Spotlight on State

Spotlight on State: New Hampshire

This is part of a series of summaries that highlight notable legislation and initiatives in health policy and reform of all 50 states. Check back on The Source as we roll out additional states each week.

See New Hampshire page.

The state of New Hampshire is a trailblazer that is highly active in considering innovative cost containment solutions and expanding price transparency initiatives. New Hampshire created one of the nation’s first all-payer claims databases (“APCD”) in 2003 to collect and disseminate healthcare price information, leading the way for many other states. In 2007, price transparency leader New Hampshire took its APCD one step further and launched, a website that provides the median bundled prices for the thirty most common healthcare services. Continuing the trend, the state was the first state to use health insurance claims to rate networks and also the first state to implement right-to-shop or shared incentive policies. In 2015, The state commissioned Anthem Blue Cross and Blue Shield to develop a right-to-shop pilot program for state employees. Powered by Vitals SmartShopper, the program resulted in $12 million in savings with $1 million paid out to patients as rewards in just the first three years.

New Hampshire’s antitrust legislation bans most-favored nation clauses in provider contracts and prohibits exclusive contracting for managed care plans. New Hampshire also prohibits most non-compete agreements for physicians. In merger review authority, New Hampshire law requires healthcare-specific notice of transactions involving nonprofit hospitals to the attorney general and a broad public interest criterion that includes consideration of competition concerns. As a result, the AG is active in antitrust enforcement of provider mergers in the state, blocking the proposed merger of Exeter Health Resources and Wentworth-Douglass Hospital in 2019 due to concerns that it would adversely impact competition for certain health care services in the Seacoast region of New Hampshire.

Additionally, New Hampshire established a work requirement for those seeking Medicaid who are part of the Expansion population and received CMS approval in 2020 for its Section 1332 waiver for state-based reinsurance program to reduce premium rates. The legislature has also proposed several bills to implement single payer in the state and continues to push for parity in telehealth reimbursement to supplement its existing coverage parity law.

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