Out of Recess.

1999-1336-EBA

03/09

Enrolled Bill Amendment to HB 357

The Committee on Enrolled Bills to which was referred HB 357

Having considered the same, report the same with the following amendment, and the recommendation that the bill as amended ought to pass.

FOR THE COMMITTEE

This enrolled bill amendment corrects the name of a house committee and inserts language for consistency and to clarify the duties of the study committee established by this bill.

Amend section 2 of the bill by replacing line 4 with the following:

criminal justice and public safety committee and one of whom shall be from the judiciary committee, appointed by the

Amend section 3 of the bill by replacing line 2 with the following:

investigation, indictment, trial, conviction, and sentencing of sex offenders. The committee shall also study and

Senator Trombly moved adoption.

Senator Cohen moved that the business of day being complete that the Senate now adjourn until Thursday, May 20, 1999 at 10:00 a.m.

The Senate met at 10:00 a.m..

A quorum was present.

The prayer was offered by the Rev. David P. Jones, Senate Chaplain.

Senator Wheeler led the Pledge of Allegiance.

The Committee on Enrolled Bills has examined and found correctly Enrolled the following entitled House and/or Senate Bill:

HB 79, relative to reports to the bank commissioner and to safe deposit box openings.

HB 292, relative to ballot procedures for constitutional amendments.

HB 340, establishing a committee to study mercury source reduction and recycling issues.

HB 426, relative to clean indoor air in state buildings.

HB 442, relative to charitable gift annuities.

HB 513, relative to approved permissible fireworks.

HB 583, extending the reporting date for the committee studying the issue of updating New Hampshire laws related to fences.

HB 651, revising the speed limit law.

SB 56, amending the law relative to who may adopt.

SB 38, relative to the optional term for election of a cooperative school district moderator.

SB 109, deleting the witnessing requirement for notices of lease.

SB 138, relative to joint tenancy with rights of survivorship.

SB 160, establishing a committee to study and identify or establish the duties of the fish and game commission.

Senator D’Allesandro moved adoption.

HJR 3, urging ISO-New England to adopt policies furthering the state's interest in electric utility restructuring. Energy and Economic Development Committee. Vote 7-0. Ought to Pass, Senator Below for the committee.

HB 535, establishing a committee to study the department of resources and economic development. Energy and Economic Development Committee.

MINORITY REPORT: Inexpedient to Legislate, Senator Fraser for the committee. Vote 3-4

MAJORITY REPORT: Ought to Pass, Senator Johnson for the committee. Vote 4-3

SB 196-FN-L, relative to electric rate reduction financing. Energy and Economic Development Committee. Vote 7-0. Ought to pass with amendment, Senator F. King for the committee.

1999-1324s

05/10

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

1 Statement of Purpose.

I. The state of New Hampshire and Public Service Company of New Hampshire (PSNH) are in the process of negotiating a settlement to resolve the outstanding issues concerning the implementation within PSNH’s service territory of electric utility restructuring pursuant to RSA 374-F. Any settlement proposal that results from these negotiations will in all likelihood include a component for securitizing a portion of PSNH’s stranded costs.

II. It is important that the general court, through the declaration of purpose and findings of RSA 369-A:1, express its understanding of securitization and the criteria that are essential to meet prior to authorizing the use of securitization.

CHAPTER 369-A

Electric Rate Reduction financing

369-A:1 Declaration of Purpose and Findings. The general court finds that:

I. Restructuring of electric utilities to provide greater competition and more efficient regulation has been found by the general court to be in the public good and New Hampshire is now aggressively pursuing restructuring and increased customer choice in order to provide electric service at lower and more competitive rates.

II. The transition to competitive markets for electricity is a complex endeavor and requires the development of creative and flexible mechanisms to facilitate the movement from monopoly to competition.

III. The establishment of structured financing options for public utilities will enhance and facilitate the expeditious transition to competition, choice for retail electric customers, and reductions in electric rates for all customer classes consistent with the near term rate relief principle of RSA 374-F:3, XI, without creating any debt or obligation of the state or other adverse impacts upon the state’s finances or credit rating. Structured financing options may facilitate and help mitigate stranded cost recovery that the commission determines is appropriate, equitable, and balanced pursuant to authority granted in RSA 374-F:3, XII and 374-F:4.

IV. Structured finance options are best pursued in the context of settlement agreements between a utility and the commission concerning the implementation of competition.

V. Rate reduction bonds are instruments underwritten for recovery by a guaranteed promise of customer repayment as part of the stranded cost recovery charge on a customer’s bill. These bonds’ irrevocable guarantee of repayment creates a secure expectation of performance and thus allows for an attractive rate of refinancing of a utility’s stranded costs.

VI. Stranded costs are at significant risk of not being recovered under traditional rate regulation and market pressures. Electricity prices in New Hampshire are so high as to cause customers to aggressively consider fuel switching, conservation, or self generation. Technological innovation may soon allow small scale self generation units to be viable in the near future. Over time, technological innovation will increasingly threaten the recovery of stranded costs.

VII. Once stranded costs are securitized through rate reduction bonds, a utility immediately recovers through a lump sum payment that portion of its stranded costs underwritten by the bond. As such, the risk of not recovering that portion of a utility’s stranded costs is completely removed. The utility may then favorably recapitalize its debt structure taking advantage of its improved risk profile.

VIII. A lump sum payment derived from a rate reduction bond provides a large infusion of cash with which a utility may repay its debt. This infusion of cash also gives a utility a tremendous opportunity to become a major participant in deregulated electric generation markets or deregulated telecommunication markets.

IX. The financial and security advantages that accrue to a utility in the form of improved debt structure, risk reduction, and new cash resources could make such a utility an attractive investment opportunity. It is likely that any such utility’s publicly traded stock value would rise considerably, especially for a utility that had faced significant investor uncertainty.

X. The extraordinary benefits that utilities and their investors will receive through issuance of rate reduction bonds are appropriate and fair, but only to the extent that customers also receive equitable and extraordinary benefits. Unless these customer benefits can be achieved at the same time that utilities receive the extraordinary benefits of securitization, the use of revenue reduction bonds and the irrevocable obligation they create for customers is not in the public interest. The benefits to customers should be substantially consistent with the following principles:

(a) The opportunity to choose among a range of competitive suppliers in a manner that promotes public trust in the benefits of competitive options. Public trust is not achieved if a utility uses rate reduction bonds to maintain a commanding presence in all of the traditional utility functions of transmitting, distributing, and generating electricity.

(b) Electricity prices consistent with RSA 374-F:3, XI, the near term rate relief principles for all customer classes.

(c) Electricity prices that approach the regional average within 4 years.

(d) Electricity prices that do not create another rate gap for New Hampshire customers.

(e) Risk sharing by the utility of the non securitized portion of the utility’s stranded cost should regional average prices not be approached in 4 years.

(f) The continued opportunity for end users to generate electricity for their own use without an exit fee.

(g) Further renegotiations between representatives of the 6 wood-to-energy facilities, Public Service Company of New Hampshire, the public utilities commission, and other interested parties in order to reduce customer cost of this source of electricity.

(h) The cessation of any dispute, litigation, or regulatory proceedings concerning any electric restructuring issue, in any forum where the utility’s position is adverse to the state of New Hampshire, the commission, or the New Hampshire Electric Cooperative prior to use of structured financing options.

(i) Retention of commission jurisdiction over any proposed settlement.

(j) Filing of any proposed settlement at the public utilities commission prior to further legislative consideration of authorization to use structured financing options.

3 Effective Date. This act shall take effect upon its passage.

1999-1324s

AMENDED ANALYSIS

This bill expresses certain legislative purposes and findings relative to electric rate reduction financing.

Senator F. King moved to have SB 196-FN-L, relative to electric rate reduction financing, laid on the table.

SB 196-FN-L, relative to electric rate reduction financing.

SB 68, establishing minimum 400 foot buffer zones around sensitive areas from application of herbicides. Environment Committee.

SPLIT REPORT: Inexpedient to Legislate, Senator Krueger for the committee. Vote 4-4

SPLIT REPORT: Ought to pass with amendment, Senator Russman for the committee. Vote 4-4

1999-1298s

08/03

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

AN ACT establishing minimum 300 foot buffer zones around sensitive areas from application of herbicides, authorizing a study of environmental effects from residual herbicides and making an appropriation therefor.

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

1 Findings. The general court finds that scientific measurement and monitoring of residual herbicides in waters and aquatic resources of the state from aerial spraying of forest lands for timber management purposes should be conducted to provide a greater basis for adequate regulatory safeguards and controls on aerial herbicide spraying.

2 Study.

I. Beginning July 1, 1999, the department of environmental services is authorized to conduct an ongoing study of the environmental effects from residual herbicides due to aerial spraying of forest lands. The study shall be in addition to other monitoring of pesticide residuals which may be conducted by the department, and shall be focused on those north country watersheds which have received aerial herbicide application in the recent past. These watersheds shall include Lake Umbagog and the Third Connecticut Lake.

II. The department is instructed to seek funding for the study from federal and private sources.

3 New Subparagraph; Scientific Measurement and Monitoring of Residual Pesticides in the Waters and Aquatic Resources of the State Fund. Amend RSA 6:12, I by inserting after subparagraph (vvv) the following new subparagraph:

(www) Money received from state, federal, or private sources for monitoring of residual pesticides under 485-A:4, XI, which shall be credited to the scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state fund.

4 Appropriation. The sum of $20,000 is hereby appropriated to the scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state fund for the biennium ending June 30, 2000 for the purposes of section 2 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

5 New Section; Buffer Zones for Aerial Application of Herbicides. Amend RSA 430 by inserting after section 41 the following new section:

430:41-a Buffer Zones for Aerial Application of Herbicides. A buffer zone or non-spray area of at least 300 feet shall be maintained between the targeted spray area of an aerial herbicide application and the following critical areas:

I. Private wells, springs, and other sources of water used for drinking or domestic purposes.

II. Surface waters, as defined in RSA 485-A:2, XIV.

III. Depressions or runoff areas where there is active water flow.

IV. Adjacent property lines, provided adjacent property has ownership other than that of applicant.

V. Houses, barns, and other structures.

VI. Animal feeding and watering tanks.

VII. Public roads.

6 Effective Date. This act shall take effect upon its passage.

1999-1298s

AMENDED ANALYSIS

This bill:

I. Establishes minimum 300 foot buffer zones around sensitive areas from application of herbicides.

II. Authorizes the department of environmental services to conduct a study of the environmental effects from residual herbicides due to aerial spraying of forest lands, and appropriates $20,000 to the department for this purpose.

III. Creates a special fund for scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state.

Senator Below offered a floor amendment.

Sen. Below, Dist. 5

Sen. D’Allesandro, Dist. 20

1999-1361s

08/03

Floor Amendment to SB 68

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

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

1 Findings. The general court finds that scientific measurement and monitoring of residual herbicides in waters and aquatic resources of the state from aerial spraying of forest lands for timber management purposes should be conducted to provide a greater basis for adequate regulatory safeguards and controls on aerial herbicide spraying.

2 Study.

I. Beginning July 1, 1999, the department of environmental services is authorized to conduct an ongoing study of the environmental effects from residual herbicides due to aerial spraying of forest lands. The study shall be in addition to other monitoring of pesticide residuals which may be conducted by the department, and shall be focused on those north country watersheds which have received aerial herbicide application in the recent past. These watersheds shall include Lake Umbagog and the Third Connecticut Lake. The Piscataquog River shall also be monitored, to serve as a control.

II. The department is instructed to seek funding for the study from federal and private sources.

3 New Subparagraph; Scientific Measurement and Monitoring of Residual Pesticides in the Waters and Aquatic Resources of the State Fund. Amend RSA 6:12, I by inserting after subparagraph (vvv) the following new subparagraph:

(www) Money received from state, federal, or private sources for monitoring of residual pesticides under 485-A:4, XI, which shall be credited to the scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state fund.

4 Appropriation. The sum of $20,000 is hereby appropriated to the scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state fund for the biennium ending June 30, 2000 for the purposes of section 2 of this act. The governor is authorized to draw a warrant for said sums out of any money in the treasury not otherwise appropriated.

5 New Section; Buffer Zones for Aerial Application of Herbicides. Amend RSA 430 by inserting after section 41 the following new section:

430:41-a Buffer Zones for Aerial Application of Herbicides. A buffer zone or non-spray area of at least 300 feet shall be maintained between the targeted spray area of an aerial herbicide application and the following critical areas:

I. Private wells, springs, and other sources of water used for drinking or domestic purposes.

II. Adjacent property lines, provided adjacent property has ownership other than that of applicant.

III. Houses, barns, and other structures.

IV. Animal feeding and watering tanks.

V. Public roads.

VI. Surface waters, as defined in RSA 485-A:2, XIV.

6 Effective Date. This act shall take effect 60 days after its passage.

1999-1361s

AMENDED ANALYSIS

This bill:

I. Establishes minimum 300 foot buffer zones around sensitive areas from application of herbicides.

II. Authorizes the department of environmental services to conduct a study of the environmental effects from residual herbicides due to aerial spraying of forest lands, and appropriates $20,000 to the department for this purpose.

III. Creates a special fund for scientific measurement and monitoring of residual pesticides in the waters and aquatic resources of the state.

SB 71, establishing a ban on MTBE in gasoline as of January 1, 2000. Environment Committee. Vote 6-2. Ought to pass with amendment, Senator Wheeler for the committee.

1999-1265s

08/09

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

AN ACT prohibiting the use of MTBE as an additive in gasoline.

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

1 New Section; Prohibition on Sale of Gasoline Containing MTBE. Amend RSA 339 by inserting after section 30-a the following new section:

339:30-b Sale of Gasoline Containing MTBE Prohibited.

I. A person shall not sell or offer for sale at wholesale in this state any gasoline, as defined in RSA 259:37-b, that has been treated with the fuel oxygenate methyl tertiary butyl ether (MTBE).

II. The commissioner of environmental services, in consultation with the commissioner of health and human services and the air pollution advisory committee, shall implement the provisions of this section. The provisions of this section shall be exempt from the requirements of RSA 541-A.

III. The commissioner of environmental services shall develop a timetable by April 1, 2000 for the removal of MTBE from gasoline at the earliest possible date, but not later than January 1, 2003. The timetable shall ensure the adequate supply and availability of gasoline for New Hampshire consumers at a reasonable price.

2 Clean Air Act Requirements. The commissioner of environmental services shall make a formal request to the administrator of the Environmental Protection Agency for an immediate waiver for New Hampshire gasoline from the federal Clean Air Act requirement for oxygen content in reformulated gasoline.

3 Effective Date. This act shall take effect upon its passage.

1999-1265s

AMENDED ANALYSIS

This bill:

I. Prohibits gasoline containing the fuel additive MTBE from being sold or offered for sale at wholesale in this state.

II. Requires the commissioner of environmental services to implement the provisions of this act. Such provisions shall be exempt from the requirements of the administrative procedure act.

III. Requires the commissioner of environmental services to develop a timetable by April 1, 2000 for the removal of MTBE from gasoline.

IV. Requires the commissioner of environmental services to make a formal request to the Environmental Protection Agency for a waiver from the Clean Air Act requirement for reformulated gasoline oxygen content.

The following Senators voted No: F. King, Gordon, Johnson, Fraser, Roberge, Francoeur, Krueger, Brown, Klemm.

