SB 287 - AS AMENDED BY THE SENATE

03/24/2022 1129s

2022 SESSION

22-2945

12/10

SENATE BILL 287

AN ACT relative to balance billing for certain health care services.

SPONSORS: Sen. Bradley, Dist 3; Sen. Sherman, Dist 24; Rep. Bartlett, Merr. 19

COMMITTEE: Health and Human Services

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ANALYSIS

This bill modifies insurance coverage to reflect changes in federal law and clarifies coverage related to emergency services.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/24/2022 1129s 22-2945

12/10

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty Two

AN ACT relative to balance billing for certain health care services.

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

1 New Paragraphs; Patients' Bill of Rights. Amend RSA 151:21 by inserting after paragraph XXI the following new paragraphs:

XXII. The patient shall be fully informed, in writing in language that the patient can understand, of requirements and prohibitions relating to balance billing.

XXIII. The patient shall be fully informed, in writing in language that the patient can understand, of the patients’ rights when receiving care or services from a provider or facility that is outside the patient’s insurance or group health plan network.

2 Emergency Medical and Trauma Services; Definitions. Amend RSA 153-A:2, I to read as follows:

I. “Air ambulance service” means medical transport by a rotary wing air ambulance as defined in 42 C.F.R. 414.605, or a fixed wing air ambulance, as defined in 42 C.F.R. 414.605, for patients.

I-a. "Coordinating board" means the emergency medical and trauma services coordinating board established in RSA 153-A:3.

3 New Subdivision; Prohibition on Balance Billing. Amend RSA 153-A by inserting after section 36 the following new subdivision:

Prohibition on Balance Billing

153-A:37 Prohibition on Balance Billing. Providers of air ambulance services shall not balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance for emergency services performed in the facility. This prohibition shall apply whether or not the air ambulance service provider is contracted with the patient's insurance carrier.

4 New Chapter; Prohibition on Balance Billing. Amend RSA by inserting after chapter 332-L the following new chapter:

CHAPTER 332-M

PROHIBITION ON BALANCE BILLING

332-M:1 Definitions. In this chapter:

I. "Emergency services" means health care services that are provided to a patient in a licensed health facility by a health care provider after the onset of a medical condition, including a mental health condition or substance use disorder, that manifests itself by symptoms of sufficient severity that a prudent layperson with average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention could be expected to result in any of the following:

(a) Serious jeopardy to the patient's health.

(b) Serious impairment to bodily functions.

II. “Health care provider” or "provider" means a physician or other health care practitioner licensed, accredited, or certified to perform specified health services consistent with state law.

III. “Insurer" means a group health plan as defined in 42 U.S.C. section 300gg-91 or an entity subject to the insurance laws and rules of this state offering group or individual health insurance coverage.

IV. “Nonparticipating emergency facility” means an emergency department of a hospital or an independent freestanding emergency department that does not have a contractual relationship directly or indirectly with an insurer as defined in this chapter.

V. “Nonparticipating provider” means any health care provider who is acting within the scope of practice of that provider’s license or certification under applicable State law and who does not have a contractual relationship directly or indirectly with an insurer as defined in this chapter.

VI. “Participating facility” means a health care facility that has a contractual relationship with the insurer, as defined in this chapter, for furnishing such item or service under the plan or coverage, respectively.

332-M:2 Prohibition on Balance Billing.

I. No health care provider shall balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance for emergency services performed at an emergency facility or services performed in a participating facility. This prohibition shall apply whether or not the health care provider is a participating provider.

II. No emergency department of a hospital or an independent freestanding emergency department that provides emergency services shall balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance for emergency services performed in the facility. This prohibition shall apply whether or not the health care provider is contracted with the patient’s insurance carrier or group health plan as defined in 42 U.S.C. section 300gg-91.

332-M:3 Provision of Information for Scheduled Appointments. Each health care provider shall comply with the requirements of 42 U.S.C. section 300gg-136.

332-M:4 Violations. The state entity that licenses, accredits, certifies, or credentials the health care provider shall take regulatory action against the health care provider for any violations of this chapter.

5 Insurance Coverage for Emergency Services; Definitions. Amend RSA 417-F:1 to read as follows:

417-F:1 Definitions. In this chapter:

I. "Emergency services" means health care services that are provided to an enrollee, insured, or subscriber in a licensed hospital emergency facility by a provider after the [sudden] onset of a medical condition, including a mental health condition or substance use disorder, that manifests itself by symptoms of sufficient severity that a prudent layperson with average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention could be expected to result in any of the following:

(a) Serious jeopardy to the patient's health.

(b) Serious impairment to bodily functions.

II. “Health care provider” means a health care provider as defined in RSA 420-J:3, XXI.

III. "Insurer" means any entity providing managed care coverage or accident or health insurance or accident and health insurance policies, contracts, certificates, or other evidence of coverage to enrollees, insureds, or subscribers pursuant to RSA 415, 415-A, 419, 420, 420-A, 420-B, or 420-J.

