Bill Text: NH SB177 | 2024 | Regular Session | Amended
Bill Title: Relative to health insurance coverage of prosthetics for children under 19 years of age.
Spectrum: Moderate Partisan Bill (Democrat 9-1)
Status: (Engrossed) 2024-04-09 - Public Hearing: 04/23/2024 11:00 am Legislative Office Building 302-304 [SB177 Detail]
Download: New_Hampshire-2024-SB177-Amended.html
SB 177-FN - AS AMENDED BY THE SENATE
01/03/2024 2418s
2023 SESSION
23-1041
05/04
SENATE BILL 177-FN
AN ACT relative to health insurance coverage of prosthetics for children under 19 years of age.
SPONSORS: Sen. Prentiss, Dist 5; Sen. Perkins Kwoka, Dist 21; Sen. Watters, Dist 4; Sen. Soucy, Dist 18; Sen. Whitley, Dist 15; Sen. Fenton, Dist 10; Sen. Carson, Dist 14; Rep. Bolton, Graf. 8; Rep. Palmer, Sull. 2; Rep. Morse, Graf. 9
COMMITTEE: Health and Human Services
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AMENDED ANALYSIS
This bill requires group insurance policies, health service corporations, and health maintenance organizations to provide insurance coverage for prosthetic devices, including activity-specific devices, for children under 19 years of age.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
01/03/2024 2418s 23-1041
05/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to health insurance coverage of prosthetics for children under 19 years of age.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Accident and Health Insurance; Coverage for Prosthetic Devices; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Prosthetic Devices for Children. Each insurer that issues or renews a policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide coverage for prosthetic devices, including activity-specific prosthetic devices, for children under 19 years of age, who are residents of this state and covered by such insurance. The insurer may limit coverage for activity-specific prosthetic devices to one activity-specific prosthetic device per plan year. Medically necessary prosthetic devices shall not be subject to any annual limits. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply.
I. Covered benefits shall include:
(a) All materials and components necessary to use the device;
(b) Instruction to the enrollee on using the device; and
(c) The repair or replacement of a prosthetic device that is determined medically necessary or is necessary for maximizing the enrollee’s ability to engage in the specific activity.
II. In this section:
(a) “Prosthetic” means an artificial substitute for a body part for functional or therapeutic purposes.
(b) “Activity-specific prosthetic device” means a prosthetic device designed to allow an individual to participate in a specific activity that could damage the residual limb or everyday prosthesis, or when the everyday prosthesis would not function effectively to perform that specified activity.
III. This section shall not apply to plans available through the Small Business Health Options Program (SHOP).
2 Health Services Corporations; Applicable Statutes. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, V, RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-i, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
3 Health Maintenance Organizations; Statutory Construction. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415:18-ff, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
4 Effective Date. This act shall take effect January 1, 2025.
23-1041
1/11/23
SB 177-FN- FISCAL NOTE
AS INTRODUCED
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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STATE: | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Various Government Funds | |||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
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LOCAL: |
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Revenue | $0 | $0 | $0 | $0 |
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
The Insurance Department indicates there already exists in New Hampshire law at RSA 415:6-j and RSA 415:8-n a mandate for individual and group accident and health insurance coverage for certain prosthetic devices. In addition, New Hampshire’s Essential Health Benefits requirements, which apply to the individual and small group market, also require some coverage for prosthetic and orthotic devices. The Medicare definition of prosthetic and orthotic devices appears to be broader than the definition of prosthetic devices in RSA 415:6-j and RSA 415:8-n. However, because of the 80% coverage limitation in the Medicare regulations, the Insurance Department is unable to determine whether this new coverage requirement would expand or contract mandated benefits for prosthetics. To the extent this bill would require coverage at a level greater than current plan designs offer, the Department assumes there would be a corresponding and indeterminable increase in claims costs and premiums, and therefore premium tax revenues. To the extent that the coverages required in this bill are applicable to health benefits offered by state, county, and local government entities, this could represent an increase in expenditures. Similarly, to the extent that this bill would require coverage at a level lower than current plan designs offer, the Insurance Department assumes that there would be a corresponding and indeterminable decrease in claims costs and premiums, and therefore premium tax revenues.
This new coverage requirement could be subject to cost defrayal of state-mandated requirements pursuant to 45 CFR §155.170. Under this federal regulation, passage of this bill could be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits (EHB) offered in the Exchange Marketplace. This could be the case even though the specific coverage required is already subsumed under existing categories of EHB coverage. Under this regulation, the state must make payments to defray the cost of the additional required benefits to Qualified Health Plan (QHP) enrollees or to QHP issuers. This would represent a general fund expense which is indeterminable at this time.
The Department notes, under RSA 400-A:39-b, the legislative committee having jurisdiction over this bill may refer the proposed mandated coverage to the Insurance Department which is authorized to retain an external actuarial review of the costs and benefits of the proposed mandate. In this manner, a qualified opinion of the cost could be obtained. In addition, the Centers for Medicare and Medicaid Serves (CMS) encourages states to reach out to CMS concerning any state defrayal questions in advance of passing and implementing benefit mandates and to provide QHP issuers in the state ample time to quantify the cost attributable to each additional required benefit and report these calculations to the state.
It is assumed that any fiscal impact would occur after FY 2023.
AGENCIES CONTACTED:
Insurance Department