SB 218-FN-L, regulating the land application of sewage sludge. Environment Committee.

SPLIT REPORT: Inexpedient to Legislate, Senator Krueger for the committee. Vote 4-4

SPLIT REPORT: Ought to pass with amendment, Senator Wheeler for the committee. Vote 4-4

1999-1299s

08/03

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

1 Land Application of Sludge. Amend RSA 485-A:5-d to read as follows:

485-A:5-d Land Application of Sludge

I. Sludge or biosolids which are to be land applied in New Hampshire shall not exceed the maximum concentrations for specific chemical contaminants contained in the rules of the department, or the rules or regulations of the state in which the sludge was generated, whichever are more stringent.

VIII. Class A and class B sludge shall not be stockpiled or land applied on 100 year flood plains. Stockpiles may be placed on application sites that are not flood plains up to and including 30 days before any planting or seeding. Sludge shall not be stockpiled where there is less than 3 feet of unsaturated soil between the lowest point of such storage and the maximum high groundwater table.

X. Deliveries of class A sludge exceeding 20 tons per site per year shall be reported to the department.

2 New Sections; Sludge Quality Certification Requirements. Amend RSA 485-A by inserting after section 5-d the following new sections:

485-A:5-e Sludge Quality Certification Requirements.

I. All publicly owned treatment works (POTWs) who land apply sludge shall list all industrial waste water contributors and chemical constituents of their waste water.

II. As of January 1, 2001, the following maximum metal concentrations shall be required by any wastewater treatment facility if such facility shall be issued a sludge quality certification by the department:

(a) For arsenic, 10 mg/kg.

(b) For cadmium, 10 mg/kg.

(c) For chromium, 160 mg/kg.

(d) For copper, 1000 mg/kg.

(e) For lead, 270 mg/kg.

(f) For mercury, 7 mg/kg.

(g) For molybdenum, 18 mg/kg.

(h) For nickel, 98 mg/kg.

(i) For selenium, 18 mg/kg.

(j) For zinc, 1780 mg/kg.

III. Sludge quality certifications shall expire 2 years from the date of issuance.

IV. University of New Hampshire cooperative extension services best management practices with regard to agronomic application rates of sludge shall be adhered to by any person who land applies sludge.

485-A:5-f Sludge Containing Dioxins. In addition to all other rules and laws applying to the land application of sewage sludge, no pasturing of livestock whose products are consumed by humans shall occur on fields that receive sludge or residuals containing dioxins TEQ above 1 ppt.

485-A:5-g Required Record Keeping for Land Application of Sludge.

I. Each sludge hauler permit holder shall record the following information, on a form provided by the department, for each load of sludge:

(a) The date the sludge is transported from the generator’s site or facility.

(b) The generator’s name, address, and telephone number.

(c) The quantity of sludge, in wet tons.

(d) The type of sludge, such as domestic or industrial.

(e) The name, address, and telephone number of the hauler permit holder and driver of the motorized vehicle.

(f) The name, address, and telephone number of the sites, facilities, solid waste facilities, or wastewater treatment facilities to which the sludge is to be delivered.

(g) The date delivered to the sites or facilities.

II. The information required in paragraph I shall be maintained in the motorized unit used to transport the sludge when the sludge is being transported.

III. Records required under this section shall be maintained on a permanent basis.

485-A:5-h Exclusion of Use by Towns that Regulate Prohibited. No wastewater treatment plant shall exclude a town from using its facility solely for the reason that the town exercises its rights under applicable state laws to regulate sludge disposal within its borders.

3 Effective Date. This act shall take effect 60 days after its passage.

1999-1299s

AMENDED ANALYSIS

This bill establishes:

I. Record keeping requirements for haulers of sludge.

II. A prohibition on wastewater treatment plants from excluding towns that regulate sludge disposal within their borders.

III. Limitations to land application of sludge including sludge containing dioxins.

IV. Specific requirements and limitations for the land application of class A and class B sludge.

V. Requirements for persons or facilities acquiring sludge quality certification.

Senator Wheeler offered a floor amendment.

1999-1363s

08/03

Floor Amendment to SB 218-FN-A-LOCAL

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

1 Land Application of Sludge. Amend RSA 485-A:5-d to read as follows:

485-A:5-d Land Application of Sludge

I. Sludge or biosolids which are to be land applied in New Hampshire shall not exceed the maximum concentrations for specific chemical contaminants contained in the rules of the department, or the rules or regulations of the state in which the sludge was generated, whichever are more stringent.

2 New Sections; Sludge Quality Certification Requirements. Amend RSA 485-A by inserting after section 5-d the following new sections:

485-A:5-e Sludge Quality Certification Requirements.

I. All publicly owned treatment works (POTWs) who land apply sludge shall list all industrial waste water contributors and chemical constituents of their waste water.

II. As of January 1, 2001, the following maximum metal concentrations shall be required by any wastewater treatment facility if such facility shall be issued a sludge quality certification by the department:

(a) For arsenic, 10 mg/kg.

(b) For cadmium, 10 mg/kg.

(c) For chromium, 160 mg/kg.

(d) For copper, 1000 mg/kg.

(e) For lead, 270 mg/kg.

(f) For mercury, 7 mg/kg.

(g) For molybdenum, 18 mg/kg.

(h) For nickel, 98 mg/kg.

(i) For selenium, 18 mg/kg.

(j) For zinc, 1780 mg/kg.

III. Sludge quality certifications shall expire 2 years from the date of issuance.

IV. University of New Hampshire cooperative extension services best management practices with regard to agronomic application rates of sludge shall be adhered to by any person who land applies sludge.

485-A:5-f Sludge Containing Dioxins. In addition to all other rules and laws applying to the land application of sewage sludge, no pasturing of livestock whose products are consumed by humans shall occur on fields that receive sludge or residuals containing dioxins TEQ above 1 ppt.

485-A:5-g Required Record Keeping for Land Application of Sludge.

I. Each sludge hauler permit holder shall record the following information, on a form provided by the department, for each load of sludge:

(a) The date the sludge is transported from the generator’s site or facility.

(b) The generator’s name, address, and telephone number.

(c) The quantity of sludge, in wet tons.

(d) The type of sludge, such as domestic or industrial.

(e) The name, address, and telephone number of the hauler permit holder and driver of the motorized vehicle.

(f) The name, address, and telephone number of the sites, facilities, solid waste facilities, or wastewater treatment facilities to which the sludge is to be delivered.

(g) The date delivered to the sites or facilities.

II. The information required in paragraph I shall be maintained in the motorized unit used to transport the sludge when the sludge is being transported.

III. Records required under this section shall be maintained on a permanent basis.

3 Effective Date. This act shall take effect 60 days after its passage.

1999-1363s

AMENDED ANALYSIS

This bill establishes:

I. Record keeping requirements for haulers of sludge.

II. Limitations to land application of sludge including sludge containing dioxins.

III. Specific requirements and limitations for the land application of class A and class B sludge.

4. Requirements for persons or facilities acquiring sludge quality certification.

The following Senators voted No: F. King Gordon, Johnson, Fraser, Roberge, Squires, Francoeur, Krueger, Brown, Klemm.

Senator F. King moved to have SB 196-FN-L, relative to electric rate reduction financing, taken off the table.

SB 196-FN-L, relative to electric rate reduction financing.

1999-1350-EBA

03/01

Enrolled Bill Amendment to SB 139

The Committee on Enrolled Bills to which was referred SB 139

Having considered the same, report the same with the following amendment, and the recommendation that the bill as amended ought to pass.

FOR THE COMMITTEE

This enrolled bill amendment deletes a section of the bill which corrected a reference in an RSA section that has been repealed by 1999, 17.

Amend the bill by deleting section 2 and renumbering the original sections 3-9 to read as 2-8, respectively.

Senator Trombly moved adoption.

SB 199, establishing certain standards of accountability for health maintenance organizations and other entities providing health insurance through a managed care system. Insurance Committee. Vote 5-3. Ought to pass with amendment, Senator McCarley for the committee.

1999-1325s

05/10

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

1 Statement of Purpose. The purpose and intent of this act is to strengthen protections for New Hampshire families who receive their medical care from managed care organizations by providing consumers with the information and tools consumers need to hold managed care organizations accountable for the health care treatment decisions they make.

2 Practice of Medicine; Medical Directors. Amend RSA 329:1 to read as follows:

329:1 Practice. Any person shall be regarded as practicing medicine under the meaning of this chapter who shall diagnose, treat, perform surgery, or prescribe any treatment of medicine for any disease or human ailment. "Surgery" means any procedure, including but not limited to laser, in which human tissue is cut, shaped, burned, vaporized, or otherwise structurally altered, except that this section shall not apply to any person to whom authority is given by any other statute to perform acts which might otherwise be deemed the practice of medicine. "Laser" means light amplification by stimulated emission of radiation. A medical director, as defined in RSA 420-J:3, XXV-a, shall be regarded as practicing medicine under the meaning of this chapter whenever: I. A medical necessity determination is made for which he or she is responsible under RSA 420-J:6, V or RSA 420-E:2-a; II. The medical necessity determination denies authorization or payment for a covered health care service, supply or drug that the treating health care provider has prescribed; and III. Such denial causes the covered person not to receive the health care service, supply or drug that the treating health care provider has prescribed. 3 New Section; Medical Directors Required. Amend RSA 420-E by inserting after section 2 the following new section:

420-E:2-a Medical Director. Every medical utilization review entity licensed by the department under this chapter shall employ a medical director licensed under RSA 329, who shall have final responsibility for the utilization system and its administration and implementation, including utilization review decisions affecting health care services provided to beneficiaries.

4 New Paragraph; Definition Added. Amend RSA 420-J:3 by inserting after paragraph XXV the following new paragraph:

XXV-a. "Medical director" means a physician licensed under RSA 329 and employed by a health carrier or medical utilization review entity who is responsible for the utilization review techniques and methods of the health carrier or medical utilization review entity and their administration and implementation, including utilization review decisions affecting health care services provided to covered persons under a health benefit plan.

5 New Paragraph; Medical Director Required. Amend RSA 420-J:6 by inserting after paragraph IV the following new paragraph:

V. Each health carrier that conducts utilization review shall employ a medical director who shall have final responsibility for all utilization review techniques and methods and their administration and implementation, including utilization review decisions affecting health care services provided to covered persons under a health benefit plan.

6 Information Provided to Covered Persons. Amend RSA 420-J:5, II to read as follows:

II. A health carrier shall provide to consumers:

(a) A description of the internal grievance procedure required under RSA 420-J:5 for adverse determinations and other matters [which] and a description of the process for obtaining external review under RSA 420-J:5-a. These descriptions shall be set forth in or attached to the policy, certificate, membership booklet, or other evidence of coverage provided to covered persons.

(b) A statement of a covered person's right to contact the commissioner's office for assistance at any time. The statement shall include the toll-free telephone number and address of the commissioner.

(c) Upon written denial of a requested medical service or claim by the health carrier, a statement of the covered person's right to access the internal grievance process. This statement shall also include a written explanation of any adverse determination, with the name and credentials of the health carrier medical director, including board status and the state or states where the person is currently licensed, and the relevant clinical rationale used to make the adverse determination. If the person making the adverse determination is not the medical director but a designee, then the name, credentials, board status, and state or states of current license shall also be provided for that person. Nothing in this section shall be construed to require a health carrier to provide proprietary information protected by third party contracts. (d) Staff assistance in filing a grievance.

(e) [If requested by the consumer or health care provider acting on behalf of the consumer, a written explanation of any adverse determination, with the name and credentials of the health carrier medical director or designee, including board status and the state or states where the person is currently licensed, and the relevant clinical rationale used to make the adverse determination. Nothing in this section shall be construed to require a health carrier to provide proprietary information protected by third party contracts] Upon exhausting the second level grievance review process, a statement of the covered person’s right to obtain an independent external review of the health carrier’s determination. This shall include a description of the process for obtaining external review, a copy of the written procedures governing external review, including the required time frames for requesting external review, and notice of the conditions under which expedited external review is available. 7 First Level Grievance; Names Required. Amend RSA 420-J:5, III(b)(1) to read as follows:

(1) The names, titles and qualifying credentials of the persons participating in the first level grievance review process.

8 Second Level Grievance; Names Required. Amend RSA 420-J:5, V(a)(3) to read as follows:

(3) The review panel shall issue a written decision to the covered person within 5 business days of completing the review meeting. Upon concurrence of the covered person, a copy of the decision shall be forwarded to the insurance department. The decision shall include the names and titles of the members of the review panel; a statement of the review panel's understanding of the nature of the grievance, including issues raised by the covered person, and all pertinent facts; the rationale for the review panel's decision; reference to evidence or documentation considered by the review panel in making the decision; if an adverse decision is made, the instructions for requesting a written statement of the clinical rationale, including the clinical review criteria used to make the determination; and a statement of the covered person's right to file an external appeal as provided in RSA [420-J:5, VIII] 420-J:5-a. The statement of appeal rights shall include a description of the process for obtaining external review of a determination, a copy of the written procedures governing external review, including the required time frames for requesting external review, and notice of the conditions under which expedited external review is available.. 9 Review Panel; Names Required. Amend RSA 420-J:5, V(b)(3) to read as follows:

(3) The review panel shall issue a written decision to the covered person within 5 business days of completing the review meeting. The decision shall include the names and titles of the members of the review panel; a statement of the review panel's understanding of the nature of the grievance and all pertinent facts; the rationale for the review panel's decision; reference to evidence or documentation considered by the review panel in making the decision; if an adverse decision is made, the instructions for requesting a written statement of the clinical rationale, including the clinical review criteria used to make the determination; and a statement of the covered person's right to file an external appeal as provided in RSA [420-J:5, VIII] 420-J:5-a. The statement of appeal rights shall include a description of the process for obtaining external review of a determination, a copy of the written procedures governing external review, including the required time frames for requesting external review, and notice of the conditions under which expedited external review is available.

10 Expedited Internal Grievance Review. Amend RSA 420-J:5, VI(e) to read as follows:

(e) In any case where the expedited review process does not resolve a difference of opinion between the health carrier and the covered person or the provider acting on behalf of the covered person, the covered person or the provider acting on behalf of the covered person may submit a written grievance, unless the provider is prohibited from filing a grievance by federal or other state law. A health carrier shall review it as a second level grievance. In conducting the review, the health carrier shall [adhere to time frames that are reasonable under the circumstances] make a decision and notify the covered person as expeditiously as the covered person’s medical condition requires, but in no event more than 72 hours after the grievance is submitted. 11 New Paragraph; Definition Added. Amend RSA 420-J:3 by inserting after paragraph III the following new paragraph:

(a) The covered person;

(b) A person authorized by law to provide substituted consent for a covered person; or

(c) A family member of the covered person when adherence to the requirement of express written consent is impracticable or would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function.

12 New Paragraph; Definition Added. Amend RSA 420-J:3 by inserting after paragraph XXIII the following new paragraph:

XXIII-a. "Independent review organization" means an entity that employs or contracts with clinical peers to conduct independent external reviews of health carrier determinations.

