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Statutory Overview in New Hampshire

Legislation Signed into Law

2019

Primary Focus: Parity: General
Title/Description: Establishing a commission to study the business environment for mental health providers in New Hampshire.
Citation: RSA 330-A
Summary: This act amends RSA 330-A by adding a new section to establish a commission on the business environment for mental health providers in the state. The act specifies who must be on such committee and the focus of such committee, including examining billing practices and regulations, access to affordable education, insurance rates and mental health parity, and methods to strengthen the network of providers within the state.
Effective: November 1, 2020
Notes: Enacted through SB 115

Primary Focus: Enforcement: Reporting Requirement
Title/Description: Relative to mental health parity under the insurance laws
Citation: RSA 417-E:1
Summary: This act amends RSA 417-E:1, II to authorize the Insurance Commissioner to enforce the Federal Parity Law and its implementing regulations. The commissioner must periodically examine and evaluate insurers, health service corporations, and health maintenance organizations for compliance and the results of such examinations and evaluations must be made available to the public.
Effective: January 1, 2020
Notes: Enacted through  SB 272

2017-2018

SB 158
Introduced: 1/2017
Sponsor: Sens. Feltes, Fuller Clark, Hennessey, Kahn, Lasky, Soucy, Watters, Woodburn, Butler, Luneau, and Williams
Status: Signed into law 6/2017
Summary: This bill amends the section of state law related to substance use disorder coverage by prohibiting renewal of prior authorization of approved medication assisted treatment more frequently than once every 12 months.

SB 157
Introduced: 1/2017
Sponsor: Sens. Feltes, Fuller Clark, Hennessey, Kahn, Lasky, Soucy, Watters, Woodburn, Luneau, Williams, and Butler
Status: Signed into law 7/2017
Summary: This bill amends state insurance law by expanding existing network adequacy and consumer rights under managed care law to include individuals with substance use disorders. Additionally, the bill requires insurers to notify consumers of their rights regarding managed care, appeal rights, and ability to access services out of network.

HB 517
Introduced: 1/2017
Sponsor: Reps. Ober, Beaudoin, Weyler, Umberger, McGuire, D’Allesandro, Reagan, and Bradley
Status: Signed into law 6/2017
Summary: Among many things, this bill requires the development of an online prior authorization form for drugs used to treat mental illness. Community mental health centers and managed care organizations are required to use this form.

2015-2016

Primary Focus: Reporting Requirements
Title/Description: Reporting Requirements
Citation: New Hampshire Revised Statutes § 135-F:6
Summary: The statute requires the state department of health and human services and of education to issue an annual report addressing the provision of children’s behavioral health in the state.
Effective Date: June 6, 2016
Notes: Created by NH SB 534.

SB 533
Introduced: 1/2016
Sponsor: Sen. Woodburn
Status: Signed into law 6/2016
Summary: This is a comprehensive bill that addresses many areas related to substance use disorders, focusing on opioids. Among many things, the bill requires that when substance use disorder services are a covered benefit, no prior authorization should be required for the first 2 routine visits of an episode of care or the first 72 hours of inpatient treatment for emergency services.

SB 532
Introduced: 1/2016
Sponsor: Sen. Stiles
Status: Signed into law 6/2016
Summary: This bill requires all policies issued or renewed after December 31, 2016 to provide either coverage for medically necessary substance use disorder treatment without prior authorization or a 24-hour hotline capable of offering a drug treatment assessment. If treatment is found to be necessary via the hotline, prior authorization must occur within 12 hours of the initial call.
The bill requires that insurers use American Society for Addiction Medicine (ASAM) criteria when making medical necessity determination. On January 1 of each year, insurers must file an annual attestation with the commissioner of insurance showing that they are using the most current ASAM criteria.

SB 576
Introduced: 1/2016
Sponsor: Sen. Bradley
Status: Signed into law 6/2016
Summary: This is a comprehensive bill that addresses many areas related to substance use disorders, focusing on opioids. Among many things, the bill requires that when substance use disorder services are a covered benefit within a health plan, no prior authorization should be required for the first 2 routine outpatient visits of substance use disorder treatment. The bill also requires insurers use the American Society for Addiction Medicine criteria when making medical necessity determinations.

Primary Focus: Mandated Benefit: telemedicine
Title/Description: Telemedicine
Citation: New Hampshire Revised Statutes § 329:1-d
Summary: The statute requires that out-of-state physicians providing services using telemedicine shall be deemed to be in the practice of medicine and licensed.
Effective Date: September 11, 2015.
Notes: Created by NH SB 84.

HB 2
Introduced: 2/2015
Sponsor: Rep. Kurk
Status: Veto overridden 9/2015
Summary: This bill requires the commissioner of the Department of Health and Human Services to submit a state plan amendment to the Center for Medicare and Medicaid Services to provide substance use disorder services to beneficiaries. The benefits must be consistent with the Substance Abuse and Mental Health Service Administration (SAMHSA) treatment guidelines. The commissioner must also detail the process and timeline for implementing the services.

