reglab/housing_qa huggingface dataset:
NH Rev Stat § 420-J:10 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:10 - Confidentiality of Insurer Records.

    420-J:10 Confidentiality of Insurer Records. –||I. Data or information pertaining to the diagnosis, treatment, or health of a covered person obtained from the person or from a provider by a health carrier is confidential and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter and as allowed by any applicable state or federal law; or upon the express consent of the covered person; or pursuant to statute or court order for the production of evidence or the discovery thereof; or in the event of a claim or litigation between the covered person and the health carrier where the data or information is pertinent, regardless of whether the information is in the form of paper, is preserved on microfilm, or is stored in a computer retrievable form.||II. If any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant is disclosed pursuant to paragraph I, the health carrier making this required disclosure shall not be liable for the disclosure or any subsequent use or misuse of the data.||III. A health carrier shall be entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the health carrier is entitled to claim.||IV. The records of the quality assessment program, and the information considered by any quality committee and the records of its actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the department or other appropriate state licensing or certifying agency, or in an appeal, if permitted, from the quality committee's findings or recommendations. This section shall not be construed to affect the confidentiality of any other proprietary record of a health carrier.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:11 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:11 - Confidentiality of Insurance Department Records.

    420-J:11 Confidentiality of Insurance Department Records. –||All information, documents and copies thereof obtained by or disclosed to the commissioner or any other person in the course of an examination or investigation made pursuant to RSA 400-A:37, and, unless otherwise provided in this chapter, all information reported and maintained pursuant to this chapter shall be given confidential treatment and shall not be made public by the commissioner or any other person, except to insurance departments of other states, unless the commissioner after consultation with the affected parties, determines that the interest of policyholders, shareholders, or the public will be served by the publication thereof, in which event the commissioner may disclose all or any part thereof in such manner as the commissioner may deem appropriate.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:12 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:12 - Rulemaking Authority.

    420-J:12 Rulemaking Authority. –||The commissioner may adopt such rules, under RSA 541-A, and issue such orders as may be necessary to carry out the purposes and provisions of this chapter.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:13 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:13 - Severability.

    420-J:13 Severability. –||If any provision of this chapter or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:14 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:14 - Penalties.

    420-J:14 Penalties. –||Any health carrier or other organization violating any of the provisions of this chapter may be subject to an administrative fine not to exceed $2,500 per violation. The commissioner may also suspend or revoke the certificate of authority or license of a health carrier or other organization for any violation of this chapter or the failure to comply with an order of the commissioner issued under this chapter.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:15 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:15 - Definitions.

    420-J:15 Definitions. –||In this subdivision:||I. "ASAM criteria" means the latest edition of the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, developed by the American Society of Addiction Medicine.||II. "Clinical stabilization services" means 24-hour clinically-managed post-withdrawal management treatment for adults or adolescents which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and after-care planning, for individuals beginning to engage in recovery from addiction.||III. "Short-term inpatient withdrawal management" means 24-hour medically-supervised addiction treatment for adults or adolescents provided in medically-managed or medically-monitored inpatient facilities that provide evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychological educational groups, and discharge planning.||IV. "Substance use disorder services" means health care services that are provided to a covered person as treatment for an addictive substance-related condition, not including treatment for any condition related to tobacco use.|||Source. 2016, 2:11, eff. Jan. 1, 2017; 275:1, eff. Jan. 1, 2017 at 12:01 a.m.|
NH Rev Stat § 420-J:16 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:16 - Levels of Care Criteria; Attestation.

    420-J:16 Levels of Care Criteria;  Attestation. –||I. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, the health carrier providing such benefits shall rely upon ASAM criteria when determining medical necessity and developing utilization review standards for levels of care for substance use disorder services.||II. On January 1 of each year, each health carrier that provides coverage for substance use disorder services shall file with the commissioner an annual attestation of compliance with this subdivision.|||Source. 2016, 2:11, eff. Jan. 1, 2017.|
NH Rev Stat § 420-J:17 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:17 - Prior Authorization.