13 New Section; External Review. Amend RSA 420-J by inserting after section 5 the following new section:

420-J:5-a External Review Process. The insurance department shall arrange for independent external review of certain health carrier determinations as follows: I. A covered person shall have the right to independent external review of a health carrier determination when the following conditions apply:

(a) The subject of the request for external review is: (1) An adverse determination; or

(2) A determination by the health carrier that a service, supply or drug is not a covered benefit, when the covered person is asserting that the service, supply or drug should be considered covered for medical reasons. This shall include, but not be limited to, the following circumstances: (A) a service, supply or drug is denied, reduced or terminated by the carrier because the health benefit plan does not cover experimental or investigational treatment, but the covered person asserts that the treatment in question should not be considered experimental or investigational.

(B) a service is denied, reduced or terminated by the carrier because the health benefit plan does not cover procedures that are performed for cosmetic reasons or for reasons of convenience, but the covered person asserts that the service is required for medical reasons rather than cosmetics or convenience.

(C) a referral is denied by the carrier because treatment by out-of-network providers is not covered unless the service in question cannot be provided within the carrier’s network, and the covered person asserts that the network does not have providers with the appropriate clinical expertise for the service in question.

(D) a drug is denied by the carrier because it is not on the formulary list, but the covered person asserts that the drug is covered under the medical exception criteria.

(E) a service, supply or drug is denied because of a medically-based decision that a condition is preexisting, and the covered person disputes this. (b) The covered person has completed the internal review procedures provided by the health carrier pursuant to RSA 420-J:5, III through VI, or the health carrier has agreed to submit the determination to independent external review prior to completion of internal review, or the covered person has requested first or second level, standard or expedited review and has not received a decision from the health carrier within the required time frames.

(c) The covered person or the covered person’s authorized representative has submitted the request for external review in writing to the commissioner within 12 months of the date of the health carrier’s second level denial decision provided pursuant to RSA 420-J:5, V or VI, or if the health carrier has failed to make a first or second level, standard or expedited review decision that is past due, within 12 months of the date the decision was due.

(d) Except in the case of a request for expedited review, the covered person or the covered person’s authorized representative has paid to the commissioner a filing fee of $25 at the time of submitting the request for external review. However, the commissioner may waive the filing fee upon a showing of financial hardship.

(e) The health carrier determination does not relate to any category of health care services that is excluded from the external review provisions of this section pursuant to paragraph II.

(f) The request for external review is not based on a claim or allegation of provider malpractice, professional negligence, or other professional fault excluded from the external review provisions of this section pursuant to paragraph III. II. Determinations relating to the following health care services shall not be reviewed under this section, but shall be reviewed pursuant to the review processes provided by applicable federal or state law: (a) Health care services provided through medicaid, the state Children’s Health Insurance Program (Title XXI of the Social Security Act), medicare or services provided under these programs but through a contracted health carrier. (b) Health care services provided to inmates by the department of corrections.

(c) Health care services provided pursuant to a health plan not regulated by the state, such as self-funded plans administered by an administrative services organization or third-party administrator or federal employee benefit programs.

III. The external review procedures set forth in this section shall not be utilized to adjudicate claims or allegations of health care provider malpractice, professional negligence, or other professional fault against participating providers. IV. Standard external review shall be conducted as follows: (a) Within 7 days after the date of receipt of a request for external review, the commissioner shall complete a preliminary review of the request in order to determine whether: (1) The individual is or was a covered person under the health benefit plan; (2) The determination that is the subject of the request for external review meets the conditions of eligibility for external review stated in paragraph I; and (3) The covered person has provided all the information and forms required by the commissioner that are necessary to process an external review. (b) Upon completion of the preliminary review pursuant to subparagraph IV(a), the commissioner shall immediately notify the covered person or the covered person’s authorized representative in writing: (1) Whether the request is complete; and (2) Whether the request has been accepted for external review. (c) If the request for external review is accepted, the commissioner shall:

(1) Include in the notice provided to the covered person pursuant to subparagraph IV(b) a statement that if the covered person wishes to submit new or additional information or to present oral testimony via teleconference, such information shall be submitted, and the oral testimony must be scheduled and presented, within 20 days of the date of issuance of the notice. (2) Immediately notify the health carrier in writing of the request for external review and its acceptance.

(d) If the request is not complete, the commissioner shall inform the covered person or the covered person’s authorized representative what information or documents are needed to make the request complete.

(e) If the request for external review is not accepted, the commissioner shall inform the covered person or the covered person’s authorized representative and the health carrier in writing of the reason for its non-acceptance. (f) At the time a request for external review is accepted, the commissioner may select an independent review organization that is certified pursuant to paragraph VI to conduct the external review. If an independent review organization is not selected to conduct the review, then the policies and procedures established by the commissioner for selecting clinical peer reviewers and conducting the review shall meet the minimum qualifications established under paragraph VII for certification of independent review organizations. (g) Within 10 days after the date of issuance of the notice provided pursuant to subparagraph IV(c)(2), the health carrier or its designated utilization review organization shall provide to the commissioner or the selected independent review organization and to the covered person all information in its possession that is relevant to the adjudication of the matter in dispute, including but not limited to:

(1) The terms of agreement of the health benefit plan, including the evidence of coverage, benefit summary or other similar document;

(2) All relevant medical records, including records submitted to the carrier by the covered person, the covered person’s authorized representative, or the covered person’s treating provider;

(3) A summary description of the applicable issues, including a statement of the health carrier’s final determination;

(4) The clinical review criteria used and the clinical reasons for the determination;

(5) The relevant portions of the carrier’s utilization management plan;

(6) Any communications between the covered person and the health carrier regarding the internal or external review; and

(7) All other documents, information, or criteria relied upon by the carrier in making its determination.

(h) In providing the information required in subparagraph IV(g), the health carrier may not present different reasons than those the health carrier or its designated utilization review organization communicated to the covered person upon internal review, unless the reasons relate to new information presented by the covered person or the covered person’s authorized representative or treating provider subsequent to the internal review.

(i) Failure by the health carrier to provide the documents and information required in subparagraph IV(g) within the specified time frame shall not delay the conduct of the external review.

(j) The commissioner or the selected independent review organization shall review all of the information and documents received from the carrier pursuant to subparagraph IV(g) and any other information submitted by the covered person or the covered person’s authorized representative or treating provider pursuant to subparagraph IV(c)(1) and any testimony provided. The commissioner or the independent review organization shall consider anew all previously determined facts, allow the introduction of new information, and make a decision that is not bound by decisions or conclusions made by the health carrier during internal review. In addition to the information provided by the health carrier and the covered person or the covered person’s authorized representative or treating provider, the commissioner or the independent review organization may consider the following in reaching a decision:

(1) The covered person’s pertinent medical records;

(2) The treating health care professional’s recommendation;

(3) Consulting reports from appropriate health care professionals and other similar documents submitted by the health carrier, covered person, or the covered person’s authorized representative or treating provider; (4) Any applicable, generally accepted clinical practice guidelines, including those developed by the federal government, national or professional medical societies, boards and associations;

(5) Any applicable clinical review criteria developed and used by the health carrier or its designated utilization review organization;

(6) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts;

(7) Peer-reviewed literature, biomedical compendia, and other medical literature that meet the criteria of the National Institute of Health’s Library of Medicine for indexing or that are recognized by the Secretary of Health and Human Services under section 1861(t)(2) of the Social Security Act;

(8) Standard reference compendia; and

(9) Findings, studies, or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes. (k) The commissioner or the selected independent review organization shall render a decision upholding or reversing the determination of the health carrier and notify the covered person or the covered person’s authorized representative and the health carrier in writing within 20 days of the date that any new or additional information from the covered person is due pursuant to subparagraph IV(c)(1). This notice shall include a written review decision that contains a statement of the nature of the grievance, references to evidence or documentation considered in making the decision, findings of fact, and the clinical and legal rationale for the decision, including, as applicable, clinical review criteria and rulings of law. The decision shall have the same force and effect as a final order of the commissioner and shall be enforceable pursuant to the penalty provisions of RSA 420-J:14. V. Expedited external review shall be conducted as follows: (a) Expedited external review shall be available when the covered person’s treating health care provider certifies to the commissioner that adherence to the time frames specified in paragraph IV would seriously jeopardize the life or health of the covered person or would jeopardize the covered person’s ability to regain maximum function.

(b) Except to the extent that it is inconsistent with the provisions of this subsection, all requirements for the conduct of standard external review specified in paragraph IV shall apply to expedited external review.

(c) At the time the commissioner receives a request for an expedited external review, the commissioner shall immediately make a determination whether the request meets the standard set forth in subparagraph V(a) for expedited external review, as well as the reviewability requirements set forth in subparagraph IV(a). If these conditions are met, the commissioner shall immediately notify the health carrier. If the request is not complete, the commissioner shall immediately contact the covered person or the covered person’s authorized representative and attempt to obtain the information or documents that are needed to make the request complete.

(d) The commissioner may select an independent review organization that is certified pursuant to paragraph VI to conduct the expedited external review. If an independent review organization is not selected to conduct the review, then the policies and procedures established by the commissioner for selecting clinical peer reviewers and conducting the review shall meet the minimum qualifications established under paragraph VII for certification of independent review organizations.

(e) The health carrier or its designated utilization review organization shall provide or transmit the documents and information specified in subparagraph IV(g) to the commissioner or the selected independent review organization by telephone, facsimile or any other available expeditious method within one day of receiving the commissioner’s notice of the request for expedited external review pursuant to subparagraph V(c).

(f) When handling a review on an expedited basis, the commissioner or the selected independent review organization shall make a decision and notify the carrier and the covered person as expeditiously as the covered person’s medical condition requires, but in no event more than 72 hours after the expedited external review is requested. The decision shall have the same force and effect as a final order of the commissioner and shall be enforceable pursuant to the penalty provisions of RSA 420-J:14.

(g) If the notice provided pursuant to subparagraph V(f) was not in writing, within 2 days after the date of providing that notice, the commissioner or the selected independent review organization shall:

(1) Provide written confirmation of the decision to the covered person or the covered person’s authorized representative and the health carrier; and

(2) Include the information set forth in subparagraph IV(k).

(h) Reviews that the health carrier handled on an expedited basis in its internal review process shall be handled on an expedited basis in the external review process.

(i) An expedited external review shall not be provided for determinations made by the health carrier on a retrospective basis.

(j) Continuation of benefits pending expedited external review shall be provided when appropriate and as determined by the commissioner.

VI. The certification of independent review organizations shall be conducted as follows:

(a) The commissioner shall certify independent review organizations eligible to be selected to conduct external reviews under this section to ensure that an independent review organization satisfies the minimum qualifications established under paragraph VII.

(b) The commissioner shall develop an application form for initially certifying and recertifying independent review organizations to conduct external reviews.

(c) Independent review organizations wishing to be certified shall submit the application form and include all documentation and information necessary for the commissioner to determine whether the independent review organization satisfies the minimum qualifications established under paragraph VII.

(d) The commissioner may determine that accreditation by a nationally recognized private accrediting entity with established and maintained standards for independent review organizations that meet or exceed the minimum qualifications established under paragraph VII is sufficient for certification under this paragraph.

(e) The commissioner shall maintain and periodically update a list of certified independent review organizations.

VII. To be certified under paragraph VI to conduct external reviews, an independent review organization shall meet the following minimum qualifications:

(a) It shall develop and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process.

(b) It shall establish and maintain a quality assurance program that:

(1) Ensures that external reviews are conducted within the specified time frames and required notices are provided in a timely manner;

(2) Ensures the selection of qualified and impartial clinical peer reviewers to conduct external reviews on behalf of the independent review organization with suitable matching of reviewers to specific cases;

(3) Ensures the confidentiality of medical and treatment records; and

(4) Ensures that any person employed by or under contract with the independent review organization adheres to the requirements of this section.

(c) It shall maintain a toll-free telephone service on a 24-hour, 7-day-a-week basis related to external reviews that is capable of accepting or recording information from, and providing appropriate instruction to callers.

(d) It shall agree to maintain and provide to the commissioner such information as may be required to fulfill the provisions and purposes of this section.

(e) It shall assign clinical peer reviewers to conduct external reviews who are physicians or other appropriate health care providers and who:

(1) Are experts in the treatment of the covered person’s medical condition that is the subject of the external review;

(2) Are knowledgeable about the recommended health care service or treatment through actual clinical experience;

(3) Hold a non-restricted license in a state of the United States and, for physicians, a current certification by a specialty board recognized by the American Board of Medical Specialties in the area or areas appropriate to the subject of the external review; (4) Have no history or disciplinary actions or sanctions that have been taken or are pending by any hospital, governmental agency, or regulatory body that raise a substantial question as to the clinical peer reviewer’s physical, mental or professional competence or moral character; and

(5) Have agreed to disclose any potential conflict of interest.

(f) It shall be free of any conflict of interest. To meet this qualification, an independent review organization may not own or control or in any way be owned or controlled by a health carrier, a national, state or local trade association of health carriers, or a national state or local trade association of health care providers. In addition, in order to qualify to conduct an external review of a specific case, neither the independent review organization selected to conduct the external review nor any clinical peer reviewer assigned by the independent organization to conduct the external review may have a material professional, familial or financial interest in any of the following:

(1) The health carrier that is the subject of the external review;

(2) Any officer, director or management employee of the health carrier that is the subject of the external review;

(3) The health care provider or the health care provider’s medical group or independent practice association recommending the health care service or treatment that is the subject of the external review;

(4) The facility at which the recommended health care service or treatment would be provided;

(5) The developer or manufacturer of the principal drug, device, procedure or other therapy being recommended for the covered person whose treatment is the subject of the external review; or

(6) The covered person or the covered person’s authorized representative. (g) For the purpose of allowing in-state health care providers to act as clinical peer reviewers in the conduct of external reviews, the commissioner may determine, in specific cases, that an affiliation with a hospital, an institution, an academic medical center, or a health carrier provider network does not in and of itself constitute a conflict of interest which is sufficient to preclude that provider from acting as a clinical peer reviewer, so long as the affiliation is disclosed to the covered person and the covered person has given his or her prior written consent.

(h) The following organizations shall not be eligible for certification to conduct external reviews:

(1) Professional or trade associations of health care providers;

(2) Subsidiaries or affiliates of such provider associations;

(3) Health carrier or health plan associations; and

(4) Subsidiaries or affiliates of health plan or health carrier associations.

VIII. A covered person shall: (a) Be provided with timely and adequate notice of his or her rights with respect to external review. (b) Have the right to be represented by any person, including the covered person’s treating provider, and to otherwise make use of outside assistance during the review process, to receive a copy of all documents, all information, and all clinical review criteria or other standards relied upon by the health carrier in making its determination, and to present to the commissioner or the selected independent review organization any information, including new information not previously considered by the health carrier, which the covered person believes to be relevant to the adjudication of the matter in dispute, provided that such information is simultaneously provided to the health carrier. (c) Be provided the opportunity, under standard external review, to present oral testimony to the independent review organization via teleconference. At any such hearing, the health carrier shall also have the opportunity to present oral testimony and to respond to issues raised. (d) Be protected from retaliation for exercising the right to an independent external review under this section. IX. The health carrier against which a request for external review is filed shall pay the cost of the external review. The commissioner shall ensure that such costs assessed to the health carrier are at all times reasonable in relation to the services provided. If the covered person is the prevailing party in the external review, the health carrier shall pay to the covered person the amount of any filing fee paid by the covered person.

X. The confidentiality of any health care information acquired or provided to the commissioner or an independent review organization shall be maintained, and the records, and internal materials prepared for specific reviews by the commissioner or an independent review organization under this section shall be exempt from public disclosure under RSA 91-A.

