accident or health insurance providing maternity benefits [shall]

may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.

4 Coverage for Certified Midwives; Health Maintenance Organizations. Amend RSA 420-B:8-p to read as follows:

420-B:8-p Coverage for Certified Midwives. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing maternity benefits [shall]

may also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. If coverage is provided, such coverage shall be subject to each insurer’s standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. If benefits are provided they shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.

5 Coverage for Children’s Early Intervention Services; Individual. Amend RSA 415:6-n to read as follows:

415:6-n Coverage for Children’s Early Intervention Therapy Services. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to certificate holders of such insurance, who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this sectionmay be subject to deductibles, copayments, coinsurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.

6 Coverage for Children’s Early Intervention Services; Group. Amend RSA 415:18-s to read as follows:

415:18-s Coverage for Children’s Early Intervention Services. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.

7 Coverage for Children’s Early Intervention Services; Health Service Corporations. Amend RSA 420-A:17-g to read as follows:

420-A:17-g Coverage for Children’s Early Intervention Services. Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, which provides coverage for outpatient services shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.

8 Coverage for Children’s Early Intervention Services; Health Maintenance Organizations. Amend RSA 420-B:8-r to read as follows:

420-B:8-r Coverage for Children’s Early Intervention Services. Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child’s primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child’s third birthday.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.

9 Coverage for Treatment of Pervasive Developmental Disorder or Autism. Amend RSA 417-E:2, V to read as follows:

V.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department.

VI.

The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the insurance coverage requirements established under this section.

10 Coverage for Hearing Aids. Amend the introductory paragraph of RSA 415:6-p to read as follows:

415:6-p Coverage for Hearing Aids. Each insurer that issues or renews any individual policy or certificate for delivery in this state, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the professional services associated with the practice of fitting, dispensing, servicing, or sale of hearing instruments or hearing aids

for persons under the age of 21 years when the audiogram indicates a unilateral or bilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz(Hz) to 4000Hz and for persons 21 years of age or over when the audiogram indicates a unilateral or bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction. The benefits included in this section shall not be subject to any greater deductible or coinsurance or copay than any other benefits provided by the insurer. Insurers are required to cover the cost of a hearing aid for each ear, as needed, as well as related services necessary to assess, select, and fit the hearing aid with a maximum for the hearing aid and related services of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost. The hearing aid shall be prescribed and dispensed by a licensed audiologist or hearing instrument specialist. The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall not apply to the medical assistance program, pursuant to RSA 161 and RSA 167. In this section:

11 Coverage for Hearing Aids; Group. Amend the introductory paragraph of RSA 415:18-u to read as follows:

415:18-u Coverage for Hearing Aids. Each insurer that issues or renews any policy or certificate for delivery in this state of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the professional services associated with the practice of fitting, dispensing, servicing, or sale of hearing instruments or hearing aids [by a hearing instrument dispenser or other hearing care professional]

for persons under the age of 21 years when the audiogram indicates a unilateral or bilateral hearing loss of one or more thresholds of 25 decibels (dB) hearing level (HL) or poorer at any frequency from 1000 hertz(Hz) to 4000Hz and for persons 21 years of age or over when the audiogram indicates a unilateral or bilateral hearing loss with an average threshold of 35 dBHL or poorer for 1000 Hz, 2000 Hz, 3000 Hz, and 4000 Hz by pure tone air conduction. The benefits included in this section shall not be subject to any greater deductible or coinsurance or copay than any other benefits provided by the insurer. Insurers are required to cover the cost of a hearing aid for each ear,

Does not include any members of the public as needed, as well as related services necessary to assess, select, and fit the hearing aid with a maximum for the hearing aid and related services of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost. The hearing aid shall be prescribed and dispensed by a licensed audiologist or hearing instrument specialist.

The benefits included in this section shall be subject to utilization review consistent with rules adopted by the insurance department. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall not apply to the medical assistance program, pursuant to RSA 161 and RSA 167. In this section:

 

12 Committee Established.

I. There is established a committee to study current New Hampshire insurance mandates.

(a) The membership of the committee shall be as follows:

(1) Three members of the house of representatives, appointed by the speaker of the house of representatives.

(2) Two members of the senate, appointed by the president of the senate.

(b) Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.

II. The committee shall study current New Hampshire insurance mandates. The committee’s study shall include, but not be limited to, the costs of such mandates and whether some or all of the mandates should be optional.

The committee shall also review the "essential benefits" section of the Patient Protection and Affordable Care Act of 2009, as amended, when it is released and compare that section with the mandates under New Hampshire law.

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

IV. The committee 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, 2012.

13 Effective Date.

I. Section 12 of this act shall take effect upon its passage.

II. The remainder of this act shall take effect 60 days after its passage.

 

2011-2815h

AMENDED ANALYSIS

This bill:

I. Makes insurance coverage for certified midwives optional.

II. Requires utilization review for coverage for children’s early intervention therapy

services, diagnosis and treatment of pervasive developmental disorder or autism, and hearing aids.

III. Clarifies the coverage for hearing aids.

IV. Establishes a committee to study current New Hampshire insurance mandates.