This bill mandates the commissioner of the department of health and human services to create uniform guidelines for the authorization and utilization review of inpatient psychiatric services under the managed care law. The new guidelines will provide a single set of criteria for admission, continued stay, and discharge decisions, as well as retrospective reviews. Notably, the bill prohibits utilization review during the first 30 days of an inpatient or residential behavioral health admission, on the condition that the treating facility informs the health plan of the admission and treatment plan within two days and conducts daily clinical reviews of the patient. The act is set to take effect 60 days after its passage.

The fiscal note attached to the bill indicates that the financial impact on the state is indeterminable but could lead to increased lengths of inpatient or residential admissions and higher total costs for related claims. This, in turn, could result in an increase in insurance premium tax revenue, the extent of which is also indeterminable but potentially significant. The Insurance Department would need to hire experts to develop these guidelines, as it lacks medical experts, and the cost of these experts is unknown but would be a recurring expense. The increased costs would be recovered through insurance assessments as allowed by RSA 400-A:39. The fiscal impact is expected to begin in FY 2025. The bill does not provide funding for estimated expenditures nor does it authorize new positions for its implementation.

Statutes affected:
Introduced: 420-J:6