VI. “Qualifying payment amount” means qualifying payment amount as defined in 42 U.S.C. section 300gg-111 (3)(E).

6 New Section; Coverage for Emergency Services. Amend RSA 417-F by inserting after section 4 the following new section:

417-F:5 Coverage of Emergency Services

I. Each insurer that issues or renews any policy of health insurance providing benefits for emergency services shall cover emergency services provided by a nonparticipating provider in the same manner and without imposing any additional requirements as if the services were provided by a participating provider.

II. The patient’s cost-sharing for items or services provided by a nonparticipating provider or nonparticipating emergency facility shall be calculated using the qualifying payment amount for the item or service.

7 Managed Care Law; Definitions; Emergency Services. Amend RSA 420-J:3, XVI to read as follows:

XVI. "Emergency services" means health care services that are provided to an enrollee, insured, or subscriber in a licensed hospital emergency facility by a provider after the [sudden] onset of a medical condition, including a mental health condition or substance use disorder, that manifests itself by symptoms of sufficient severity that a prudent layperson with average knowledge of health and medicine could reasonably expect that the absence of immediate medical attention could result in any of the following:

(a) Serious jeopardy to the patient's health.

(b) Serious impairment to bodily functions.

8 New Paragraphs; Managed Care Law; Definitions. Amend RSA 420-J:3 by inserting after paragraph XXVI the following new paragraphs:

XXVI-a. “Nonparticipating emergency facility” means an emergency department of a hospital or an independent freestanding emergency department that does not have a contractual relationship directly or indirectly with a health carrier or a group health plan as defined in 42 U.S.C. section 300gg-91.

XXVI-b. “Nonparticipating provider” means any health care provider who is acting within the scope of practice of that provider’s license or certification under applicable state law and who does not have a contractual relationship directly or indirectly with a health carrier or a group health plan as defined in 42 U.S.C. section 300gg-91.

9 New Paragraph; Managed Care Law; Definition. Amend RSA 420-J:3 by inserting after paragraph XXIX the following new paragraph:

XXIX-a. “Qualifying payment amount” means qualifying payment amount as defined in 42 U.S.C. section 300gg-111 (3)(E).

10 Managed Care Law; Provider Contract Standards. Amend RSA 420-J:8, XI to read as follows:

XI. Every contract [entered into after July 1, 2003] between a health carrier and any [physician] health care provider or facility shall contain a provision that ensures that covered persons will have continued access to the provider in the event that the contract is terminated for any reason other than unprofessional behavior. The continued access to providers shall be made available for [60] 90 days from the date the health carrier provides notice to the covered person of termination of the contract and shall be provided and paid for in accordance with the terms and conditions of the covered person's health benefit plan and the prior contract between a health carrier and a health care provider. Within 5 business days of the contract termination, the health carrier shall provide written notice to affected covered persons explaining their continued access rights.

11 New Section; Managed Care Law; Preventing Surprise Medical Bills. Amend RSA 420-J by inserting after section 8-f the following new section:

420-J:8-g Preventing Surprise Medical Bills.

I. Each health carrier or a group health plan as defined in 42 U.S.C. section 300gg-91 that issues or renews any policy of health insurance providing benefits for emergency services shall cover emergency services provided at a nonparticipating emergency facility or by a nonparticipating provider in the same manner and without imposing any additional requirements as if the services were provided at a participating facility or by a participating provider.

II. Each health carrier or a group health plan as defined in 42 U.S.C. section 300gg-91 that issues or renews any policy of health insurance shall cover services provided by nonparticipating providers at a participating facility, in the same manner and without imposing any additional requirements, as if the services were provided by a participating provider.

III. The patient’s cost-sharing for emergency services or items or services provided by a nonparticipating provider at a participating facility shall be calculated using the qualifying payment amount for the item or service.

12 Managed Care Law; Rulemaking Authority. Amend RSA 420-J:12 to read as follows:

420-J:12 Rulemaking Authority. The commissioner may adopt such rules, under RSA 541-A, and issue such orders as may be necessary to carry out the purposes and provisions of this chapter. The commissioner may adopt rules applicable to health carriers and group health plans relating to price transparency for covered health benefits that are consistent with and no more burdensome than federal price transparency requirements for covered health benefits as set forth in 42 U.S.C. section 300gg-114 and 42 C.F.R. 147.210.

13 Federal Health Care Reform 2010; Purpose and Scope. Amend RSA 420-N:1 to read as follows:

420-N:1 Purpose and Scope. The intent of this chapter is to preserve the state's status as the primary regulator of the business of insurance within New Hampshire and the constitutional integrity and sovereignty of the state of New Hampshire under the Tenth Amendment to the United States Constitution and part I, article 7 of the New Hampshire constitution and to create a legislative oversight committee to supervise the insurance commissioner's administration of the insurance reforms required under the Patient Protection and Affordable Care Act of 2009, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, including any amendments thereto, and related provisions of the Public Health Service Act (42 U.S.C. section 300gg et seq.), federal regulations, interpretations, standards, or guidance issued thereunder (hereinafter "the Act").

14 Federal Health Care Reform 2010; Definitions. Amend RSA 420-N:2, I to read as follows:

I. "Act" means the Patient Protection and Affordable Care Act of 2009, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, including any amendments thereto, and related provisions of the Public Health Service Act (42 U.S.C. section 300gg et seq.), federal regulations, interpretations, standards, or guidance issued thereunder.

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