New Hampshire SB 546: relative to purchasing alliances.

Bill Text

SB 546-FN - AS INTRODUCED

2026 SESSION

 26-2129

 05/08

SENATE BILL 546-FN

AN ACT relative to health carrier network access monitoring.

SPONSORS: Sen. Rosenwald, Dist 13; Sen. McGough, Dist 11; Sen. Prentiss, Dist 5; Rep. Miles, Hills. 12; Rep. Telerski, Hills. 11; Rep. Spier, Hills. 6; Rep. Salvi, Hills. 9; Rep. Chourasia, Hills. 11

COMMITTEE: Health and Human Services

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ANALYSIS

 This bill requires health insurance carriers to adhere to the same standards of timeliness and accessibility that they have to adhere to on the health benefit exchange. The bill directs the carriers to adopt network access compliance protocols consistent with the secret shopper audit requirements established by CMS for qualified health plan issuers.

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Explanation: Matter added to current law appears in bold italics.

 Matter removed from current law appears [in brackets and struckthrough.]

 Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

 26-2129

 05/08

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Twenty-Six

AN ACT relative to health carrier network access monitoring.

Be it Enacted by the Senate and House of Representatives in General Court convened:

 1 New Section; Managed Care Law; Secret Shopper Audits for Network Adequacy Compliance. Amend RSA 420-J by inserting after section 7-e the following new section: 

 420-J:7-f Secret Shopper Audits for Network Adequacy Compliance.

 I. Beginning January 1, 2027, all health carriers offering commercial health insurance coverage in this state shall implement network access compliance protocols consistent with the secret shopper audit requirements established by the Centers for Medicare and Medicaid Services (CMS) for Qualified Health Plan issuers in the "2025 Final Letter to Issuers in the Federally-facilitated Exchanges," published on April 10, 2024, and the technical guidance outlined in CMS's "Appointment Wait Time Secret Shopper Survey Technical Guidance for Qualified Health Plan (QHP) Issuers in the Federally-facilitated Exchanges (FFEs)," published in April of 2024.

 II. The purpose of such audits shall be to assess and validate carrier compliance with the appointment wait time standards and provider accessibility requirements set forth in RSA 420-J:7 and corresponding rules adopted by the insurance department.

 III. Each carrier shall contract with an independent third-party entity to conduct annual secret shopper surveys. The surveys shall:

 (a) Include behavioral health and primary care providers, with specialty care providers added if directed by CMS in future guidance;

 (b) Follow CMS's technical guidance published in 2024 for survey timing, methodology, and reporting formats;

 (c) Be completed no later than April 30 of each calendar year and submitted to the insurance department by May 31.

 IV. The insurance department shall adopt rules under RSA 541-A to implement this section, including: 

 (a) Procedures for carrier reporting and data submission; and

 (b) Public transparency requirements for survey results.

 V.(a) The insurance department may impose civil monetary penalties on any health carrier that: 

 (1) Fails to submit a complete secret shopper audit report;

 (2) Submits a report in which fewer than 80 percent of contacted provider listings are confirmed to be in-network and accepting appointments; or

 (3) Is found to be noncompliant with network adequacy standards under RSA 420-J:7 and corresponding rules.

 (b) In addition to any penalties imposed under subparagraph (a), a health carrier shall reimburse all out-of-network claims incurred by enrollees for the provider types for which the carrier:

 (1) Failed to submit complete audit data;

 (2) Fell below the accuracy threshold described in subparagraph (a)(2); or

 (3) Did not meet applicable network adequacy standards during the preceding calendar year.

 (c) The insurance department shall require any noncompliant carrier to enter into a corrective action plan, signed by both the department and the carrier, specifying the deficiencies, required remedial actions, and a timeline for achieving compliance with audit reporting and network adequacy standards.

 2 Effective Date. This act shall take effect January 1, 2027.

 LBA

 26-2129

 11/6/25

SB 546-FN- FISCAL NOTE

AS INTRODUCED

AN ACT relative to health carrier network access monitoring.

FISCAL IMPACT: 

 Estimated State Impact

FY 2026

FY 2027

FY 2028

FY 2029

 Revenue

$0

Indeterminable Increase 

(not provided by agency)

Indeterminable Increase

 (not provided by agency)

Indeterminable Increase 

(not provided by agency)

 Revenue Fund(s)

General Fund

 Expenditures*

$0

$0

$0

$0

 Funding Source(s)

None

 Appropriations*

$0

$0

$0

$0

 Funding Sou