Bill Text: NH SB622 | 2020 | Regular Session | Amended


Bill Title: Establishing minimum standards for insurance claim review and settlement practices.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Engrossed - Dead) 2020-09-23 - Died on Table [SB622 Detail]

Download: New_Hampshire-2020-SB622-Amended.html

SB 622-FN - AS AMENDED BY THE SENATE

 

03/11/2020   1057s

2020 SESSION

20-3047

01/04

 

SENATE BILL 622-FN

 

AN ACT establishing minimum standards for insurance claim review and settlement practices.

 

SPONSORS: Sen. Sherman, Dist 24; Sen. Feltes, Dist 15; Sen. Rosenwald, Dist 13; Rep. Keans, Straf. 23; Rep. Van Houten, Hills. 45; Rep. Marsh, Carr. 8

 

COMMITTEE: Commerce

 

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ANALYSIS

 

This bill establishes minimum standards for insurance claim review and settlement practices.  This bill also establishes a private right of action for violation of such standards.

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/11/2020   1057s 20-3047

01/04

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT establishing minimum standards for insurance claim review and settlement practices.

 

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

 

1  New Paragraphs; Standards for Accident and Health Insurance; Minimum Standards for Claim Review.  Amend RSA 415-A:4-a by inserting after paragraph V the following new paragraphs:

VI.  Any carrier requiring prior authorization or a pre-service claim to be filed for a covered benefit or service deemed medically necessary by a licensed health care provider which delays a claimant’s receipt of the covered benefit or service and results in harm to the claimant, will be considered to have engaged in an unfair claim settlement practice by an insurer under RSA 417:4, XV.

VII.  In any request for a pre- or post-service claim or benefit determination by a claimant or a physician, if the carrier fails to follow the provisions of this statute or denies a medical benefit claim for a covered service that a licensed health care provider as defined in RSA 420-J:3, XXI has determined to be medically necessary, without reasonable grounds for doing so, it will be considered an unfair claim settlement practice by an insurer under RSA 417:4, XV.

2  New Section; Private Right of Action.  Amend RSA 415-A by inserting after section 7 the following new section:

415-A:7-a  Private Right of Action.  Any person injured by an action or unfair claim settlement practice declared unlawful under this chapter may bring an action for damages and for such equitable relief, including an injunction, as the court deems necessary and proper.  If the court finds for the plaintiff, recovery shall be in the amount of actual damages or $1,000, whichever is greater.  If the court finds that the use of the method of competition or the act or practice was a willful or knowing violation of this chapter, it shall award as much as 3 times, but not less than 2 times, such amount.  In addition, a prevailing plaintiff shall be awarded the costs of the suit and reasonable attorney's fees, as determined by the court.  Any attempted waiver of the right to the damages set forth in this paragraph shall be void and unenforceable.  Injunctive relief shall be available to private individuals under this chapter without bond, subject to the discretion of the court.  Upon commencement of any action brought under this section, the clerk of the court shall mail a copy of the complaint or other initial pleadings to the insurance commissioner and, upon entry of any judgment or decree in the action, shall mail a copy of such judgment or decree to the commissioner.

3  Effective Date.  This act shall take effect January 1, 2021.

 

LBAO

20-3047

12/31/19

 

SB 622-FN- FISCAL NOTE

AS INTRODUCED

 

AN ACT establishing minimum standards for insurance claim review and settlement practices.

 

FISCAL IMPACT:      [ X ] State              [ X ] County               [ X ] Local              [    ] None

 

 

 

Estimated Increase / (Decrease)

STATE:

FY 2020

FY 2021

FY 2022

FY 2023

   Appropriation

$0

$0

$0

$0

   Revenue

$0

Indeterminable

Indeterminable

Indeterminable

   Expenditures

$0

$0

$0

$0

Funding Source:

  [ X ] General            [    ] Education            [    ] Highway           [    ] Other

 

 

 

 

 

COUNTY:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

 

 

 

 

LOCAL:

 

 

 

 

   Revenue

$0

$0

$0

$0

   Expenditures

$0

Indeterminable

Indeterminable

Indeterminable

 

METHODOLOGY:

This bill establishes minimum standards for insurance claim review and settlement practices and establishes a private right of action for violation of such standards.  The Insurance Department states the bill would make significant changes to the regulation of health insurance and the determination of medical necessity.  Currently, if a provider disagrees with an insurer, state law delineates an appeal process.  This bill strengthens the position of the health care provider proscribing the service and determining medical necessity.  The Department indicates this would cause inflationary pressure on claims and utilization which would increase premiums.   The State collects premium tax which is deposited in the general fund.  It's unclear how the bill would impact premium tax revenue, as purchasers may respond by buying less costly coverage.  In addition, the bill impacts fully insured products and not self-funded plans.  This could impact the number of employers choosing to self-insure.  An increase in employers choosing to self-fund would reduce premium tax revenue.

 

AGENCIES CONTACTED:

Insurance Department

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