Bill Text: NH HB554 | 2023 | Regular Session | Introduced
Bill Title: Relative to treatment alternatives to opioids.
Spectrum: Moderate Partisan Bill (Republican 5-1)
Status: (Introduced - Dead) 2023-05-18 - Full Committee Work Session: 05/24/2023 10:00 am Legislative Office Building 205-207 [HB554 Detail]
Download: New_Hampshire-2023-HB554-Introduced.html
HB 554-FN - AS INTRODUCED
2023 SESSION
23-0161
08/05
HOUSE BILL 554-FN
AN ACT relative to treatment alternatives to opioids.
SPONSORS: Rep. Lundgren, Rock. 16; Rep. Love, Rock. 13; Rep. Nagel, Belk. 6; Rep. T. Dolan, Rock. 16; Rep. Massimilla, Graf. 1; Rep. Crawford, Carr. 3
COMMITTEE: Health, Human Services and Elderly Affairs
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ANALYSIS
This bill requires the department of health and human services to create a voluntary nonopioid directive form which may be used for nonopioid treatment options for pain. This bill also establishes insurance coverage for such treatment options, including coverage for chronic pain management 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
23-0161
08/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Three
AN ACT relative to treatment alternatives to opioids.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Subdivision; Nonopioid Directives. Amend RSA 126-A by inserting after section 88 the following new subdivision:
Nonopioid Directives
126-A:89 Definitions. In this subdivision:
I. "Health care facility" means a facility licensed under RSA 151.
II. "Health care practitioner" or "prescribing practitioner" means a person who is lawfully entitled to prescribe, administer, dispense, or distribute controlled drugs.
126-A:90 Treatment of Chronic Pain.
I. When patients seek treatment for any of the myriad conditions that cause pain, a health care practitioner may refer or prescribe to a patient any of the following treatment alternatives, based on the practitioner's clinical judgment and the availability of the treatment, before starting a patient on an opioid: chiropractic, physical therapy, occupational therapy, acupuncture, auricular therapy, massage therapy, osteopathic manipulation, and/or naturopathic physicians or any professional duly licensed by the state of New Hampshire.
II. The health care practitioner shall honor the nonopioid directive first, by administering less addictive, nonopioid medications or nonpharmacological modalities as a first line of treatment, whenever possible.
III. Nothing in this section shall be construed to require that all of the treatment alternatives set forth in paragraph I shall be required to be exhausted prior to the patient receiving a prescription for an opioid.
IV. Nothing in this section shall preclude a health care practitioner from simultaneously prescribing an opioid and prescribing or recommending any of the procedures set forth in paragraph I.
126-A:91 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to:
I. A standard form for the recording and transmission of the voluntary nonopioid directive form, which shall include verification by the patient's practitioner and which shall comply with the appropriate confidentiality requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as amended, and shall include the basic procedures necessary to revoke the voluntary nonopioid directive form.
II. Procedures to record the voluntary nonopioid directive form in the patient's medical record or, if available, the patient's interoperable electronic medical record in the system.
III. Requirements and procedures for a patient to appoint a duly authorized guardian or health care proxy to override a previously filed voluntary nonopioid directive form and circumstances under which an attending practitioner may override a previously filed voluntary nonopioid directive form based on documented medical judgment which shall be recorded in the patient's medical record.
IV. Procedures to ensure that any recording, sharing, or distributing of data relative to the voluntary nonopioid directive form complies with all federal and state confidentiality laws.
126-A:92 Protections.
I. A written prescription which is presented at an outpatient pharmacy or a prescription that is electronically transmitted to an outpatient pharmacy shall be presumed to be valid for the purposes of this subdivision, and a pharmacist in an outpatient setting shall not be held in violation of this subdivision for dispensing a controlled substance containing an opioid or other controlled substance in contradiction to a voluntary nonopioid directive form, except upon evidence that the pharmacist acted knowingly against the voluntary nonopioid directive form.
II. No health care practitioner or employee of a health care practitioner acting in good faith shall be subject to criminal or civil liability or be considered to have engaged in unprofessional conduct for failing to offer or administer a prescription or medication order for a controlled substance containing an opioid under the voluntary nonopioid directive form.
III. No person acting as a representative or an agent under a health care proxy shall be subject to criminal or civil liability for making a decision under RSA 126-A:90 in good faith.
2 New Section; Coverage for Nonopioid Treatment for Pain; Individual. Amend RSA 415 by inserting after section 6-aa the following new section:
415:6-bb Coverage for Nonopioid Treatment for Pain; Individual. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for the costs of options to patients for evidenced-based nonopioid treatment for pain, including but not limited to, chiropractic care, osteopathic manipulative treatment and acupuncture treatment. Policies issued pursuant to this section shall provide coverage for at least 20 visits per event of physical therapy, occupational therapy, osteopathic manipulation, a chronic pain management program, and chiropractic services when ordered by a health care practitioner to treat conditions that cause chronic pain. Reimbursement, coinsurance, copayment, and deductible amounts for pain management care utilizing yoga therapy, chiropractic, acupuncture, and/or osteopathic manipulation shall be determined as a service under the Patient Protection and Affordable Care Act of 2009, as amended, definition of rehabilitation and habilitation, but in no case shall be greater than the deductible, coinsurance, or co-pay required for a primary care visit.
