This bill amends the Managed Care Law to enhance the criteria for assessing an insurer's network adequacy, particularly for primary health care and mental and behavioral health care. Key provisions include the requirement for health carriers to maintain a sufficient network of providers to ensure timely access to services, with specific standards for waiting times, geographic accessibility, and provider availability. Notably, the bill mandates that an independent third party conduct a periodic evaluation of mental health access adequacy every three years, which will include measuring appointment availability and clinician access at various levels. The bill introduces new criteria for defining network adequacy while deleting outdated provisions, ensuring that the standards reflect current needs in health care access.

Furthermore, the bill imposes stricter network adequacy requirements, mandating the exclusion of providers who are not accepting new patients, cannot provide timely appointments, or are located out of state or beyond a 30-minute drive. These requirements may lead to a shortage of available providers in New Hampshire, potentially causing some health carriers to reconsider offering coverage in the state. The legislation also includes administrative penalties for violations, escalating fines for repeated offenses, and grants a private right of action for affected individuals. Additionally, the Insurance Department is required to engage an independent third party for comprehensive reviews of network adequacy every three years, with estimated costs of $500,000 to $750,000 per year starting in FY 2027, funded through the Insurance Department Administration Fund. The potential reduction in carrier participation and changes in premium levels could have an indeterminate effect on Insurance Premium Tax revenues and the premiums of counties and municipalities purchasing group health insurance.

Statutes affected:
Introduced: 420-J:7
HB1812 text: 420-J:7