New Hampshire

SUMMARY

Early on, in 2003, New Hampshire created one of the nation’s first all-payer claims databases (“APCD”) to collect and disseminate healthcare price information, and many other states were soon to follow. In 2007, price transparency leader New Hampshire took its APCD one step further and launched NHHealthCost.org, a website that provides the median bundled prices for the thirty most common healthcare services. Continuing the trend, New Hampshire’s legislature was highly active in considering innovative cost containment solutions and expanding price transparency initiatives during most recent legislative sessions.

 

LEGISLATION/REGULATION

Legislative Calendar

New Hampshire’s regular legislative session for 2017 has ended.

 

Recent Legislative Developments

Healthcare Transparency

  • None identified.

 

Healthcare Cost

2017 HB443 PROHIBITING PRESCRIPTION DRUG MANUFACTURERS FROM OFFERING COPAYMENT REIMBURSEMENT:  No prescription drug manufacturer doing business in New Hampshire shall establish a copayment reimbursement program or otherwise offer to pay, waive, or reimburse a patient for his or her insurance copayment. Inactive — Died.
SB156 PHARMACY PRICING: A pharmacy benefits manager or health carrier shall require that a covered person pay the lesser of the amount charged by the pharmacy for filling the prescription, the provider specified contract payment amount, or the covered person’s benefit copayment. Inactive –Died.
SB238 USUAL AND CUSTOMARY PRICE OF PRESCRIPTION FILING: A pharmacy benefits manager or insurer shall require a contracted pharmacy to charge and enrollee or insured person the pharmacy’s usual and customary price of filing the prescription or the contracted copayment, whichever is less. Passed.

 

Healthcare Markets

  • None identified.

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

ACA Implementation

  • RSA 420-N et seq.: establishes a Joint Health Care Reform Oversight Committee to steward health care reform under the Affordable Care Act.

 

Transparency in Healthcare

  • RSA 420-g:11 creates the state’s Comprehensive Health Care Information System (CHIS) to make health care data “available as a resource for insurers, employers, providers, purchasers of health care, and state agencies to continuously review health care utilization, expenditures, and performance in New Hampshire and to enhance the ability of New Hampshire consumers and employers to make informed and cost-effective health care choices.” New Hampshire has deployed the data online for consumers at http://www.nhhealthcost.org/, an all-payer claims database that disseminates healthcare price information for insured and uninsured patients.

 

  • RSA 420-H et seq. requires that third-party payers provide to beneficiaries an explanation of benefits, limitations, and cost-sharing in simple and concise language. Policy forms shall not be issued in the state that do not meet the required standard of readability.

 

  • RSA 126:25 requires that licensed healthcare facilities provide specified data to the commissioner of health and human services, including financial information, utilization data, demographic information, and charge data.

 

  • RSA 151:31 requires hospitals to make an annual report to the Attorney General for his/her review, including the following information:
    • The hospital’s financial relationship with physician hospital organizations;
    • the number and type of providers employed by the hospital;
    • the frequency of contract negotiations with providers and physician hospital organizations;
    • an organizational chart of the corporate structure of the hospital and any affiliates including a description of the services offered; and
    • a copy of the hospital’s policy concerning the prohibition that no physician employed by the hospital or any affiliate is required or in any way obligated to refer patients to physicians also employed or under contract with the hospital or any affiliate.

 

Network Adequacy

  • RSA 420-J:7 and Ins 2701: a health carrier must maintain a network that is sufficient in numbers, types, and geographic location of providers to ensure that all services to covered persons will be accessible without unreasonable delay, and a carrier must maintain a detailed description of their procedures for monitoring network adequacy at its place of business. The carrier must annually submit a report of their compliance with rules for network adequacy to the commission of insurance. Generally, a carrier must meet the geographic accessibility requirements for 90% of covered persons in a particular geographic area.

 

  • RSA 400-B:3 requires that a health insurer maintain its books, records, and documents in a manner so that the practices of the insurer regarding network adequacy, utilization review, quality assessment and improvement, and provider credentialing may be ascertained during a market conduct examination.

 

Healthcare Contracting

  • RSA 416:4 prohibits most favored nation or equally favored nation provisions in any contract for medical care provider services. A most favored nation clause is a requirement that a provider give the insurer the benefit of any lower fee schedules or charges for services which the provider may subsequently agree to with other persons or entities.

 

Healthcare Markets

  • RSA 400-A establishes the New Hampshire Insurance Department, which was the first insurance regulatory agency in the United States.

 

  • RSA 151-C:1 through C:16 implements New Hampshire’s certificate of need regulatory review, which a provider must obtain prior to constructing or modifying health care facilities, offering new or expanded services, acquiring new medical equipment, or offering new inpatient care beds. A certificate of need ensures there is a genuine need in the community for the expanded capacity or newly offered service.

 

  • RSA 415: 24 requires that rate modifications on health policy forms shall be filed with the commissioner of insurance prior to implementation. For a comprehensive look on rate regulation in New Hampshire, see this 2012 report.

 

  • RSA 417:1 to 31 prohibits unfair and deceptive trade practices in the provision of insurance.

 

FY 2018-2019 BUDGET

New Hampshire enacts budgets on a two-year cycle, beginning July 1 of each odd-numbered year. New Hampshire’s new Biennial Budget will take effect on July 1, 2017 and is valid through June 30, 2019. To view New Hampshire’s 2018-2019 Budget, click here.

 

LITIGATION/ENFORCEMENT

Antitrust (Healthcare Markets)

  • The New Hampshire Attorney General is conducted a review on the proposed affiliation of The Memorial Hospital at North Conway (“Memorial Hospital”) and MaineHealth pursuant to RSA 7:19-b. The Attorney general approved the merger in June 2016. The transaction made MaineHealth the sole corporate member of Memorial Hospital with certain reserved powers over Memorial Hospital’s governance and operations.

 

  • Additional enforcement actions by the Department of Insurance can be found on the Department’s website.

 

KEY RESOURCES

New Hampshire General Court

New Hampshire Department of Justice

New Hampshire Insurance Department

NH HealthCost