I. Notwithstanding any provision of law
to the contrary, health insurers, health maintenance organizations and
health service corporations shall offer to and accept as providers any
provider who is in good standing with the state licensing board whose
specialty of practice is within the scope of services covered by the health
plan. Health insurers shall not terminate a provider without cause and due
process. Any such termination may be appealed to the health insurance review
board, then through the courts.
II. Providers may withdraw from insurance
rosters at any time. They shall be reinstated voluntarily, if they desire,
upon re-application, at the next fiscal year renewal. Insurers shall not
include "gag" clauses or exclusivity requirements. Clauses of the
provider agreement shall in no way alter or limit the ownership of records,
the professional conduct, and communications of the provider.
III. Health insurers which currently use
the term "managed care" shall be prohibited from using the term
"care" in the description of their own services. Insurers who
participate in remote direction of care, without licenses or without seeing
the patient in person shall be guilty of practicing medicine without a
license or malpractice, respectively.
IV. Insurers may require either provider
or patient to notify the company at the onset of care. The insurance company
shall indicate any cost limitations if applicable to coverage for that
incident/episode. Procedures eligible for coverage shall be any of those
which are reasonably related to the care of the patient's condition and
which the practitioner is licensed to perform. Review procedures for
determining reasonable cost containment for particular patients shall in no
way impede the practitioner's care plan and the patient's right to choose or
refuse such care. Periodic reviews for extended care patients shall be
spaced according to reasonable practice expectations of recovery and patient
change. For most diagnoses, the review period shall correspond to the
average duration of care for each diagnostic grouping as determined by the
insurance commissioner. The health insurance review board, established in
RSA 400-A:15-c, may consider changes in the spacing of reviews.
I. There is hereby established a health
insurance review board. The members of the board shall be as follows:
(a) The insurance commissioner, or
designee.
(b) Five representatives of health
insurers, appointed by the insurance commissioner.
(c) Five public consumer members,
appointed by the governor and council.
(d) Two physicians licensed under RSA
329, appointed by the board of medicine.
(e) One licensed mental health
practitioner, appointed by the board of mental health practice.
(f) A chiropractor, appointed by the
board of chiropractic examiners.
(g) One licensed pharmacist, appointed
by the board of pharmacy.
II. The members appointed under
subparagraphs I(b)-(g) shall serve 3-year terms; provided that initially 2
members under subparagraph I(b), 2 members under subparagraph I(c) and one
member under subparagraph I(d) shall serve for one year; 2 members under
subparagraph I(b), 2 members under subparagraph I(c), the member under
subparagraph I(e) and the member under subparagraph I(g) shall serve 2
years; and one member under subparagraph I(b), one member under subparagraph
I(c), one member under subparagraph I(d), and the member under subparagraph
I(f) shall serve 3 years. The insurance commissioner shall serve a term
coterminous with the commissioner's term of office.
III. The board shall hear appeals under
RSA 400-A:15-b, I in accordance with RSA 541-A and consider review
procedures under RSA 400-A:15-b, IV, upon petition by the insurance company,
or a petition by a minimum of one percent of the providers, or 50 patient
signatures. The board shall also generally advise the commissioner of
concerns about the administration of health insurance.