    420-J:17 Prior Authorization. –||I. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for the first 2 routine outpatient visits of an episode of care by an individual for assessment and care with respect to a substance use disorder.||II. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for short-term inpatient withdrawal management and clinical stabilization services for up to 24 hours, when prescribed by a clinician trained in the use and application of the ASAM criteria; provided, that the facility notifies the patient's health carrier as soon as practicable after admission of the patient. If the facility fails to notify the patient's health carrier as soon as practicable after admission of the patient, the facility shall be financially responsible for the costs of any services provided by the facility to the patient.||III. Alternatively, a carrier may require prior authorization for the services described in paragraph II, but only if the carrier has a medical clinician or licensed alcohol and drug counselor available on a 24-hour hotline to make the medical necessity determination and assist with placement at the appropriate level of care, and the carrier provides a prior authorization decision as soon as practicable after receipt from the treating clinician of the clinical rationale consistent with the ASAM criteria, but in no event more than 6 hours of receiving such information; provided that until such hotline determination is made, coverage for substance use disorder services shall be provided at an appropriate level of care consistent with the ASAM criteria, as defined in RSA 420-J:15, I.||IV. If an insurance policy does not require prior authorization for short-term inpatient withdrawal management services or clinical stabilization services, paragraphs II and III shall not apply.||V. Nothing in this section shall be construed to require coverage for services provided by a non-participating provider.|||Source. 2016, 2:11, eff. Jan. 1, 2017; 275:2, eff. Jan. 1, 2017 at 12:01 a.m.|
NH Rev Stat § 420-J:18 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:18 - Authorization for Medication-Assisted Treatment.

    420-J:18 Authorization for Medication-Assisted Treatment. –||Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, a health carrier shall:||I. Be required to offer at least one medication-assisted treatment therapy option approved by the federal Food and Drug Administration for treatment of substance use disorders without a requirement for prior authorization.||II. Not require a renewal of a prior authorization for a medication-assisted treatment therapy for treatment of substance use disorders more frequently than once every 12 months.|||Source. 2017, 185:1, eff. Aug. 28, 2017. 2020, 39:52, eff. Sept. 27, 2020.|
NH Rev Stat § 420-J:19 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:19 - Medication Synchronization.

    420-J:19 Medication Synchronization. –||I. An individual or group health insurance plan or policy providing prescription drug coverage in New Hampshire, shall permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a 30-day supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a 30-day supply for the purpose of synchronizing the patient's medications. For the purposes of this paragraph, the insured's or enrollee's maintenance prescription drugs to be synchronized shall meet all of the following requirements:||(a) They are covered by the policy, certificate, or contract described in this chapter.||(b) They are used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee.||(c) Except as otherwise provided in this paragraph, they are not a controlled substance included in schedules II-V.||(d) They meet all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple, maintenance-prescription drugs.||(e) They are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.||(f) They do not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.||II. The plan or policy described in paragraph I shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.||III. The plan or policy described in paragraph I shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.||IV. A synchronization shall only occur once per year per maintenance-prescription drug.|||Source. 2018, 103:2, eff. Jan. 1, 2019.|
NH Rev Stat § 420-M:1 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:1 - Purpose.

    420-M:1 Purpose. –||The purpose of this chapter is to:||I. Increase the affordability, efficiency, and fairness of health insurance coverage for employers by setting standards for the licensure and oversight of purchasing alliances through which employers and their employees may purchase health coverage.||II. Allow employers and their employees to obtain better value in purchasing health insurance by consolidating purchasing responsibilities and resources, thereby increasing purchasing expertise and reducing the administrative cost of health plan contracting, enrollment, premium collection, and payment for multiple employers.||III. Foster competition based on value.|||Source. 2010, 346:1, eff. July 20, 2010.|
NH Rev Stat § 420-M:2 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:2 - Definitions.