XI. No independent review organization or clinical peer reviewer working on behalf of an independent review organization shall be liable for damages to any person for any opinions rendered during or upon completion of an external review conducted pursuant to this section, unless the opinion was rendered in bad faith or involved gross negligence.

XII. The right to external review under this section shall not be construed to change the terms of coverage under a health benefit plan.

XIII. When requested by the covered person, the commissioner shall provide consumer assistance in pursuing the internal grievance procedures and the external review process under RSA 420-J:5 and this section.

XIV. The commissioner shall report annually to the governor and the legislature on the number of grievances subjected to external review, the number of decisions resolved wholly or partially in favor of the covered person, the number of decisions resolved wholly or partially in favor of the health carrier, and any common themes or issues that may require legislative action.

XV. The commissioner shall report annually to the New Hampshire board of medicine the names of the medical directors responsible for determinations that resulted in external review and the outcomes of such external reviews. 14 New Paragraphs; Provider Contract Standards. Amend RSA 420-J:8 by inserting after paragraph VI the following new paragraphs: VII. No contract between a health carrier and a participating provider shall contain any payment or reimbursement provision the terms of which create incentives for the provider to limit medically necessary care to covered persons. Nothing in this section shall be construed to prohibit the use of payment arrangements between a health carrier and a participating provider or provider group which involve capitation or withholds. VIII. A health carrier shall provide to consumers, upon request, a description, in general terms, of the types of payment and reimbursement provisions contained in its contracts with participating providers. Such descriptions shall be set forth in clear, understandable language and shall, at a minimum, convey basic information about any financial incentives to providers that may directly or indirectly have the effect of reducing or limiting services to covered persons. IX. Every contract between a health carrier and a participating provider shall provide that the health carrier may not remove a health care provider from its network or refuse to renew the health care provider with its network for advocating on behalf of a covered person for medically necessary care for the covered person. 15 Repeal. RSA 420-J:5, VIII and IX, relative to an external process and annual report, are hereby repealed. 16 Effective Date. This act shall take effect 60 days after its passage.

1999-1325s

AMENDED ANALYSIS

This bill creates an independent external consumer appeal process to review certain determinations made by managed care entities. The bill requires health carriers that conduct utilization review and licensed utilization review entities to employ a medical director and amends the definition of the practice of medicine to include the making of certain medical necessity determinations. The bill prohibits contracts between health carriers and participating providers from including provisions that create financial incentives to deny medically necessary care. The bill also requires that health insurers disclose certain information necessary for consumers to hold managed care entities accountable for health care treatment decisions.

Senator Squires offered a floor amendment.

1999-1341s

01/09

Floor Amendment to SB 199

Amend the bill by replacing sections 3 and 4 with the following:

3 New Section; Medical Directors Required. Amend RSA 420-E by inserting after section 2 the following new section:

420-E:2-a Medical Director. Every medical utilization review entity licensed by the department under this chapter shall employ a medical director, as defined in RSA 420-J:3, XXV-a, licensed under RSA 329, who shall have final responsibility for the utilization system and its administration and implementation, including utilization review decisions affecting health care services provided to beneficiaries.

4 New Paragraph; Definition Added. Amend RSA 420-J:3 by inserting after paragraph XXV the following new paragraph:

XXV-a. "Medical director" means a physician licensed under RSA 329 and employed by a health carrier or medical utilization review entity who is responsible for the utilization review techniques and methods of the health carrier or medical utilization review entity and their administration and implementation, including utilization review decisions affecting health care services provided to covered persons under a health benefit plan. The qualifications the medical director shall possess shall include, but not be limited to the following:

(a) Be licensed under RSA 329.

(b) Meet credentialing requirements equivalent to those met by plan providers.

(c) Be familiar with local medical practices and standards in the plan’s service area.

(d) Be knowledgeable concerning the applicable accreditation or "program approval" standards for preferred provider organizations and health maintenance organizations.

(e) Demonstrate knowledge of risk management standards.

(f) Be able to review, advise, and take action on questionable hospital admissions, medically unnecessary days, and all other medical care cost issues.

Amend the bill by inserting after section 14 the following and renumbering the original sections 15-16 to read as 17-18, respectively:

15 New Section; Notification of Denial of Claims. Amend RSA 329 by inserting after section 9-e the following new section:

329:9-f Notification of Denial of Claims.

I. A covered person’s treating physician may notify the board of any claim which has been denied by a medical director, as defined in RSA 420-J:3, XXV-a, which denial is contrary to the advice of the covered person’s treating physician. The notice shall be in a form adopted pursuant to rules under RSA 541-A and shall include, but not be limited, to the following information:

(a) A patient identifier.

(b) Diagnosis.

(c) Recommendation of the treating physician.

(d) Recommendation of the medical director.

(e) Any second opinions.

II. The board shall, on an annual basis beginning on or before November 2000, submit a list of such notifications to the insurance commissioner. The list shall contain the doctors’ names, the health benefit plan, the number of denials per medical director, and the medical directors’ names. The list compiled pursuant to this paragraph shall not include any patient identifiers.

16 New Paragraph; Rulemaking Added. Amend RSA 329:9 by inserting after paragraph XV the following new paragraph:

XV-a. Format of the form required under RSA 329:9-f.

SB 54-FN, relative to partial birth abortion. Public Institutions, Health and Human Services Committee.

MINORITY REPORT: Ought to pass with amendment, Senator Krueger for the committee. Vote 1-5

MAJORITY REPORT: Inexpedient to Legislate, Senator Wheeler for the committee. Vote 5-1

1999-1315s

01/03

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

1 New Subparagraph; Discipline of Physicians; Grounds Added. Amend RSA 329:17, VI by inserting after subparagraph (k) the following new subparagraph:

(l) Has violated RSA 329:32, relative to performing certain abortions.

2 New Section; Certain Abortions Prohibited. Amend RSA 329 by inserting after section 31 the following new section:

329:32 Certain Abortions Prohibited.

I. In this section:

(a) "Abortion" means the intentional use of an instrument, drug, or other substance or device to terminate a woman’s pregnancy.

(b) "Partial-birth abortion" means an abortion in which the physician or individual acting under the delegatory authority of the physician performing the abortion partially vaginally delivers a living fetus before killing the fetus and completing the delivery.

(c) The terms "fetus" and "infant" are interchangeable.

II. Any person who knowingly performs a partial-birth abortion and thereby kills a human fetus or infant shall be guilty of a class B felony. Notwithstanding the provisions of RSA 651:2, a person found guilty under this paragraph may be fined up to $100,000 or be imprisoned for not more than 2 years, or both.

III. Paragraph II shall not apply to a partial-birth abortion that is necessary to save the life of a mother because her life is endangered by a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, if no other medical procedure would suffice for that purpose.

IV. A woman upon whom a partial-birth abortion is performed shall not be prosecuted under this section for a conspiracy to violate this section.

3 Effective Date. This act shall take effect January 1, 2000.

1999-1315s

AMENDED ANALYSIS

The bill prohibits certain abortions.

The following Senators voted No: Gordon, Fraser, Below, McCarley, Trombly, Blaisdell, Fernald, Squires, Pignatelli, Larsen, Russman, D’Allesandro, Wheeler, Klemm, Hollingworth, Cohen.

SB 214-FN, establishing new procedures under the certificate of need law for certain ambulatory surgical facilities. Public Institutions, Health and Human Services Committee.

SPLIT REPORT: Ought to pass with amendment, Senator Squires for the committee. Vote 3-3

SPLIT REPORT: Ought to pass with amendment, Senator Wheeler for the committee. Vote 3-3

1999-1322s

01/10

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

AN ACT establishing a committee to study the health services planning and review board and relative to the certificate of need process.

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

1 Legislative Findings; Public Interest; Review and Assessment of New Health Services. RSA 151-C:1, III is repealed and reenacted to read as follows:

III. The general court recognizes the fact that many New Hampshire citizens receive surgical care in facilities not directly related to, or connected with, the traditional hospital setting. The past few years have witnessed a steady increase in the development of ambulatory surgery centers that, as a result of technical and scientific advances, offer patients surgical care that only a short time ago required overnight stays. The general court further recognizes that, as a result of prior legislation, the construction of ambulatory surgery centers has been subject to review by the health services planning and review board through the certificate of need process. While it is acknowledged that a competitive environment for the provision of surgical services may be in the public’s interest, there is ample evidence to support the belief that New Hampshire citizens have been well served by the institution of the community hospital. Community hospitals of a small size are particularly vulnerable to economic pressures that may ensue following construction of ambulatory surgical centers. Finally, public testimony has been presented suggesting that the certificate of need process, as applied to ambulatory surgery centers, requires examination and review to ensure that all parties are treated in a fair and impartial manner. These concerns and issues have, on occasion, resulted in a difficult and adversarial environment in which physicians and hospitals find themselves at odds with one another whereas the general court feels that, collaboration and cooperation should be encouraged and fostered.

2 Members of the Board. Amend RSA 151-C:3, I(a)(2)(B) and (c) to read as follows:

(B) [Three] Four consumers, each from a different region of the state. For the purposes of this subparagraph "consumer" means an individual whose occupation is not in the delivery of health care services, who has no fiduciary obligation or financial interest in any health care facility or health care insurer licensed or regulated by this state, and who is not related in their immediate family to anyone who is involved in the delivery of health care services or health insurance.

(C) [Two] Three providers whose occupation is in the delivery of health care services regulated by the board. One of these providers shall be nominated by the New Hampshire Hospital Association. The [other] second provider shall be nominated by the New Hampshire Health Care Association. The third provider shall be nominated by the New Hampshire Ambulatory Surgery Association.

3 Terms. Amend RSA 151-C:3, I(b) to read as follows:

(b) The commissioner of the department of health and human services or designee shall serve as the only permanent member of the board. All other members of the board shall serve only for one 3-year term, provided that of the initial members, the representative of health care insurers and one consumer shall serve for one year, one consumer and one provider shall serve for 2 years and one consumer and one provider shall serve for 3 years. Members of the board are not eligible for reappointment upon expiration of their terms.

4 Staff; Meetings. Amend RSA 151-C:3, VII to read as follows:

VII.(a) The commissioner of the department of health and human services shall provide staff to support the work of the board and shall appoint, from among the staff, a person to serve as staff director who shall oversee the staff and act as liaison between the commissioner and the board. The staff director shall also testify at public hearings to defend staff analyses and recommendations to the board. The commissioner shall also provide space for the board and staff and other assistance and materials as necessary; provided, that all meetings of the board shall take place on government property owned or leased by the state of New Hampshire.

(b) The staff director shall account to the commissioner of the department of health and human services for the administration of funds allocated under this chapter, for the conduct of the staff, and shall timely and appropriately execute his or her duties.

5 Committee Established. There is established a committee to study RSA 151-C and the structure and duties of the health services planning and review board.

6 Membership and Compensation.

I. The members of the committee shall be as follows:

(a) Three members of the senate, appointed by the president of the senate.

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

II. Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.

7 Duties. The committee’s study shall include, but not be limited to;

I. A review of RSA 151-C and a review of the structure and duties of the health services planning and review board.

II. The role of ambulatory surgical centers and other advancements in medical technology which are currently changing the environment of health care.

8 Chairperson; Quorum. 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 senate member. The first meeting of the committee shall be held within 45 days of the effective date of this section. Four members of the committee shall constitute a quorum.

9 Report. The committee shall report its findings and any recommendations for proposed legislation to the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library on or before November 1, 1999.

10 Applicability. If the court remands the case of Appeal of Central NH Ambulatory Surgical Center to the health services planing and review board for further review, such case shall be reviewed by the board as it was constituted before the effective date of this act and considered under the threshold amounts in effect before the effective date of this act.

11 Effective Date. This act shall take effect upon its passage.

1999-1322s

AMENDED ANALYSIS

This bill requires the health services planning and review board to meet on government property owned by the state of New Hampshire.

This bill establishes a committee to study the structure and duties of the health planning services planning and review board.

1999-1321s

01/10

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

AN ACT relative to ambulatory surgical facilities and establishing a committee to study the health services planning and review board.

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

1 Members of the Board. Amend RSA 151-C:3, I(a)(2)(B) and (c) to read as follows:

(B) [Three] Four consumers, each from a different region of the state. For the purposes of this subparagraph "consumer" means an individual whose occupation is not in the delivery of health care services, who has no fiduciary obligation or financial interest in any health care facility or health care insurer licensed or regulated by this state, and who is not related in their immediate family to anyone who is involved in the delivery of health care services or health insurance.

(C) [Two] Three providers whose occupation is in the delivery of health care services regulated by the board. One of these providers shall be nominated by the New Hampshire Hospital Association. The [other] second provider shall be nominated by the New Hampshire Health Care Association. The third provider shall be nominated by the New Hampshire Ambulatory Surgery Association.

2 Terms. Amend RSA 151-C:3, I(b) to read as follows:

(b) The commissioner of the department of health and human services or designee shall serve as the only permanent member of the board. All other members of the board shall serve [only for one] 3-year [term] terms, provided that of the initial members, the representative of health care insurers and one consumer shall serve for one year, one consumer and one provider shall serve for 2 years and one consumer and one provider shall serve for 3 years. Members of the board shall not serve more than 2 full consecutive terms.

3 Staff; Meetings. Amend RSA 151-C:3, VII to read as follows:

VII.(a) The commissioner of the department of health and human services shall provide staff to support the work of the board and shall appoint, from among the staff, a person to serve as staff director who shall oversee the staff and act as liaison between the commissioner and the board. The staff director shall also testify at public hearings to defend staff analyses and recommendations to the board. The commissioner shall also provide space for the board and staff and other assistance and materials as necessary; provided, that all meetings of the board shall take place on government property owned or leased by the state of New Hampshire. Notwithstanding this paragraph or any other provision of law to the contrary, the staff members shall report to the board.

(b) The staff director shall account to the commissioner of the department of health and human services for the administration of funds allocated under this chapter, for the conduct of the staff, and shall timely and appropriately execute his or her duties.

4 Ambulatory Surgical Facilities. Amend RSA 151-C:5, II(f) to read as follows:

(f) Except as provided in subparagraph (g), the construction, development, expansion, renovation, or alteration of any nursing home, ambulatory surgical facility, rehabilitation hospital, psychiatric hospital, specialty hospital, or other health care facility requiring a capital expenditure of more than $1,000,000. The board shall, by rule, adjust the capital expenditure threshold annually using an appropriate inflation index;

(g) The construction, development, expansion, renovation, or alteration of any ambulatory surgical facility which results in the addition of an operating room and having a capital cost of $250,000 or more; provided, that such conduct shall not require the application of such standards if it has been the subject of a public hearing and no health care facility whose service area includes any area to be served by such facility has objected in writing within 15 days following such hearing.

5 New Paragraph; Definition Added. Amend RSA 151-C:2 by inserting after paragraph XXVI the following new paragraph:

XXVI-a. For the purposes of RSA 151-C:5, II(g), "operating room" means any room in a licensed hospital or ambulatory surgical facility equipped and used to perform outpatient surgical cases.

6 Ambulatory Surgical Facility; Definition. Amend RSA 151-C:2, I to read as follows:

I. "Ambulatory surgical facility" means a health care facility [which is not physically attached to a health care facility and] or a portion of a health care facility which provides surgical treatment to patients not requiring hospitalization, and does not include the offices of private physicians or dentists, whether in individual or group practices.

