Bill > SB546

This bill requires all health carriers offering commercial health insurance in the state to implement network access compliance protocols based on secret shopper audit requirements established by the Centers for Medicare and Medicaid Services (CMS) starting January 1, 2027. The purpose of these annual audits is to assess carrier compliance with appointment wait time standards and provider accessibility requirements. Each carrier must contract with an independent third-party entity to conduct surveys that include behavioral health and primary care providers, following CMS's 2024 technical guidance, and submit the completed reports to the insurance department by May 31 each year. The insurance department is authorized to impose civil monetary penalties on carriers that fail to submit complete audit reports, have less than 80% of provider listings confirmed as in-network and accepting appointments, or are found non-compliant with network adequacy standards. Additionally, non-compliant carriers must reimburse out-of-network claims and enter into a corrective action plan with the department. The bill aims to improve transparency and ensure that health insurance networks provide adequate and accessible healthcare services to enrollees.

Health and Social Services

https://gc.nh.gov/bill_Status/billinfo.aspx?id=1320&inflect=2