    420-M:2 Definitions. –||In this chapter:||I. "Commissioner" means the insurance commissioner.||II. "Eligible dependents" means "eligible dependents" as defined in RSA 420-G:2, V.||III. "Eligible employee" means "eligible employee" as defined in RSA 420-G:2, VI.||IV. "Employee enrollee" means an eligible employee, self-employed individual, or an eligible dependent of an eligible employee who is enrolled in a health benefit plan offered through an alliance by a participating carrier.||V. "Health benefit plan" means "health coverage" as defined in RSA 420-G:2, IX.||VI. "Health carrier" or "carrier" means "health carrier" as defined in RSA 420-G:2, VIII.||VII. "Member employer" means an employer who enrolls in an alliance.||VIII. "Participating carrier" means a carrier that contracts with the alliance.||IX. "Purchasing alliance" or "alliance" means a non-risk bearing corporation or other entity licensed pursuant to RSA 420-G:10-a that provides health insurance coverage to member employers and their employees.|||[Paragraph X effective until 60 days after certification by the insurance commissioner that 29 C.F.R. section 2510.3-5(b) is valid and that issues raised in State of New York v. United States Department of Labor have been resolved, but not later than December 1, 2021; see also paragraph X set out below.]||||X. "Qualified purchasing alliance" means a purchasing alliance that has obtained certification from the commissioner under RSA 420-M:13 as a qualified purchasing alliance with authority to operate in the same manner as a qualified association trust pursuant to RSA 420-G:10.|||[Paragraph X effective 60 days after certification by the insurance commissioner that 29 C.F.R. section 2510.3-5(b) is valid and that issues raised in State of New York v. United States Department of Labor have been resolved, but not later than December 1, 2021; see also paragraph X set out above.]||||X. "Qualified purchasing alliance" means a purchasing alliance that has obtained certification from the commissioner under RSA 420-M:13 as a qualified purchasing alliance with authority to sponsor fully-insured bona fide pathway II association coverage under RSA 415-E.||XI. "Small employer" means "small employer" as defined in RSA 420-G:2, XVI.|||Source. 2010, 346:1, eff. July 20, 2010. 2019, 346:410.|
NH Rev Stat § 420-M:3 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:3 - Jurisdiction of the Commissioner; Penalties.

    420-M:3 Jurisdiction of the Commissioner;  Penalties. –||I. The commissioner shall regulate the establishment and conduct of purchasing alliances.||II. No person or entity, other than a qualified association trust, shall market, sell, offer, or arrange the sale of one or more health benefit plans to 2 or more employers or their eligible employees without first being licensed by the commissioner pursuant to this chapter.||III. A person or entity, not licensed by the commissioner as a purchasing alliance and engaged in the purchase, sale, marketing, or distribution of health insurance or health care benefit plans shall not hold itself out as a health insurance purchasing alliance, health insurance purchasing cooperative, or a health insurance purchasing association.|||Source. 2010, 346:1, eff. July 20, 2010.|
NH Rev Stat § 420-M:4 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:4 - Purchasing Alliance Application and Licensing.

    420-M:4 Purchasing Alliance Application and Licensing. –||To obtain authority to operate as a purchasing alliance, an application shall be completed and filed with the commissioner by an authorized representative of the corporation or other entity established to operate as a purchasing alliance. An application shall not be deemed filed until all information necessary to properly process the application has been received by the commissioner. Upon filing, the commissioner shall make a determination concerning the application and shall provide notice of the determination to the applicant. If approved, a copy of a license shall be provided to the purchasing alliance. The license shall serve as authorization to operate pursuant to this chapter.|||Source. 2010, 346:1, eff. July 20, 2010.|
NH Rev Stat § 420-M:6 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:6 - Revocation of License and Insolvency.