7 References Changed. Amend RSA 151-C:13, I(f) to read as follows:

(f) Facilities and services which are intended to serve only outpatients and which do not require construction of greater than the appropriate threshold level, as determined under RSA 151-C:5, II(a) [or RSA 151-C:5, II], (f) or (g) or new equipment costing more than $400,000;

8 Applicability. The provisions of sections 4-7 and 9 of this act shall not apply to applications or requests filed before January 1, 1999, or to applications or requests filed after January 1, 1999 and finally acted upon by the board in public hearing prior to the effective date of this act.

9 Reference Addition. Amend RSA 151-C:2, XII to read as follows:

XII. "Construction" includes actual commencement of any construction or fabrication of any new building, or addition to any existing facility, or any expenditure of more than the appropriate threshold level, as determined under RSA 151-C:5, II(a) [or RSA 151-C:5, II], (f) and (g), relating to the alteration, remodeling, renovation, modernization, improvement, relocation, repair, or replacement of a health care facility or health maintenance organization, including expenditures necessary for compliance with life and health safety codes.

10 Committee Established. There is established a committee to study the structure and duties of the health services planning and review board.

11 Membership and Compensation.

I. The members of the committee shall be as follows:

(a) Three members of the senate, appointed by the president of the senate.

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

II. Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.

12 Duties. The committee’s study shall include, but not be limited to, a review of the structure and duties of the health services planning and review board, a review of RSA 151-C, and methods for expedited review.

13 Chairperson; Quorum. 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 senate member. The first meeting of the committee shall be held within 45 days of the effective date of this section. Four members of the committee shall constitute a quorum.

14 Report. The committee shall report its findings and any recommendations for proposed legislation to the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library on or before December 1, 1999.

15 Effective Date. This act shall take effect upon its passage.

1999-1321s

AMENDED ANALYSIS

This bill requires the health services planning and review board to meet on government property owned by the state of New Hampshire. The bill establishes new procedures for developing standards under the certificate of need law for ambulatory surgical facilities. The bill also establishes a committee to study the structure and duties of the health services planning and review board.

SB 219-FN-L, establishing a procedure for providing educational improvement assistance to local school districts. Education Committee. Vote 5-2. Ought to pass with amendment, Senator McCarley for the committee.

1999-1339s

04/01

Amend the bill by replacing all after section 1 with the following:

2 Adequate Public Education; Delivery of an Adequate Public Education; Local Educational Improvement Plan. RSA 193-E:3 is repealed and reenacted to read as follows:

193-E:3 Delivery of an Adequate Education. In order to implement New Hampshire’s policy of providing all students with the opportunity to acquire an adequate education, each school district shall put in place and evaluate the following quality standards:

I. By June 30, 2001, and every 3 years thereafter, each school district, through a process involving parents, teachers, employers, and other community members, shall prepare and implement a local education improvement and assessment plan and file such plan with the department of education. The department of education shall comment to the district on the plan in a timely fashion. Districts may reference the statewide education improvement and assessment plan established in RSA 193-E:4, VII, in preparing the district plan. At a minimum, the plan shall include:

(a) Curriculum and proficiency standards for all students.

(b) School and district performance goals based on reported data on educational indicators listed in paragraph II.

(c) Procedures for aligning curriculum, instructional practices, and student and programmatic assessments, including annual reporting of results.

(d) Local assessment measures which focus on individual student performance.

(e) Role of support services and programs.

(f) Role of instructional leadership.

(g) Strategies to promote family and community involvement; and

(h) Staff supervision and evaluation and performance-based professional development.

II.(a) By July 15, 2000, each school district shall report to the department of education its data for the previous school year on its school and district performance indicators. The requirements for data keeping and the form of the report shall be established in accordance with rules adopted by the state board of education. Performance indicators shall include the following areas:

(1) Attendance and dropout rates.

(2) School environment indicators, such as safe-school data.

(3) Proportion of graduating students going on to post-secondary education, military service, and the workplace; and

(4) Performance on state tests administered pursuant to RSA 193-C and other standardized tests administered at local option.

(b) In addition, local districts shall report on locally developed performance indicators and assessment measures.

III. Each public elementary, middle, junior high, and high school in the school district shall meet the standards for school approval adopted by the state board of education.

IV. Beginning December 1, 2001, and annually thereafter, the commissioner of education shall determine the extent to which each school district is meeting the quality standards established in paragraphs I, II, and III of this section. A school district that meets or exceeds the quality standards shall be recognized in accordance with RSA 193-E:4, II. A school district that does not meet the quality standards shall be designated by the commissioner of education as a school district in need of assistance. Each year, the commissioner of education shall provide a report of such determinations to the governor and council, state board of education, speaker of the house, president of the senate, and chairs of the house and senate committees responsible for education and finance.

V. Beginning no later than December 1, 2000, and annually thereafter, the department of education shall issue a report on the condition of education statewide and on a district-by-district and school-by-school basis. This report shall include demographic and student performance data including, but not limited to, school and district performance on state tests administered pursuant to RSA 193-C, other standardized tests administered at local option by at least 25 percent of school districts, data provided under paragraph I of this section, as well as other relevant statistics. Comparisons with state averages and with the condition of each district and school in comparison with previous years shall be provided, including, but not limited to, statewide rankings of each district and school on the state tests administered pursuant to RSA 193-C and on other standardized tests administered at local option by at least 25 percent of the school districts. The report shall be organized and presented in a manner that is easily understood by the public and that assists each school board with the identification of trends, strengths, and weaknesses and the development of its local education improvement and assessment plan.

3 New Sections; Adequate Public Education; Education Improvement Assistance to Local School Districts. Amend RSA 193-E by inserting after section 3 the following new sections:

193-E:4 Educational Assistance to Local School Districts.

I. Within 60 days of the issuance of the annual report on the condition of education as provided in RSA 193-E:3, V each school board shall provide an opportunity for public discussion of the report at a meeting of the board called for the exclusive purpose of reviewing the report. At least 7 days advance public notice shall be given.

II. A school district that has been identified pursuant to RSA 193-E:3, IV as meeting or exceeding the quality standards shall receive formal recognition from the state board of education and the governor. Any school district, school, or teacher that demonstrates a best practice worthy of recognition shall also receive formal recognition from the state board of education and the governor. Such school districts, schools, or teachers shall be eligible to apply for grants from a special projects and improvement fund administered by the department of education pursuant to RSA 193-E:5, VII.

III.(a) A school board, in response to the annual report on the condition of education, may request from the department of education the assistance available under paragraph IV.

(1) If a school board requests assistance on behalf of a school district that has not been designated as a school district in need of assistance pursuant to RSA 193-E:3, IV, then the assistance requested under paragraph IV to be provided by the department of education shall be based on the availability of resources as determined by the commissioner of education.

(2) If a school board requests assistance on behalf of a school district that has been designated as a school district in need of assistance, then the school or district shall receive assistance from the department of education in accordance with subparagraph IV(a)(2).

(b) If a school board has received notice pursuant to paragraph VI, then the school district shall receive assistance from the department of education in accordance with subparagraph IV(a)(3).

IV. The department of education and the state board of education shall work cooperatively with school boards to provide assistance as follows:

(a)(1) Within 30 days of a school board’s request for assistance pursuant to subparagraph III(a)(1), the commissioner of education may appoint a quality assurance team to review the educational programming and effectiveness of the school district. In cooperation with local officials, the team shall prepare and present a report at a regularly scheduled public meeting of the local school board and to the state board of education. This report shall be issued within 4 months of the team’s appointment. Based on this report, the local school board and superintendent shall, within 6 months of the issuance of the report, prepare a corrective action plan and submit it to the state board of education for approval. If the plan is not approved, the local school board may revise the plan and resubmit it to the state board. The school board may decide to implement the corrective action plan on its own, through the use of a technical assistance advisor, or through the use of a peer review team. Any such decision shall be included in the corrective action plan.

(2) Within 30 days of a school board’s request for assistance pursuant to subparagraph III(a)(2), the commissioner of education shall appoint a quality assurance team to review the educational programming and effectiveness of the school district. In cooperation with local officials, the team shall prepare and present a report at a regularly scheduled public meeting of the local school board and to the state board of education. This report shall be issued within 4 months of the team’s appointment. Based on this report, the local school board and superintendent shall, within 6 months of the issuance of the report, prepare a corrective action plan and submit it to the state board of education for approval. The school board may decide to implement the corrective action plan on its own, through the use of a technical assistance advisor, or through the use of a peer review team. Any such decision shall be included in the corrective action plan.

(3) Within 30 days of the issuance of a notice to a school board pursuant to paragraph VI, the commissioner of education shall appoint a quality assurance team to review the educational programming and effectiveness of the school district. In cooperation with local officials, the team shall prepare and present a report at a regularly scheduled public meeting of the local school board and to the state board of education. This report shall be issued within 4 months of the team’s appointment. Based on this report, the local school board and superintendent shall, within 6 months of the issuance of the report, prepare a corrective action plan and submit it to the state board of education for approval. The school board may decide to implement the corrective action plan on its own, through the use of a technical assistance advisor, or through the use of a peer review team. Any such decision shall be included in the corrective action plan.

(b) If the state board of education does not approve a corrective action plan submitted in accordance with subparagraphs IV(a)(2) or IV(a)(3), then the commissioner of education shall work with the local school board and superintendent to revise the corrective action plan. If the local school board and superintendent do not revise the corrective action plan within 2 months or the state board of education does not approve the revised corrective action plan, then the commissioner of education shall submit in a timely manner a corrective action plan, including methods for implementing it, to the state board of education for approval without further action of the local school board.

(c) If an approved corrective action plan includes the use of a technical assistance advisor, then the commissioner of education shall appoint a technical assistance advisor who is authorized to access the state special projects and improvement fund to provide assistance to local school district staff in the implementation of the corrective action plan until the goals of the corrective action plan are met.

(d) If an approved corrective action plan includes the use of a peer review team, then the commissioner of education shall name a peer review team consisting of one person appointed by the chairperson of the local school board, one person appointed by the chairperson of the state board of education, and a third member chosen by the local school board and state board of education appointees to advise the school district’s superintendent and the local school board relative to the implementation of the corrective action plan until the goals of the corrective action plan are met.

V. If, by the time of the annual school district meeting or by April 30 in a city with a dependent school department, the school board of a school district in which a school district has been designated as a school district in need of assistance pursuant to RSA 193-E:3, IV has not submitted a request for assistance under paragraph III, then the legislative body of the school district may vote to direct the school board to submit a request for assistance under paragraph III. If a majority of the legislative body votes in favor of requesting assistance, then that assistance shall be requested and provided in accordance with paragraphs III and IV.

VI. A school board shall have one year from the date that a school district has been designated as a school district in need of assistance pursuant to RSA 193-E:3, IV to remedy identified problems at the local level. If the school district is designated as a school district in need of assistance and the school board does not request assistance under paragraph III within one year of such designation, then on December 1 of the year following the designation, if the school district continues to be designated as a school district in need of assistance, the commissioner of education shall issue a notice to the school board and shall initiate a process for providing assistance pursuant to subparagraph IV(a)(3), without further action of the school board.

193-E:5 Assistance to Local School Districts.

I. By June 30, 2000, and every 3 years thereafter, the state board of education through a process that provides opportunities for public input from parents, employers, educators, and other citizens shall review and update the statewide education improvement plan developed in accordance with RSA 193-C that describes how the department of education will help schools and school districts improve student achievement. The plan shall include goals and strategies for the delivery of technical assistance and professional development, the sharing of best practices, the modification or expansion of existing programs, and the establishment of new programs.

II.(a) Notwithstanding any other provisions of law, no later than June 30, 2001, and every 5 years thereafter, the state board of education shall review and update school approval standards based on input from parents, employers, educators and other citizens.

(b) The state board of education shall work with a joint select committee of the house and senate education committees, whose members shall be appointed by the speaker of the house and the president of the senate, to identify amendments that should be made to the school approval standards to reflect the provisions of RSA 193-E. Further, any proposed amendments shall consider the recommendations of the adequate education and education financing commission established in RSA 198:49 and should be reviewed by the house and senate education committees, which may submit comments on the proposed amendments to the state board of education. The state board of education shall consider such recommendations and comments in adopting amendments to the school approval standards pursuant to RSA 541-A.

III. Beginning no later than January 1, 2000 the commissioner of education shall ensure that the state curriculum frameworks adopted under RSA 193-C shall be reviewed on a staggered, 5-year cycle such that no more than 2 frameworks are being reviewed at the same time. In order to provide reliable annual comparisons of data at the school and district levels, the statewide improvement and assessment program shall be expanded to include more than the 3 grades required under RSA 193-C:6.

IV. No later than January 1, 2000, the state board of education shall adopt rules, pursuant to RSA 541-A, establishing the requirements for data keeping and the form of the report as required in RSA 193-E:3, II.

V. No later than December 1, 2000, the state board of education shall adopt rules, pursuant to RSA 541-A, for the approval of corrective action plans as required by RSA 193-E:4, IV(a).

VI. The department of education shall implement credible procedures to review compliance with school approval standards.

VII. A special projects and improvement fund shall be established in the department of education and continually appropriated to the department. The department of education shall use moneys appropriated for this fund to provide grants to school districts pursuant to RSA 193-E:4, II. The department of education shall also use moneys appropriated for this fund to support the implementation of approved corrective action plans. The technical assistance advisor assigned to work in school districts pursuant to subparagraph IV(c) shall be authorized to access this fund in accordance with procedures established by the department of education.

193-E:6 Legislative Oversight Committee.

I. An oversight committee shall be established consisting of:

(a) The chairperson of the house education committee, or a designee.

(b) The chairperson of the senate education committee, or a designee.

(c) One member of the house of representatives, appointed by the speaker of the house.

(d) One member of the senate, appointed by the senate president.

(e) One member of the house finance committee, appointed by the speaker of the house.

(f) One member of the senate finance committee, appointed by the senate president.

II. The chair of the oversight committee shall rotate biennially between the chairperson of the house education committee and the chairperson of the senate education committee. The first chairperson shall be the chairperson of the house education committee. A member shall only serve while a member of the general court. The members shall not be compensated but shall receive mileage at the legislative rate when carrying out their duties.

III. The oversight committee shall examine the goals, purposes, organization, operation, and financing of the state’s program to provide a constitutionally adequate education, and it shall evaluate and make recommendations for the continued provisions and improvement of the program.

IV. The oversight committee shall review the development and implementation of the program to ensure that they are in accordance with legislative policy.

V. The oversight committee shall submit a report to the general court by June 30, of each even-numbered year. Copies of the report shall be submitted to the governor, the senate finance and education committees, the house finance and education committees, the department of education, the department of revenue administration and to any other individual or organization as the committee deems advisable.

193-E:7 Enforcement. The attorney general has authority to enforce the provisions of this act in accordance with New Hampshire law through appropriate civil and equitable relief, including but not limited to injunctive relief.

4 Repeal. RSA 194:23-d, relative to state financial aid to elementary schools and high schools which are approved by the state board of education, is repealed.

5 Effective Date. This act shall take effect July 1, 1999.

SB 108, relative to the dispensing of medications by optometrists. Public Institutions, Health and Human Services Committee.

