New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 2200 - HEALTH MAINTENANCE ORGANIZATIONS
Part Ins 2201 - LICENSING AND REGULATION OF HEALTH MAINTENANCE ORGANIZATIONS
Section Ins 2201.03 - Definitions
Universal Citation: NH Admin Rules Ins 2201.03
Current through Register No. 40, October 3, 2024
Ins 2201.03 Definitions.
(a) For the purposes of this part, the definitions appearing in RSA 420-B:1 shall apply.
(b) With respect to the following words or phrases used in this part, not defined in RSA 420-B:1, the following definitions shall apply:
(1)
"Active recipient of mental health services" means an insured,
subscriber, or member of a replacing carrier's health
insurance benefit plan who received mental health services from a mental health
provider while covered by a prior carrier's benefit plan provided such services
were for a purpose other than monitoring medications and were received at least
as often as:
a. In the case of outpatient
services:
1. For 2 separate days during the
30 day period immediately prior to the effective date of the replacing
carrier's plan;
2. For 3 separate
days during the 90 day period immediately prior to the effective date of the
replacing carrier's plan; or
3. For
5 separate days within the 12 month period immediately preceding the effective
date of the replacing carrier's plan; and
b. In the case of inpatient services, one
inpatient confinement during the 12 month period immediately prior to the
effective date of the replacing carrier's plan;
(2) "Complaints" means the grievances of
persons concerning the services of the health maintenance
organization;
(3) "Controlling
interest" means the possession, either directly or indirectly, of the power of
a person or persons to direct or cause the direction of the management and
policies of the health maintenance organization, whether through the ownership
of voting stock, or by contract, other than commercial contract for goods or
management services, or through official position or positions of, or corporate
office or offices held by, the person or persons, or otherwise, and includes a
presumed controlling interest;
(4)
"Mental health provider" means any professional or institution listed under
RSA
415:18-a, IV; and
(5) "Presumed controlling interest" means the
existence of a controlling interest when any person, directly or indirectly,
owns, controls, holds, with the present power to vote more than 5 percent of
the voting stock of the health maintenance organization, or holds proxies
representing more than 5 percent of the voting stock of any other person or
persons.
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5655, eff 7-1-93; ss by #7018, INTERIM, eff 7-1-99, EXPIRED: 10-29-99
New. #9335, eff 12-5-08
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