SB 564
Introduced: 3/2015
Sponsor: Rep. Sherman and Sen. Feltes
Status: Signed into law 6/2015
Summary: This bill changed state law so that Medicaid managed care organizations cannot require prior authorization for medications for treatment of individuals with schizophrenia, bipolar disorder, and major depression.

2009-2010

HB 1493
Introduced: 1/2010
Sponsor: Rep. Merry
Status: Signed into law 5/2010
Summary: This bill created a committee in the General Court to study parity for the purposes of potentially changing the sections of the state insurance law about parity. The committee was to specifically look into the following:

  • Other state parity laws throughout the country
  • Costs and benefits associated with expanding behavioral health coverage
  • Whether any addition to the law should require plans to cover treatment of all conditions in the DSM
  • Whether the law can/should apply to self-insured plans
  • Whether any addition to the law should require mandatory coverage
  • Whether any addition to the law should apply to small employer fully-insured plans with more than 25 employees
  • Whether deductibles and copayments should be capped at a certain percentage

Primary Focus: Mandated Benefit: Provider; SUD
Title/Description: Health Maintenance Organization Benefits for Mental and Nervous Conditions and Treatment for Chemical Dependency
Citation: New Hampshire Revised Statutes § 420-B:8-b
Summary: The statute requires that benefits for mental or nervous conditions shall conform to RSA 415:18-a or the basic health services requirements for HMOs. The statute also requires coverage for the treatment of chemical dependency, including alcoholism, up to a specified limit and allows the Commissioner to adopt, as necessary, rules to effectuate any provisions of the Mental Health Parity Act of 2008 that relate to the business of insurance.
Effective Date: July 16, 2009
Notes: Amended by NH HB 330.

HB 569
Introduced: 1/2009
Sponsor: Rep. Butcher
Status: Signed into law 6/2009
Summary: This bill changed a section of the state insurance law about parity by adding a subsection that detailed how autism services must be covered (this subsection is summarized at the bottom of this page under “New Hampshire Parity Law,” “Autism Coverage”).

New Hampshire Parity Law

There are several sections of the state insurance law relevant to parity. They are summarized below in three parts: Behavioral health coverage; Biologically-based mental illness coverage; Autism coverage

Behavioral Health Coverage

This section requires individual plans, and large employer fully-insured plans to cover behavioral health services. However, there are different requirements for different conditions and different plans.

For substance use disorder services, this section only specifies that plans must cover inpatient care and outpatient care and that there may be annual maximums and annual limits in place, but it does not clarify what those maximums and limits should be.

For mental health services, small employer fully-insured plans and large employer fully-insured plans are required to cover inpatient care and residential treatment in a way that is “at least as favorable” as coverage inpatient care and residential treatment for other medical services. It also specifies (the wording is indirect) that financial requirements for inpatient care and residential treatment must be the “same ratio” as those for other medical services.

Plans must cover at least 15 hours per year for outpatient care.

For individual plans, deductibles and coinsurance for mental health services must be “at least as favorable” as those in place for other medical services. There is a $3,000 annual maximum and a $10,000 lifetime maximum for mental health services (however, the Affordable Care Act eliminates all lifetime maximums and annual maximums for most plans). This section specifies that this coverage is for inpatient care, outpatient care, and partial hospitalization.

This section also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Federal Parity Law.

Biologically-Based Mental Illness

This section applies to small employer fully-insured plans and large employer fully-insured plans and specifies that it takes effect when coverage benefits from the above section are exhausted. It states that coverage for the following conditions must be “under the same terms and conditions and…no less extensive” than coverage for other medical conditions:

  • Schizophrenia and other psychotic disorders
  • Schizoaffective disorder
  • Major depressive disorder
  • Bipolar disorder
  • Anorexia nervosa and bulimia nervosa
  • Obsessive-compulsive disorder
  • Panic disorder
  • Pervasive developmental disorder or autism
  • Chronic post-traumatic stress disorder

This section also authorizes the Commissioner of the New Hampshire Insurance Department to issue regulations regarding the Federal Parity Law.

Autism Coverage

The above section for “biologically-based mental illness” requires small employer fully-insured plans and large employer fully-insured plans to cover “pervasive developmental disorder or autism” services. This section further specifies plan requirements for this coverage.

Plans must cover the following:

  • applied behavior analysis
  • Prescription medications
  • Direct or consultative services, by a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, or licensed clinical social worker
  • Services provided by a licensed speech therapist, licensed occupational therapist, or licensed physical therapist

Plans must cover $36,000 annual maximum for applied behavior analysis for children at birth through age 12, and a $27,000 annual maximum for children and young adults age 13 through age 21.

Plans can review a child’s treatment plan once every 6 months.

Get Support

New Hampshire Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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