MINORITY REPORT: Ought to pass with amendment, Senator Gordon for the committee. Vote 3-3

MAJORITY REPORT: Ought to pass with amendment, Senator Squires for the committee. Vote 4-2

1999-1331s

10/09

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

AN ACT relative to the co-management of primary open-angle glaucoma.

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

1 Statement of Purpose. The general court finds that as the state’s health care delivery system becomes more complex, there is a need to assure high quality eye care including the preservation of appropriate safe guards and the maintenance of consumer confidence. Purchasers of health insurance are demanding high quality eye care from health plans and providers. Eye care providers strive for high quality by incorporating evidence-based medical knowledge with the needs and desires of patients. The co-management of glaucoma patients by optometrists and ophthalmologists will serve to increase the likelihood of desired health outcomes, consistent with current professional standards, and may provide measurable data upon which a decision about future legislation can be based.

2 Definition Modified; Pharmaceutical Agent. Amend RSA 327:1, III(d) to read as follows:

(d) Antibiotics, sulfonamides, and combinations thereof, which are topically applied or orally administered to treat or alleviate the effects of disease or abnormal conditions of the human eye, adnexa, and eyelids, excluding treatment of [the lacrimal drainage system,] the lacrimal gland, or structures posterior to the iris, approved by the joint pharmaceutical formulary board and included in the formulary.

3 Definition Modified; Pharmaceutical Agent. Amend RSA 327:1, III(h) to read as follows:

(h) Orally administered analgesic agents used for the purpose of alleviating pain caused by a disease or abnormal condition of the human eye or eyelid, excluding treatment of [the lacrimal drainage system,] the lacrimal gland, or structures posterior to the iris. This may include class III and IV controlled substances approved by the joint pharmaceutical formulary board and included in the formulary.

4 New Subparagraphs; Pharmaceutical Agent. Amend RSA 327:1, III by inserting after subparagraph (j) the following new subparagraphs:

(k) Anti-glaucoma agents which are topically applied or orally administered, provided that the anti-glaucoma agents are administered in accordance with RSA 327:1-a and RSA 327:1-b.

(l) Antivirals which are topically applied or orally administered, and corticosteroids which are topically applied, subject to the condition that the pharmaceutically certified optometrist shall consult with a licensed ophthalmologist with whom he or she has a co-management relationship when proscribing antivirals or corticosteroids. The consultation shall be in a manner to be determined by the ophthalmologist.

5 New Sections; Co-Management of Primary Open-Angle Glaucoma; Quality Assurance Committee. Amend RSA 327 by inserting after section 1 the following new sections:

327:1-a Co-Management of Primary Open-Angle Glaucoma. A pharmaceutically certified optometrist may treat primary open-angle glaucoma upon diagnosis subject to the following conditions:

I. Prior to initiating treatment for primary open-angle glaucoma, a pharmaceutically certified optometrist shall establish a relationship with a licensed ophthalmologist for the purpose of co-managing a glaucoma patient and shall provide such patient with written disclosure regarding such relationship.

II. A pharmaceutically certified optometrist shall exercise the current standard of care when diagnosing, treating, and co-managing glaucoma and shall consider all appropriate factors which shall include, but not be limited to:

(a) Assessment of intraocular pressure.

(b) Optic nerve head cupping and appearance.

(c) Nerve fiber layer changes.

(d) Automated threshold visual field analysis.

(e) Evaluation of the anterior chamber angle.

III. A pharmaceutically certified optometrist shall consult with a co-managing licensed ophthalmologist or another ophthalmologist of the patient’s choosing, in a manner to be determined by the ophthalmologist, prior to initiating pharmaceutical treatment of primary open-angle glaucoma.

IV. A pharmaceutically certified optometrist and a co-managing licensed ophthalmologist shall jointly agree to protocols and develop a written individualized treatment plan in accordance with currently accepted standards of care, which is agreed to by both the ophthalmologist and the optometrist and includes but is not limited to the following:

(a) Results of the tests and examinations that led to the diagnosis;

(b) Target intraocular pressures;

(c) Types of medications to be used;

(d) A schedule of follow-up visits with the ophthalmologist;

(e) Surgical referral criteria; and

(f) A schedule for a periodic consultation with the co-managing licensed ophthalmologist, in a manner to be determined by the ophthalmologist, to occur at least once every 12 months.

V. A treatment plan developed under this section may be modified after both the optometrist and ophthalmologist agree to the modification.

VI. If the results of a treatment plan do not meet the target goals within a time frame currently accepted as the medical standard of care in the treatment and management of primary open-angle glaucoma, a pharmaceutically certified optometrist shall immediately consult with the co-managing licensed ophthalmologist in a manner to be determined by the ophthalmologist.

VII. A pharmaceutically certified optometrist who co-manages primary open-angle glaucoma with a licensed ophthalmologist under the provisions of this section shall provide such ophthalmologist with written reports throughout the co-management period as requested by the ophthalmologist.

VIII. Notwithstanding any other provision of law, a pharmaceutically certified optometrist may initiate emergency treatment for acute angle closure glaucoma and shall immediately refer the patient to a licensed ophthalmologist.

IX.(a) The board shall determine the composition of the glaucoma co-management case reporting forms with recommendations from the glaucoma co-management quality assurance committee established under RSA 327:1-b.

(b) One form shall be required for each open-angle glaucoma patient, with a code for patient and case identification in order to identify the referring optometrist and to maintain patient confidentiality. Each reporting form shall be submitted to the glaucoma co-management quality assurance committee. The reporting forms shall include at least the following information:

(1) The names and signatures of the optometrist and ophthalmologist;

(2) The optometrist’s initial diagnosis, proposed treatment plan, and target intraocular pressure;

(3) Written results of tests, examinations, copies of visual field tests, and any other supporting documentation from the patient’s medical record;

(4) The actual treatment plan and target intraocular pressure agreed upon by the optometrist and ophthalmologist; and

(5) A section for the members of the glaucoma co-management quality assurance committee to indicate the results of their review and evaluation of the case.

327:1-b Glaucoma Co-Management Quality Assurance Committee.

I. There is hereby established a glaucoma co-management quality assurance committee. The committee shall consist of 2 New Hampshire licensed pharmaceutically certified optometrists appointed by the New Hampshire board of registration in optometry, 2 New Hampshire licensed ophthalmologists appointed by the New Hampshire board of medicine, and a licensed pharmacist nominated by the New Hampshire pharmacy board who shall serve as chair. The committee shall evaluate each case submitted for completeness and appropriateness of documentation and the appropriateness of the diagnosis and treatment plan.

II. The committee shall meet annually in Concord in a state-owned facility and shall issue an annual report of its findings and conclusions relative to the total patient outcomes with respect to treatment of primary open-angle glaucoma on or before December 1, 2001 to the speaker of the house, the senate president, the New Hampshire board of registration in optometry, the New Hampshire board of medicine, and appropriate committee chairs of both houses. The report shall include, but not be limited the following information:

(a) A summary of the case evaluations by the committee members;

(b) The number of patients co-managed under the provisions of RSA 327:1-a;

(c) The number of optometrists and ophthalmologists co-managing patients under the provisions of RSA 327:1-a.

(d) The number of new cases of primary open-angle glaucoma; and

(e) A summary of the outcomes of the co-managed patients.

6 New Paragraph; Authorization; Use of Certain Pharmaceutical Agents. Amend RSA 327:6-a by inserting after paragraph V the following new paragraph:

VI. Notwithstanding any other law to the contrary, an optometrist who is not certified to use pharmaceutical agents in the practice of optometry may use topically applied anesthetics, dyes, mydriatics, and cycloplegics for diagnostic purposes only.

7 New Paragraphs; Rulemaking Authority. Amend RSA 327:31 by inserting after paragraph IX the following new paragraphs:

X. The composition and format of the glaucoma co-management case reporting forms as recommended by the glaucoma co-management quality assurance committee.

XI. Procedures for the glaucoma co-management quality assurance committee to collect data, evaluate case reports, and submit annual reports.

XII. A method for tracking the number of glaucoma cases.

8 Repeal. The unnumbered concluding paragraph of RSA 327:1, IV, relative to the exclusion from the definition of the practice of optometry of the treatment of glaucoma or other intraocular pressure elevation, or the prescribing, administering, or dispensing of corticosteroids, is repealed.

9 Effective Date. This act shall take effect upon its passage.

1999-1331s

AMENDED ANALYSIS

This bill provides for the co-management of patients with primary open-angle glaucoma by licensed pharmaceutically certified optometrists and licensed ophthalmologists.

1999-1330s

10/09

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

AN ACT relative to the co-management of patients with primary open-angle glaucoma and establishing a glaucoma co-management committee.

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

1 Statement of Purpose. The general court finds that as the state’s health care delivery system becomes more complex, there is a need to assure high quality eye care including the preservation of appropriate safe guards and the maintenance of consumer confidence. Purchasers of health insurance are demanding high quality eye care from health plans and providers. Eye care providers should strive for high quality by incorporating evidence-based medical knowledge with the needs and desires of patients. The co-management of certain glaucoma patients and the evaluation of such co-management may serve to increase the likelihood of desired health outcomes consistent with current professional standards and may provide measurable data upon which a decision about future legislation can be based.

2 Modification of Definition; "Practice of Optometry". Amend the unnumbered concluding paragraph of RSA 327:1, IV to read as follows:

"Practice of optometry" shall not include and nothing in this chapter shall authorize or allow the treatment of glaucoma or other intraocular pressure elevation, except as provided in RSA 327:35, or the prescribing, administering, or dispensing of corticosteroids in any form.

3 New Section; Glaucoma Co-Management; Committee Established. Amend RSA 327 by inserting after section 34 the following new section:

327:35 Co-Management of Patients with Primary Open-Angle Glaucoma; Committee Established.

I. There is hereby established a provision for the co-management of patients with primary open-angle glaucoma by licensed pharmaceutically certified optometrists and licensed ophthalmologists.

II. Optometrists shall refer all patients to a licensed ophthalmologist of the patient’s choosing within 30 days in the event that an optometrist makes a preliminary diagnosis of glaucoma or suspects glaucoma. For the period January 1, 2000 through December 31, 2001, optometrists shall complete a glaucoma co-management reporting form pursuant to paragraphs VI or VII.

III. A pharmaceutically certified optometrist and a licensed ophthalmologist may co-manage patients with primary open-angle glaucoma provided that they obtain the patient’s written consent to be co-managed, jointly agree to protocols, and develop a written individualized treatment plan in accordance with currently accepted standards of care. The written plan shall be agreed to by both the ophthalmologist and the optometrist and shall include, but not be limited to, the following:

(a) Results of tests and examinations that led to the diagnosis;

(b) Target intraocular pressures;

(c) Medications to be used;

(d) A schedule of follow-up visits with the optometrist;

(e) Surgical referral criteria; and

(f) A schedule for periodic referrals with the co-managing ophthalmologist, in a manner to be determined by the ophthalmologist, to occur at least once every 12 months.

IV. A treatment plan developed under this section may be modified only after both the optometrist and ophthalmologist mutually agree to the modification.

V. Optometrists shall immediately consult with the co-managing ophthalmologist when there is any significant change to the patient’s condition, including but not limited:

(a) When the patient does not have the expected response to treatment;

(b) When there is any suspected adverse reaction to the treatment;

(c) When the patient’s target intraocular pressure is not reached; or

(d) When there is worsening in a patient’s visual field or optic nerve head.

VI. For the period of January 1, 2000 through December 31, 2001, when an optometrist does not want to participate in the co-management of a patient with primary open-angle glaucoma, or when a patient chooses not to be co-managed, or when the patient has another form of glaucoma, the optometrist shall submit a glaucoma co-management reporting form along with the written referral to the patient-selected ophthalmologist. Under such circumstances, the glaucoma co-management reporting form only needs to include the optometrist’s initial diagnosis, the names of the optometrist and ophthalmologist, a code in place of the patient’s name, and an indication that there will not be co-management.

VII. The New Hampshire Optometric Association and the New Hampshire Society of Eye Physicians and Surgeons shall recommend to the board, the composition of the glaucoma co-management case reporting forms. One form shall be required to be completed for each glaucoma patient, with a code for patient and case identification in order to identify the referring optometrist and to maintain patient confidentiality. Each reporting form shall be submitted by the co-managing ophthalmologist to the glaucoma co-management committee. The reporting forms shall include at least:

(a) The names and signatures of the optometrist and ophthalmologist;

(b) A place to indicate when there will not be a co-management arrangement;

(c) The optometrist’s initial diagnosis, proposed treatment plan and target intraocular pressure;

(d) Written results of all tests, examinations, copies of visual field tests and any other supporting documentation from the patient’s medical record;

(e) The actual treatment plan and target intraocular pressure agreed upon by the optometrist and ophthalmologist; and

(f) A section for the members of the glaucoma co-management committee to indicate the results of their review and evaluation of the case.

VIII. There is established a glaucoma co-management committee which shall consist of 2 New Hampshire licensed pharmaceutically certified optometrists appointed by the board, 2 New Hampshire licensed ophthalmologists appointed by the New Hampshire board of medicine, and a licensed New Hampshire pharmacist appointed by the New Hampshire pharmacy board, who shall serve as chair. The members shall be appointed within 60 days of the effective date of this section. The 2 optometrists and 2 ophthalmologists members shall individually evaluate each case submitted for completeness and appropriateness of documentation and for the accuracy of the diagnosis and treatment plan. The committee shall meet at least annually in Concord in a state-owned facility and shall submit annual reports on or before December 1 each year, to the board, the New Hampshire board of medicine, the speaker of the house, the senate president, and appropriate committee chairs of both houses. The annual reports shall include, but not be limited to:

(a) The results of the individual case evaluations by the committee members;

(b) The number of new cases of primary open-angle glaucoma;

(c) The number of patients being co-managed;

(d) The number of optometrists and ophthalmologists participating in the co-management of glaucoma patients; and

(e) A summary of the co-management study.

4 New Paragraphs; Rulemaking Authority. Amend RSA 327:31 by inserting after paragraph IX the following new paragraphs:

X. The composition and format of the glaucoma co-management case reporting forms as recommended pursuant to RSA 327:35, VII, including provisions for patient confidentiality.

XI. Procedures for the glaucoma co-management committee to collect data, evaluate case reports, and submit annual reports.

5 New Paragraph; Authorization; Use of Diagnostic Pharmaceutical Agents. Amend RSA 327:6-a by inserting after paragraph V the following new paragraph:

VI. Notwithstanding any other law to the contrary, an optometrist who is not certified to use pharmaceutical agents in the practice of optometry may use topically applied anesthetics, dyes, mydriatics, and cycloplegics for diagnostic purposes only.

6 Effective Date. This act shall take effect upon its passage.

1999-1330s

AMENDED ANALYSIS

This bill provides for the co-management of patients with primary open-angle glaucoma by licensed pharmaceutically certified optometrists and licensed ophthalmologists.

Senator Pignatelli moved to have SB 147, relative to self-referrals for chiropractic care under managed care organizations, taken off the table

SB 147, relative to self-referrals for chiropractic care under managed care organizations.

Senator Wheeler offered the following floor amendment.