3 New Section; Coverage for Nonopioid Treatment for Pain; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Nonopioid Treatment for Pain. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the costs of options to patients for evidenced-based nonopioid treatment for pain, including but not limited to, yoga therapy, chiropractic care, osteopathic manipulative treatment and acupuncture treatment. Policies issued pursuant to this section shall provide coverage for at least 20 visits per event of naturopathic therapy, physical therapy, occupational therapy, osteopathic manipulation, a chronic pain management program, and chiropractic services when ordered by a health care practitioner to treat conditions that cause chronic pain. Reimbursement, coinsurance, copayment, and deductible amounts for pain management care utilizing naturopathic therapy, chiropractic, acupuncture, and/or osteopathic manipulation shall be determined as a service under the Patient Protection and Affordable Care Act of 2009, as amended, definition of rehabilitation and habilitation, but in no case shall be greater than the deductible, coinsurance, or co-pay required for a primary care visit.
4 New Section; Accident and Health Insurance; Coverage for Pain Management Services; Group. Amend RSA 415 by inserting after section 18-ee the following new section:
415:18-ff Coverage for Pain Management Services.
I. 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 to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments, including, but not limited to: chiropractic treatment of spine, peripheral joints, and soft tissues; osteopathic manipulation of joints and tissues; and massage therapy and manual physical therapy treatments.
(c) Movement therapies, including, but not limited to therapeutic exercises administered by physical therapists and chiropractors, independent therapeutic exercise, aquatic therapy, yoga, qi gong, and tai chi.
(d) Other treatments by licensed practitioners with expertise in pain treatment including acupuncture and massage therapy.
II. Policies issued or renewed pursuant to this section shall provide for at least 20 visits and shall include coverage for coordination of pain management services during the plan year for each of the preceding pain management services to manage pain by the policy holder’s beneficiaries’ licensed providers to ensure that the provided services are both well integrated and multi-modal.
III. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
IV. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain, including those methods and treatments covered by the insurer’s pain management plan.
V. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall ensure an adequate number and type of licensed professionals to assure that all covered pain management services are accessible to policy holder beneficiaries without unreasonable burden or delay.
VI. In this section:
(a) “Pain” means an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
(b) “Pain management services plan” means a comprehensive written plan by insurers for provision of pain management services.
(c) “Pain management services” mean a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(d) “Pain education” means education aimed at understanding the neuroscience of pain, the biopsychosocial nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) “Self-management training” means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
(f) “Multi-modal” means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
5 New Section; Coverage for Pain ManagemenrManagement. Amend RSA 415 by inserting after section 6-e the following new section:
415:6-ee Coverage for Pain Management Services.
I. In this section:
(a) "Integrated" means bringing together different services in a coordinated manner.
(b) "Multi-modal" means utilization of a number of diverse approaches expected to have a synergistic or complementary effect in achieving effective pain management.
(c) "Pain" means an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.
(d) "Pain education" means education aimed at understanding the neuro science of pain, the bio psychological nature of pain, and the rationale for use of diverse approaches to effectively manage pain.
(e) "Pain management services" means a broad spectrum of pain relief services and treatments for residents of this state experiencing pain.
(f) "Pain management services plan" means a comprehensive written plan by insurers for provision of pain management services.
(g) "Self-management training' means training that engages patients in self-regulation of physical, cognitive, and emotional processes to reduce pain and improve function.
II. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses shall provide to persons covered by such insurance who are residents of this state coverage for a broad spectrum of pain management services, in addition to currently covered pharmacologic and interventionalist treatments. Such services shall include:
(a) Behavioral health interventions, including but not limited to pain self-management training, cognitive behavioral therapy, acceptance and commitment therapy, mindfulness and/or other meditation training, support groups, and pain education.
(b) Manual treatments including, but not limited to chiropractic treatment, osteopathic manipulation, massage therapy, and manual physical therapy treatments.
(c) Movement therapies including, but not limited to therapeutic exercises, independent therapeutic exercise, aquatic therapy, yoga, qi gong, and tai chi.
(d) Other treatments by licensed practitioners with expertise in pain treatment including acupuncture and massage therapy.
III. Policies issued or renewed pursuant to this section shall provide for at least 20 visits and shall include coverage for coordination of pain management services during the plan year for each of the preceeding pain management services to manage pain by the policy holder's beneficiaries' licensed providers to ensure that the provided services are both well integrated and multi-modal.
IV. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall produce and submit to the insurance commissioner for approval not later than January 1, 2025 a comprehensive pain services management plan which shall contain a description of the covered pain management services in accordance with rules adopted by the insurance commissioner under RSA 541-A. Upon approval by the insurance commissioner, the insurers shall promptly post their pain management services plan approved by the insurance commissioner and detailed descriptions of covered services to their public websites in an easily accessible location.
V. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall produce and supply with each renewed or issued policy of health insurance, educational materials to policy holder beneficiaries and all in-network providers of pain management services. Educational materials shall include pain self-management information and a description of the full range of pharmacological and non-pharmacological methods and treatments for managing pain including those methods and treatments covered by the insurer's pain management plan.
VI. Each insurer that issues or renews any individual policy, plan or contract of accident or health insurance providing benefits for medical or hospital expenses shall ensure an adequate number and type of licensed professionals to assure that all covered pain management services are accessible to policy holder beneficiaries without unreasonable burden or delay.
6 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, 415:6-z, 415:6-aa, RSA 415:6-bb, RSA 415:6-ee, 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, 415:18-dd, 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.
7 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-aa, RSA 415:6-bb, RSA 415:6-ee, 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, 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.
8 Effective Date. This act shall take effect July 1, 2023.
23-0161
1/9/23
HB 554-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to treatment alternatives to opioids.
FISCAL IMPACT:
Due to time constraints, the Office of Legislative Budget Assistant is unable to provide a fiscal note for this bill, as introduced, at this time. When completed, the fiscal note will be forwarded to the House Clerk's Office.
AGENCIES CONTACTED:
Department of Health and Human Services