    420-M:6 Revocation of License and Insolvency. –||I. The following intentional acts shall constitute grounds for denial, non-renewal, suspension, or revocation of an application or existing license, following notice and an opportunity for hearing:||(a) Failure to comply with the provisions of RSA 420-G;||(b) Failure to comply with the business plan filed and approved by the commissioner;||(c) Failure to maintain adequate financial controls;||(d) Failure to extend alliance health benefit plan coverage to eligible employees;||(e) Failure to comply with a lawful order of the commissioner;||(f) Engaging in an unfair or deceptive act or practice;||(g) Filing any necessary form, including the application form, with the commissioner that contains false or materially incorrect information or omissions; or||(h) Misappropriation, conversion, illegal withholding, or refusal to pay over upon proper demand any moneys that belong to a person or participating carrier and that have been entrusted to the alliance in its fiduciary capacity.||II. The commissioner shall require the removal and replacement of managerial or marketing staff or third party contractors if necessary to remedy compliance or performance problems.||III. In the event the alliance becomes insolvent, the commissioner shall place the alliance in receivership if necessary to protect the interests of alliance enrollees.|||Source. 2010, 346:1, eff. July 20, 2010.|
NH Rev Stat § 420-M:8 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:8 - Contracts With Participating Carriers.

    420-M:8 Contracts With Participating Carriers. –||The contracts entered into by the alliance shall:||I. Establish performance standards for specific contractual elements;||II. Set liquidated damages for breach of the contract;||III. Require the insurer to notify the member employers of cancellation of the policy;||IV. Require the member employers in the event of cancellation to arrange for continuation coverage for their employees to the extent provided under federal and state law; and||V. Contain a provision stating that if after timely receipt of the premium payment from the employer, the alliance fails to make the premium payment to the insurer, with the result that coverage is terminated, that the alliance shall be liable for benefits to the same extent as the insurer or carrier would have been liable if coverage had not been terminated.|||Source. 2010, 346:1, eff. July 20, 2010.|
NH Rev Stat § 420-M:9 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-M - Purchasing Alliances|Section 420-M:9 - Requirements for Participating Carriers.

    420-M:9 Requirements for Participating Carriers. –||I. To qualify as a participating carrier, a carrier shall demonstrate the following characteristics:||(a) That it is licensed and in good standing with the insurance department;||(b) That it has the ability to administer health coverage, to provide adequate service, and to comply with all contractual requirements of the alliance;||(c) That it has the ability to provide enrollees with access to covered services;||(d) That it has the ability to provide coverage for enrollees in any service area in which the carrier plans to participate through the alliance;||(e) That it has the ability to arrange and pay for quality health care services;||(f) That it has the ability to provide standard data required by the alliance, in a manner prescribed by the alliance, including information on:||(1) Plan performance;||(2) Enrollee satisfaction;||(3) Provider payment and incentive structures; and||(4) Such other data requirements prescribed by the alliance;||(g) That it has the ability to meet quality of care standards established by government and industry authorities; and||(h) That it is financially strong and has competent management.||II. Participating carriers that contract with or employ health care providers shall have the ability to accomplish the following in a manner satisfactory to the alliance:||(a) Review and report on the cost and quality of care covered;||(b) Review and report on the appropriateness of care covered; and||(c) Provide accessible health care services.||III. Each participating carrier shall:||(a) Meet the standards established by the alliance pursuant to this chapter;||(b) Provide data and information as required by the alliance;||(c) Comply with all laws and rules regarding underwriting, rating, claims handling, sales, solicitation, licensing, fair marketing, unfair trade practices, the provisions of this chapter, and other applicable state statutes;||(d) Enroll and terminate individuals in the manner specified by the alliance; and||(e) Comply with other requirements established by the alliance pursuant to this chapter.||IV. Nothing in this chapter shall prohibit participating carriers from contracting with particular health care providers or types, classes, or categories of health care providers, or setting reimbursement methodology.||V. In the event that the participating carrier elects to terminate its contract with the alliance, the participating carrier shall:||(a) Provide advance notice of its decision to the alliance; and||(b) Provide notice of the decision at least 180 days prior to the non-renewal of health coverage to the member employers and employee enrollees.|||Source. 2010, 346:1, eff. July 20, 2010.|