1999-1347s

01/09

Floor Amendment to SB 147

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

1 New Section; Chiropractic Care. Amend RSA 415 by inserting after section 18-h the following new section:

415:18-i Comparable Fees Required. Every insurer regulated under this chapter that covers care by doctors of chiropractic shall provide benefit payments at least equal to and consistent with the benefit payments to other health care providers. No insurer regulated under this chapter shall restrict the use of diagnostic code or current procedural terminology (CPT) codes for any provider group if those procedures are allowed for in the group’s scope of practice and are deemed medically or chiropractically necessary. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days for the administration of this section.

2 New Sections; Chiropractic Care. Amend RSA 420-A by inserting after section 17-b the following new sections:

420-A:17-c Self-referrals for Chiropractic Care. A health service corporation under this chapter offering chiropractic benefits shall provide benefits to a subscriber who utilizes services of a chiropractic provider, only by a licensed chiropractor (doctor of chiropractic) by self-referral under the following conditions:

I. A subscriber may utilize the services of a doctor of chiropractic within the subscriber’s health plan without discrimination relative to scope of practice, access, and fees.

II. The health service corporation shall fully disclose to the subscriber in clear and understandable language the exact terms and conditions of each option that the subscriber has purchased along with the co-payments or other cost-sharing features of each option. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days, regarding presentation of these terms and conditions to facilitate the comparison by the subscriber of the terms and conditions of each option.

III. Within 10 working days of the first visit or consultation the doctor of chiropractic shall send to the health service corporation, or its designee, the chiropractic case findings. This shall be sufficient documentation for the initial 12 visits or the first 4 weeks of care, whichever comes first.

IV. If the chiropractic provider recommends care beyond 12 visits or 4 weeks, the participating doctor of chiropractic shall send to the health service corporation, or its designee, documentation containing information on the subscriber’s progress and necessity of care as well as a care plan for extended chiropractic care up to 6 additional weeks or a maximum of 12 additional visits, whichever occurs first. This is recommended to provide the patient with 24 visits or 10 weeks of care without pre-certification or pre-approval and to provide the health service corporation or its designee with a more detailed record of the patient’s chiropractic care status. If the doctor of chiropractic fails to provide the required documentation, the health service corporation or its subscriber shall not be liable to the chiropractic provider for any unpaid fees.

V. After a maximum of 24 visits, a subscriber who is continuing chiropractic care shall receive prior authorization, if required, from the health service corporation or its designee for the purpose of continued care by a provider of the same or similar specialty. Without the approval of the health service corporation, or its designee, and the establishment of chiropractic necessity of care, the subscriber shall not receive benefits for more than 24 visits for the same condition to a participating doctor of chiropractic in a 12-month period.

VI. Capitation rates shall be substantially consistent with prevailing fees relative to the designated number of visits. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days, concerning capitation limits under this section. Nothing in this section is intended to restrict the ability of an insurer to offer a chiropractic rider product, which provides an annual capped benefit.

VII. The patient shall retain the right to choose chiropractic care on an elective, self-pay, fee-for-service basis, and no insurer regulated under this section shall prohibit a doctor of chiropractic from continuing care on an elective, self-pay, fee-for-service basis.

420-A:17-d Comparable Fees Required. Every health service corporation regulated under this chapter that covers care by doctors of chiropractic shall provide benefit payments at least equal to and consistent with the benefit payments to other health care providers. No health service corporation regulated under this chapter shall restrict the use of diagnostic code or current procedural terminology (CPT) codes for any provider group if those procedures are allowed for in the group’s scope of practice and are deemed medically or chiropractically necessary. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days for the administration of this section.

3 New Sections; Chiropractic Care. Amend RSA 420-B by inserting after section 26 the following new sections:

420-B:27 Self-referrals for Chiropractic Care. A health maintenance organization under this chapter offering chiropractic benefits shall provide benefits to an enrollee who utilizes services of a chiropractic provider, only by a licensed chiropractor (doctor of chiropractic) by self-referral under the following conditions:

I. An enrollee may utilize the services of a doctor of chiropractic within the enrollee’s health maintenance organization without discrimination relative to scope of practice, access, and fees.

II. The health maintenance organization shall fully disclose to the enrollee in clear and understandable language the exact terms and conditions of each option that the enrollee has purchased along with the co-payments or other cost-sharing features of each option. The commissioner shall adopt rules, under RSA 541-A, within 120 days, regarding presentation of these terms and conditions to facilitate the comparison by the enrollee of the terms and conditions of each option.

III. Within 10 working days of the first visit or consultation the doctor of chiropractic shall send to the health maintenance organization, or its designee, the chiropractic case findings. This shall be sufficient documentation for the initial 12 visits or the first 4 weeks of care, whichever comes first.

IV. If the chiropractic provider recommends care beyond 12 visits or 4 weeks, the participating doctor of chiropractic shall send to the health maintenance organization, or its designee, documentation containing information on the enrollee’s progress and necessity of care as well as a care plan for extended chiropractic care up to 6 additional weeks or a maximum of 12 additional visits, whichever occurs first. This is recommended to provide the patient with 24 visits or 10 weeks of care without pre-certification or pre-approval and to provide the health maintenance organization or its designees with a more detailed record of the patient’s chiropractic care status. If the doctor of chiropractic fails to provide the required documentation, the health maintenance organization or its enrollee shall not be liable to the chiropractic provider for any unpaid fees.

V. After a maximum of 24 visits, an enrollee who is continuing chiropractic care shall receive prior authorization, if required, from the health maintenance organization or its designee for the purpose of continued care by a provider of the same or similar specialty. Without the approval of the health maintenance organization, or its designee, and the establishment of chiropractic necessity of care, the enrollee shall not receive benefits for more than 24 visits for the same condition to a participating doctor of chiropractic in a 12-month period.

VI. Capitation rates shall be substantially consistent with prevailing fees relative to the designated number of visits. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days, concerning capitation limits under this section. Nothing in this section is intended to restrict the ability of an insurer to offer a chiropractic rider product, which provides an annual capped benefit.

VII. The patient shall retain the right to choose chiropractic care on an elective, self-pay, fee-for-service basis, and no insurer regulated under this section shall prohibit a doctor of chiropractic from continuing care on an elective, self-pay, fee-for-service basis.

420-B:28 Comparable Fees Required. Every health maintenance organization, indemnity provider, or third party payor regulated under this chapter that covers care by doctors of chiropractic shall provide benefit payments at least equal to and consistent with the benefit payments to other health care providers. No health maintenance organization regulated under this chapter shall restrict the use of diagnostic code or current procedural terminology (CPT) codes for any provider group if those procedures are allowed for in the group’s scope of practice and are deemed medically or chiropractically necessary. The commissioner of insurance shall adopt rules, under RSA 541-A, within 120 days for the administration of this section.

4 Effective Date. This act shall take effect 60 days after its passage.

Senator Trombly moved to have SB 147, relative to self-referrals for chiropractic care under managed care organizations, laid on the table.

SB 147, relative to self-referrals for chiropractic care under managed care organizations

HB 60, relative to meetings of the ballot law commission. Executive Departments and Administration Committee. Vote 4-0. Ought to Pass, Senator Cohen for the committee.

HB 261-L, relative to the official ballot option. Executive Departments and Administration Committee. Vote 4-0. Ought to Pass, Senator Roberge for the committee.

SB 221-FN, relative to competitive bidding for state construction contracts. Executive Departments and Administration Committee. Vote 4-3. Ought to pass with amendment, Senator D'Allesandro for the committee.

1999-1316s

09/01

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

AN ACT relative to procedures for bid listing for state construction contracts.

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

1 New Section; Procedures for Bid Listing for State Construction Contracts. Amend RSA 228 by inserting after section 4-a the following new section:

228:4-b Procedures for Bid Listing for State Construction Contracts.

I. A general contractor bidding on a state contract for construction work on any contract for the construction, reconstruction, installation, demolition, maintenance or repair of any building by a public agency required to be awarded through competitive bidding shall, in addition to any other provision of this chapter, include in the general contractor’s bid in writing the names, addresses, and bid prices of each subcontractor to be used in the performance of the contract.

II. If the general contractor substitutes any subcontractor listed in the general contractors’ bid, or if the subcontractor refuses to perform the contract or offered contract, then the general contractor may substitute that subcontractor after having received prior approval of the governor and council. The general contractor shall submit written evidence to the state that the substituted subcontractor is costing the same amount of money or less than the amount shown in the bid proposal. If the substituted contractor costs less than the amount shown in the bid proposal, the savings shall be deducted from the total contract of the general contractor and rebated to the state.

III. Any person who violates the provisions of this section shall be guilty of a misdemeanor and each day of a continuing violation shall constitute a separate violation.

2 Effective Date. This act shall take effect 60 days after its passage.

1999-1316s

AMENDED ANALYSIS

This bill establishes procedures for bid listing for state construction projects. A person who violates these procedures is guilty of a misdemeanor.

SB 190-FN, relative to grievance procedures of managed care entities. Insurance Committee. Vote 7-0. Inexpedient to Legislate, Senator Squires for the committee.

HB 367, relative to requesting certifying scientists to appear at DWI hearings. Judiciary Committee. Vote 7-0. Ought to pass with amendment, Senator Wheeler for the committee.

1999-1290s

05/09

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

1 Official Record of Tests. Amend RSA 265:90, I to read as follows:

I. Any person who is arraigned on a charge arising under RSA 265:84 shall file notice in said court, within 10 days immediately following the receipt by the person of the results of any alcohol concentration test administered to [him] such person, requiring the attendance of the person who conducted [said] the breath test, or in the case of any other chemical test, the certifying scientist. Failure to file notice shall be deemed a waiver to require [his] attendance of the person who conducted the breath test, or in the case of any other chemical test, the certifying scientist at the trial. The official report of the test issued pursuant to RSA 265:84 shall be deemed conclusive evidence of the conduct and result of said test.

2 Boating While Intoxicated; Implied Consent for Boaters. Amend RSA 270:56, I to read as follows:

I. Any person who is arraigned on a charge arising under RSA 270:48-a shall file notice in the court, within 10 days immediately following the receipt by said person of the results of any alcohol concentration test administered to [him] such person, requiring the attendance of the person who conducted the breath test, or in the case of any other chemical test, the certifying scientist. Failure to file notice shall be deemed a waiver to require [his] attendance of the person who conducted the breath test, or in the case of any other chemical test, the certifying scientist at the trial. The official report of the test issued pursuant to RSA 270:49 shall be deemed conclusive evidence of the conduct and result of said test.

3 Effective Date. This act shall take effect January 1, 2000.

Senator Trombly moved that all House Bills on the Senate Calendar be made a Special Order for Thursday, May 27, 1999 at 10:00 a.m.

Senator Wheeler moved to have SB 147, relative to self-referrals for chiropractic care under managed care organizations, taken off the table.

SB 157, clarifying that a prisoner's right to vote absentee is in his or her town or city of former residence. Public Affairs Committee. Vote 7-0. Inexpedient to Legislate, Senator Trombly for the committee.

Senator Trombly moved to have SB 157, clarifying that a prisoner's right to vote absentee is in his or her town or city of former residence, laid on the table.

SB 157, clarifying that a prisoner's right to vote absentee is in his or her town or city of former residence.

Senator Trombly offered the following resolution:

1999 SESSION

99-1046

04/10

ANALYSIS

99-1046

04/10

STATE OF NEW HAMPSHIRE

Whereas, that the state of New Hampshire provides programs and services essential to the prosperity and well-being of the state and its citizens; and

Whereas, we oppose budget reductions which would jeopardize the quality of life and services to the least fortunate and most vulnerable among us, particularly essential services to the low income, elderly and disabled, which would occur through reduced appropriations to the department of health and human services; and

Whereas, we oppose reducing proposed appropriations to the University system and the New Hampshire regional community-technical colleges which would add to the already severe financial pressures they face, thereby requiring tuition increases that would place the opportunity for higher education beyond the reach of the children of New Hampshire’s working families; and

Whereas, we oppose reductions in the state operating budget which would inevitably shift greater fiscal burdens on cities and towns that must be borne by property taxpayers; now, therefore, be it

Resolved by the Senate:

That the Senate intends to finance any deficit in the education trust fund established under 1999, 17 to provide every child an adequate education with new sources of revenue, not with reductions to the appropriations in the operating budget proposed by the governor; and

That copies of this resolution be forwarded to the speaker of the house of representatives and the governor.

SB 220-FN, relative to the disclosure of child abuse and neglect information. Public Institutions, Health and Human Services Committee. Vote 6-0. Ought to pass with amendment, Senator McCarley for the committee.

1999-1313s

04/01

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

1 Purpose. The general court finds that deaths or serious injury to children due to abuse or neglect, despite the involvement of government agencies charged with responsibility to protect children, is unacceptable. The general court further finds that public accountability in such cases will help prevent fatalities and near fatalities. To foster public accountability the general court authorizes the commissioner of health and human services, upon request, to publicly disclose certain case-specific information in those few cases in which there has been a fatality or near fatality resulting from abuse or neglect of a child. The general court further wishes to clarify that the commissioner may disclose case-specific information to a citizen review panel created in response to the Child Abuse Prevention and Treatment Act, as requested by that panel. The general court finds that the above purpose is consistent with the provisions of the Child Abuse Prevention and Treatment Act as amended in 1996, Public Law 104-235.

2 New Paragraphs; Disclosure of Child Abuse and Neglect Information. Amend RSA 126-A:5 by inserting after paragraph XI the following new paragraphs:

XII.(a) Notwithstanding any other provision of law to the contrary, the commissioner may, upon request, publicly disclose certain case specific information regarding the abuse or neglect of a child as set forth in this paragraph, and the investigation of such abuse or neglect and any services related thereto, if it is determined that such disclosure shall not be contrary to the best interests of the child, the child’s siblings or other children in the household and there has been a fatality or near fatality resulting from abuse or neglect of a child. "Near fatality" means an act or event that places a child in serious or critical condition as certified by a physician.

(b) Information may be disclosed as follows:

(1) Information released prior to the completion of the investigation of a report shall be limited to a statement that a report is "under investigation."

(2) When there has been a prior disclosure pursuant to subparagraph (b)(1) of this paragraph, information released in a case in which the report has been unfounded shall be limited to the statement that "the investigation has been completed, and the report has been determined unfounded."

(3) If the report has been founded, then information may be released pursuant to subparagraph (c) of this section.

(c) For the purposes of this paragraph, the following information may be disclosed:

(1) The name of the abused or neglected child.

(2) The fact that the department’s investigation resulted in a finding of either abuse or neglect and the basis for the finding.

(3) Identification of services and actions taken, if any, by the department regarding the child named in the report and his or her family as a result of any such report or reports.

(4) Any extraordinary or pertinent information concerning the circumstances of the abuse or maltreatment of the child and the investigation of such abuse or maltreatment, where the commissioner, or designee, determines such disclosure is consistent with the public interest.

(d) Any disclosure of information pursuant to this paragraph shall be consistent with the provisions of subparagraph (c). Such disclosure shall not identify or provide an identifying description of the source of the report, and shall not identify the name of the abused or neglected child’s siblings, the parent or other persons legally responsible for the child or any other members of the child’s household, other than the subject of the report.

(e) In determining pursuant to subparagraph (a) whether disclosure will be contrary to the best interests of the child, the child’s siblings or other children in the household, the commissioner, or designee, shall consider the privacy interests of the child and the child’s family and the effects which disclosure may have on efforts to reunite and provide services for the family.

