HB241 — (New Title) relative to health insurance coverage of pain management services for the management of chronic pain.

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 by providers practicing in a licensed profession, 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) Acupuncture.

(e) Massage Therapy II.

Policies issued or renewed pursuant to this section shall provide for at least 12 visits for each of the preceding pain management categories 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.

HB 241-FN - AS INTRODUCED - Page 4 - 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.

No insurer shall establish utilization controls, including prior authorization or step therapy requirements, for clinically appropriate nonopioid therapies, medicinal drugs or drug products approved by the federal Food and Drug Administration for the treatment or management of pain that are more restrictive or extensive than the least restrictive or extensive utilization controls applicable to any clinically appropriate opioid drug.

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.

4 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 HB 241-FN - AS INTRODUCED - Page 5 - 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 415:6-bb, 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 415:18-gg, RSA 415:18-hh, 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.

5 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 415:6-bb, 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 415:18-gg, RSA 415:18-hh, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.

6 Effective Date.

This act shall take effect July 1, 2025.

LBA 25-0358 12/12/24 HB 241-FN- FISCAL NOTE AS INTRODUCED AN ACT relative to treatment alternatives to opioids.

ThisEstimated billState doesImpact FY 2026 FY 2027 FY 2028 FY 2029 Indeterminable Indeterminable Indeterminable Increase Increase Increase Revenue $0 (range not provide(range funding,not nor(range doesnot itprovided authorizeby newprovided positions.by provided by agency) agency) agency) Revenue Fund(s) General Fund Expenditures* $0 $0 $0 $0 Funding Source(s) None Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill Estimated Political Subdivision Impact FY 2026 FY 2027 FY 2028 FY 2029 County Revenue $0 $0 $0 $0 County Expenditures $0 Indeterminable Indeterminable Indeterminable Local Revenue $0 $0 $0 $0 Local Expenditures $0 Indeterminable Indeterminable Indeterminable METHODOLOGY:

EstimatedThis Statebill Impactrequires FYhealth 2025carriers FYto 2026provide FYexpanded 2027coverage FYfor 2028non-opioid Indeterminablepain Indeterminablemanagement Indeterminableservices Revenue $0 Increase Increase Increase Revenue Fund(s) General Fund Insurance Premium Tax Indeterminable Indeterminable Indeterminable Expenditures* $0 Increase Increase Increase Funding Source(s) General Fund and Variouslimits Agencythe Fundsuse Appropriations* $0 $0 $0 $0 Funding Source(s) None *Expenditure = Cost of billutilization *Appropriationcontrols =for Authorizedthose fundingservices tofor coverpolicies costissued ofor billrenewed Estimatedon Politicalor Subdivisionafter ImpactJanuary FY1, 20252027. FY 2026 FY 2027 FY 2028 County Revenue $0 $0 $0 $0 County Expenditures $0 Indeterminable Indeterminable Indeterminable Increase Increase Increase Local Revenue $0 $0 $0 $0 Local Expenditures $0 Indeterminable Indeterminable Indeterminable Increase Increase Increase METHODOLOGY:

The Insurance Department states this bill wouldrequires amendhealth currentcarriers lawin bythe expandingfully insured health insurance coveragemarket requirementsto fordevelop and maintain comprehensive pain management servicesprograms beyondfor currentlythe coveredtreatment “standard”of orchronic “conventional”pain treatments.and to provide information on those programs to consumers on an annual basis.

ThisThe includesbill addingalso coveragerequires forthat servicesmedical suchmanagement astechniques mindfulnessfor ornon-opioid meditationdrugs training,approved to treat pain education,be massageno therapy,more yoga,stringent Taithan Chi,the Qimedical Gong,management movementtechniques therapyused andfor acupuncture.opioid drugs.

AllThe ofDepartment thestates listedthat servicesif wouldthe beexpanded coveredcoverage forrequirements aincrease minimumutilization of 12health visits,care services, overall health care costs and theinsurance coordinationpremiums ofcould benefitsincrease, which would beresult managedin bya thecorresponding licensedincrease provider(s)in deliveringInsurance thePremium respectiveTax service(s).revenues.

TheHowever, billthe wouldDepartment applyis unable to individualestimate (RSAthe 415:6)extent andto groupwhich andutilization blanketof (RSAhealth 415:18)care accidentservices andwould healthincrease policiesunder issuedthe inbill Newand Hampshiretherefore bycannot healthestimate insurancethe companies,fiscal healthimpact serviceon corporations,Insurance andPremium healthTax maintenancerevenues, organizations.which is indeterminable.

SinceTo athe numberextent ofcounties previouslyand non-coveredmunicipalities servicespurchase wouldfully nowinsured behealth covered,insurance, thisthey proposalcould wouldexperience representincreased an expansion of required health benefits,insurance andcosts asif such,utilization mayof resulthealth incare increasedservices claimsincreases. costs, increased premiums and premium tax revenue.

To the extent that the coverages required in this bill are applicable to health benefits offered by state, county and local government entities, this would represent an indeterminable increase in state, county and local expenditures.

The bill would require insurers submit to the Insurance Commissioner a comprehensive pain management services plan for his or her approval.

Upon approval, this plan must be promptly posted to the insurer’s website.

The information disseminated to plan beneficiaries must include a list and description of covered pharmacologic and non-pharmacologic pain management treatment therapies available to policyholders.

The Insurance Department expects a negligible impact to premiums, and thus, premium tax revenues directly attributable to this requirement.

However, the Department does not have staff qualified to review medical guidelines and would need to hire a consultant to assist with this review and with promulgating rules.

The Department estimates it would need an additional $250,000 per year to retain the appropriate consultants.

The bill also adds a provision requiring insurers to ensure an adequate supply of licensed practitioners for each type of covered pain management services without unreasonable burden or delay.

This parallels the current network adequacy requirement in the Department's administrative rule Ins 2701 which requires that covered persons will have access to covered health care services without unreasonable delay.

There does not appear to be an oversight mechanism to ensure that this provision is met and it is foreseeable that insurers would encounter a credentialing issue and be unable to credential certain providers in accordance with RSA 420-J:4.

This may result in delays of care delivery and perhaps limit the ability for insurers to comply with network adequacy requirements.

Under federal regulation at CFR Section 155.170, passage of the bill would likely be considered a state action to add a health benefit which is above or in addition to the Essential Health Benefits offered in the Exchange Marketplace.

Under this regulation, the state must make payments to the Federal government to defray the cost of the additional required benefits to Qualified Health Plan enrollees or to QHP issuers.

This would represent a general fund expense which is indeterminable at this time.

The Centers for Medicare and Medicaid Services (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.

However, 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.

Historically, external review of the cost of coverage mandates costs the Department $20,000-$40,000.

If enacted, the bill would take effect on July 1, 2025.

However, rates for plan year 2025 have already been set and cannot be changed.

These rates do not account for additional covered services so the premium collected may be inadequate to cover potential claims which could cause a financial impact to the insurance companies.