XIII. Notwithstanding any other provision of law to the contrary, the commissioner may, upon request, disclose information relative to a report of abuse or neglect of a child to a citizen review panel established as required by Public Law 104-235, to evaluate the extent to which the department is effectively discharging its child protection responsibilities. The members of a citizen review panel shall not disclose abuse or neglect case records or information identifying the subject of such case records to any other persons.

3 Effective Date. This act shall take effect upon its passage.

SB 229-FN-L, relative to the supervision of juvenile delinquents on probation and parole and the operation and organization of the youth development center. Public Institutions, Health and Human Services Committee. Vote 6-0. Rereferred to Committee, Senator Squires for the committee.

SB 156, granting the commissioner of transportation authority to layout and approve the construction of a restricted use driveway onto a public highway. Vote 6-0. Transportation Committee. Ought to pass with amendment, Senator Gordon for the committee.

1999-1323s

01/10

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

AN ACT granting the commissioner of transportation authority to layout and approve the construction of a restricted use driveway onto a public highway in Canterbury and creating a legislative study committee to consider options for addressing the development of major projects which have statewide or significant regional impacts, such as the New Hampshire International Speedway.

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

1 Findings. The general court finds it in the interest of the state to grant authority to the commissioner of the commissioner of transportation to approve the layout and construction of the north access road to Route 106, so-called, for the New Hampshire International Speedway in Canterbury. The general court further finds that the development of major projects, such as the New Hampshire International Speedway, have statewide impacts. These impacts may not be effectively addressed by current municipal land use regulations.

2 Restricted Use Driveway Approval Process for Canterbury North Access Road to New Hampshire International Speedway.

I. For the purpose of this section, a "restricted use driveway" means a driveway laid out and constructed with the approval of the commissioner of transportation and which is especially designed for restricted access to the class II Route 106 in Canterbury.

II. Notwithstanding any other provision of law, the commissioner of transportation shall have exclusive authority to layout and approve the construction of a restricted use driveway onto Route 106 in Canterbury, so-called the north access road to the New Hampshire International Speedway, upon application by the property owner to construct such a driveway.

III. All expenses relating to the layout, construction and maintenance of a restricted use driveway approved in accordance with this section shall be borne entirely by the property owner.

IV. Use of the approved restricted use driveway shall be permitted subject to terms and conditions as set forth in an agreement between the property owner and the commissioner of transportation.

3 Study Committee Established. There is hereby established a legislative study committee to review regulatory options for addressing the development of major projects, such as the New Hampshire International Speedway, which have statewide or significant regional impacts.

4 Membership and Compensation.

I. The members of the committee shall be as follows:

(a) Three members of the senate, appointed by the president of the senate.

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

II. Members of the committee shall receive mileage at the legislative rate when attending to the duties of the committee.

5 Duties. The committee shall review the regulatory options for addressing the development of major projects, such as the New Hampshire International Speedway, which have statewide or significant regional impacts. The committee shall determine if current regulatory processes included in RSA 36:54 adequately address the development of major projects of statewide or significant regional impact. Further, the committee shall recommend regulatory options for addressing the impacts of major development projects, such as the New Hampshire International Speedway.

6 Chairperson. 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 senate member. The first meeting of the committee shall be held within 45 days of the effective date of this section.

7 Report. The committee shall report its findings and any recommendations for proposed legislation to the senate president, the speaker of the house of representatives, the senate clerk, the house clerk, the governor, and the state library on or before December 1, 1999.

8 Effective Date. This act shall take effect upon its passage.

1999-1323s

AMENDED ANALYSIS

This bill authorizes the commissioner of transportation to layout and approve the construction of a restricted use driveway onto a public highway. This bill also establishes a committee to study options for addressing the development of major projects which have statewide or significant regional impacts, such as the New Hampshire International Speedway.

Senator Trombly offered a floor amendment.

1999-1367s

01/10

Floor Amendment to SB 156

Amend the bill by inserting after section 7 the following and renumbering the original section 8 to read as 9:

8 Applicability. Nothing in the provisions and findings of this act shall be used to influence or affect any judicial, administrative, or regulatory proceeding pending at the time of the passage of this act.

SB 144, relative to qualifications for members of the fish and game commission. Wildlife and Recreation Committee. Vote 6-0. Rereferred to Committee, Senator Disnard for the committee.

CACR 16, relating to use of statewide property and personal income taxes. Providing that the general court shall use net revenues from statewide property and personal income taxes exclusively for educational purposes. Education Committee. Vote 6-0. Rereferred to Committee, Senator Squires for the committee.

CACR 17, relating to establishing a restricted education trust fund. Providing that an education trust fund be established, that all moneys designated for the purpose of state aid to education shall be deposited into such trust fund, and that the moneys in such trust fund shall be used exclusively for state aid to education. Education Committee. Vote 6-0. Rereferred to Committee, Senator D'Allesandro for the committee.

Senator Gordon moved to have SB 50-FN-A-L, relative to the state's responsibility to provide an adequate education, taken off the table.

Senator Trombly moved to have CACR 20, relating to the election of governor and senators. Providing that beginning with the 2002 general election, and every 4 years thereafter, the governor and senators shall be elected, taken off the table.

CACR 20, relating to the election of governor and senators. Providing that beginning with the 2002 general election, and every 4 years thereafter, the governor and senators shall be elected.

Senator Trombly moved to have SB 94, relative to absentee voter affidavits, taken off the table.

SB 94, relative to absentee voter affidavits.

Question is on the adoption of the committee amendment (#0969).

Senator Trombly offered a floor amendment.

1999-1359s

03/10

Floor Amendment to SB 94

Amend RSA 657:7, III as inserted by section 2 of the bill by replacing it with the following:

III. Return envelopes of size sufficient to contain the preceding envelope addressed to the town and city clerks of the state in which absentee voters shall return their ballots. On the envelopes shall be printed "Enclosed is the ballot of an absentee voter" and, [at the top] on the back thereof, [4] 5 blank spaces with the words "Name, Voting Address, Ward, Town or City, I do hereby certify under penalties of perjury that I personally marked the ballot within and sealed it in the envelope (or had assistance in marking the ballot and sealing it in this envelope because I am blind)" appropriately printed thereon.

Amend the bill by replacing section 9 with the following:

9 Elections; Election Procedure; Processing Absentee Ballots; Affidavit and Signature Examinations Removed. Amend RSA 659:53 to read as follows:

659:50 Announcement by Moderator. The moderator shall begin processing absentee ballots by clearly announcing that he or she is about to open the envelopes which were delivered to him or her. The moderator shall then remove the [affidavit] envelope containing the ballots of each absentee voter and shall compare the signature on the [affidavit] envelope with the signature on the affidavit portion of the application for the ballot. If:

I. The name of the voter is on the checklist; and

II. The affidavit on the [envelope] application appears to be properly executed; and

III. The signature on the affidavit appears to be executed by the same person who signed the application; and

IV. The signatures appear to be the signatures of a duly qualified voter who has not voted at the election; then the moderator shall publicly announce the name of the absentee voter. If these conditions are not met, the moderator shall follow the procedure provided in RSA 659:53.

659:51 Challenges. All absentee ballots are subject to challenge after the moderator publicly announces the name of the absentee voter but not after the ballot is removed from the envelope. A person who makes a challenge shall state the reason for the challenge. If the ballot is challenged, the moderator shall write on the [affidavit] envelope containing the ballot the word "challenged" and the name and address of the person who makes the challenge and the basis of the challenge. The moderator shall also number each challenged envelope consecutively by marking, for example, the first challenged ballot "Challenged Ballot No. 1". The moderator shall then determine if the challenge to the ballot is well grounded. If the moderator decides the challenge is well grounded, [he] the moderator shall not open the envelope but shall preserve it with the other ballots cast at the election as provided in RSA 659:101. If the moderator decides that the challenge is not well grounded, [he] the moderator shall open the [affidavit] envelope [so the affidavit thereon is not destroyed] and proceed first to mark on the reverse of the folded ballot the corresponding challenge number as previously marked on the envelope. [He] The moderator shall then proceed to deposit the ballot as provided in RSA 659:52.

659:52 Opening Envelope; Depositing Ballot. If the absentee ballot is not challenged, the moderator shall, after announcing the name of the voter, open the [affidavit] envelope containing the ballot [so the affidavit on the envelope is not destroyed]. [He] The moderator shall then take the ballot out of the envelope without unfolding the ballot or without permitting the ballot to be examined, and [he] shall preserve the [affidavit] envelope with the ballots cast at the election as provided in RSA 659:101. The moderator shall then have a checkmark placed beside the name of the absentee voter on the checklist and write therewith the letters "A.V." in red ink and shall then deposit the ballot in the ballot box.

659:53 Forms Not in Order. If the moderator finds that the absentee voter is not entitled to vote, [he] the moderator shall not open the envelope and shall mark across the face of the envelope the reason the ballot is rejected, such as "rejected as not a voter", "voted in person", "affidavit improperly executed", "not signed by proper person", or whatever the reason is. The moderator shall save all the unopened envelopes and shall preserve the envelopes with the ballots cast at the election as provided in RSA 659:101.

Amend RSA 669:27, IV as inserted by section 11 of the bill by replacing it with the following:

IV. Return envelopes of size sufficient to contain the [affidavit envelopes] ballot, addressed to the clerk upon which shall be printed, "Enclosed is the ballot of an absentee voter", and [at the top] on the back thereof blank spaces for the name, address, [and] voting place, and signature of the sender, with the words "name," [and] "address," and "I do hereby certify under penalties of perjury that I personally marked the ballot within and sealed it in the envelope (or had assistance in marking the ballot and sealing it in this envelope because I am blind)" appropriately printed thereon.

Amend the bill by inserting after section 11 the following and renumbering the original section 12 to read as 13:

12 Elections; Absentee Voting; Application; Procedure by Applicant; Incomplete Statement. Amend RSA 657:6 to read as follows:

657:6 Procedure by Applicant. An application form for an absentee ballot shall be mailed or delivered to any person who applies therefor to the secretary of state or to any town or city clerk. It shall be filled out by the applicant and sent to the clerk of the town or city in which he desires to vote. Alternatively, a person may apply for an official absentee ballot by sending to said clerk a written statement containing the information required by the appropriate paragraph of RSA 657:4, or by the federal post card application. If the written statement does not include the affidavit required by RSA 657:4, but contains all other information required by RSA 657:4, the statement shall be considered a properly executed application, and the clerk shall include with the ballot sent pursuant to RSA 657:15 an application form with the following instructions: "The affidavit on this form must be completed and signed according to law and returned with your ballot."

Senator Cohen moved to have SB 72, exempting certain portions of Seabrook Village District and certain portions of Hampton Beach from certain provisions of the excavating, filling, and construction laws, taken off the table.

SB 72, exempting certain portions of Seabrook Village District and certain portions of Hampton Beach from certain provisions of the excavating, filling, and construction laws.

Senator Blaisdell moved to substitute ought to pass for inexpedient to legislate.

Senator Trombly moved to have SB 82, relative to the termination of employees, taken off the table.

SB 82, relative to the termination of employees.

Senator J. King offered a floor amendment.

1999-1356s

10/09

Floor Amendment to SB 82

Amend RSA 275:57 as inserted by section 1 of the bill by replacing it with the following:

275:57 Reason for Termination. Any employee who has worked for the employer for at least 6 months and is informed by an employer of the employee’s termination, may request from the employer, within 30 days after the termination, a written notice stating the reason or reasons for the termination. The employer shall, after receiving a written request, provide the employee a written reason or reasons for the termination.

1999-1356s

AMENDED ANALYSIS

This bill requires that employers provide terminated employees, who they have been employed for 6 months or more, with a written reason for the termination upon the terminated employee’s written request.

Senator F. King moved to have SB 20, limiting the price for resale of tickets to motor sports events at the New Hampshire International Speedway to the original purchase price, taken off the table.

SB 20, limiting the price for resale of tickets to motor sports events at the New Hampshire International Speedway to the original purchase price.

Question is on the adoption of the committee amendment (#0266).

CACR 23, relating to the responsibility and authority of the general court to determine the content, extent, and funding of a public education. Providing that the general court shall have the exclusive authority to determine the content, extent, and funding of a public education and that the state may fulfill its responsibility to provide to all citizens the opportunity for a public education by exercising its power to levy assessments, rates, and taxes, or by delegating this power, in whole or part, to a political subdivision; provided that upon delegation, such assessments, rates, and taxes are proportional and reasonable throughout the state or the political subdivision in which they are imposed. Education Committee. Vote 6-0. Rereferred to Committee, Senator Johnson for the committee.

Senator Cohen moved to have SB 147, relative to self-referrals for chiropractic care under managed car organizations, taken off the table.

SB 147, relative to self-referrals for chiropractic care under managed car organizations.

The House of Representatives concurs with the Senate in the passage of the following entitled Bill, with amendment, in the passage of which amendment the House asks the concurrence of the Senate:

SB 30, relative to the cruelty to animals law.

SB 30, relative to the cruelty to animals law.

Senator Disnard moved to non concur and requests a Committee of Conference.

The President, on the part of the Senate, has appointed as members of said Committee of Conference:

Senator Blaisdell moved that all Senate Bills left on the table are by this Resolution made inexpedient to legislate.

SB 50-FN-A-L, relative to the state's responsibility to provide an adequate education.

SB 51-FN-A-L, establishing a referendum for a new taxation plan to fund public education.

SB 157, clarifying that a prisoner's right to vote absentee is in his or her town or city of former residence.

SB 179, allowing for motor vehicle license suspension or revocation for certain minors.

SB 194-FN-A, dedicating certain sums in the moose management fund for the payment for damage done by moose to certain trees.

Senator Fernald Rule #44)

Senator Cohen moved that the Senate now adjourn from the early session, that the business of the late session be in order at the present time, that the bills ordered to third reading be read a third time by this resolution, all titles be the same as adopted and that they be passed at the present time.

Senator Cohen moved that the Senate be in recess for the purpose of House Messages, introduction of bills, Enrolled Bills Reports and amendments, and that when we adjourn, we adjourn until Thursday, May 27, 1999 at 10:00 a.m.

The House of Representatives concurs with the Senate in its amendment to the following entitled House Bill sent down from the Senate:

HB 206, relative to restrooms in restaurants.

SB 20, limiting the price for resale of tickets to motor sports events at the New Hampshire International Speedway to the original purchase price.

HB 60, relative to meetings of the ballot law commission.

SB 71, prohibiting the use of MTBE as an additive in gasoline.

SB 82, relative to the termination of employees.

SB 94, relative to absentee voter affidavits.

SB 108, relative to the co-management of patients with primary open-angle glaucoma and establishing a glaucoma co-management committee.

SB 156, granting the commissioner of transportation authority to layout and approve the construction of a restricted use driveway onto a public highway in Canterbury and creating a legislative study committee to consider options for addressing the development of major projects which have statewide or significant regional impacts, such as the New Hampshire International Speedway.

SB 199, establishing certain standards of accountability for health maintenance organizations and other entities providing health insurance through a managed care system.

SB 214, relative to ambulatory surgical facilities and establishing a committee to study the health services planning and review board.

SB 220-FN, relative to the disclosure of child abuse and neglect information.

HB 261-L, relative to the official ballot option.

HB 535, establishing a committee to study the department of resources and economic development.

HJR 3, urging ISO-New England to adopt policies furthering the state's interest in electric utility restructuring.