Adopt Chapter 2700 Part 2703 to read as follows:

CHAPTER Ins 2700 MANAGED CARE

PART Ins 2701 HEALTH AND DENTAL BENEFIT PLAN NETWORK ADEQUACY

Statutory Authority: RSA 400-A:15, I; RSA 420-J:7, II; and RSA 420-J:12

Ins 2701.01 Purpose. The purpose of these rules is to establish standards for determining whether a carrier’s provider network is sufficient in numbers, types, and geographic location of providers to ensure that covered persons will have access to health care services without unreasonable delay.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10; ss by #12565, eff 8-1-18

Ins 2701.02 Scope. These rules shall apply to all insurers offering or issuing policies of health and dental insurance in the state of New Hampshire when the plan design and benefits include a provider network with differential payment or coverage associated with use of an in-network provider.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10; ss by #12565, eff 8-1-18

Ins 2701.03 Definitions.

(a) “Commissioner” means the insurance commissioner.

(b) “Covered benefits” means those health care services and other medical services, including dental benefits, to which a covered person is entitled under the terms of a health benefit plan.

(c) “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.

(d) “Health benefit plan” means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of covered benefits with respect to any “health coverage” as defined in RSA 420-G:2, IX and any network-based coverage for dental services.

(e) “Health carrier” means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the covered costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.

(f) “Network” means the group of participating providers contracted under a network plan.

(g) “Network plan” means a health benefit plan that either requires a covered person to use or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with, or employed by the health carrier.

(h) “Participating provider” means a person or entity who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, co-payments, or deductibles, directly or indirectly from the health carrier.

(i) “Primary care provider” means a physician licensed by the New Hampshire board of medicine or a board of medicine of another appropriate jurisdiction who has successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education or approved by the American Osteopathic Association in family practice, internal medicine, or pediatrics, or an advanced registered nurse practitioner licensed by the New Hampshire board of nursing in the advanced practice categories of family practice, internal medicine, or pediatrics, or a doctor of naturopathic medicine authorized and licensed to practice naturopathic medicine under RSA 328-E.

(j) “Retail pharmacy” means any licensed pharmacy that is not a mail order pharmacy and is open to dispense prescription drugs to the walk-in public without being required to receive medical services from a provider or institution affiliated with that pharmacy.

(k) “Urgent services” means health care services that are provided to treat a medical or behavioral health condition or symptomatic illness of a covered person that, if not treated within 48 hours, presents a risk of serious harm.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.01); ss by #12565, eff 8-1-18

Ins 2701.04 Basic Access Requirement.

(a) Each health carrier offering a network plan shall maintain a network of primary care providers, dental providers, specialists, institutional providers, and other ancillary health care personnel that is sufficient in numbers and types of providers to ensure that all covered health care services are accessible to covered persons without unreasonable delay.

(b) A health carrier’s network of participating providers shall be considered sufficient to meet the basic access requirement in Ins 2701.04(a) if it meets all of the standards contained in Ins 2701.04 through Ins 2701.13. The evaluation of network adequacy shall be based on the most recent United States census data for populations under 65 years of age.

(c) The basic access requirement in Ins 2701.04(a) shall be met in each county in which the health carrier is actively marketing a health benefit plan. For the purpose of this paragraph, “actively marketing” means advertising in publications published within the county or initiating contact with a potential policyholder in person, by phone, or by mail.

(d) In any county in which compliance with Ins 2701.04(a) is required and in which a health carrier’s network is insufficient to meet one of the access standards in Ins 2701.06 and in which the carrier has not been granted an exception pursuant to Ins 2701.08 or Ins 2701.14, the health carrier shall cover services provided by a non-participating provider located within the applicable geographic area at no greater cost to the covered person than if the services were obtained from a participating provider. Coverage under this paragraph shall be subject to all other terms and conditions of the covered person’s health benefit plan, including, but not limited to, referral and authorization requirements. Nothing in this paragraph shall be construed to require a health carrier to provide coverage for services provided by a non-participating provider who has been excluded from the health carrier’s network for failing to meet any applicable credentialing standards.

(e) A health carrier shall not actively solicit new policyholders in any county in which compliance with Ins 2701.04(a) is required and in which it does not meet the access standards in Ins 2701.06, unless the health carrier has been granted an exception under Ins 2701.08.

(f) Nothing in (e) above shall be construed to prohibit a health carrier from:

(1) Advertising in publications distributed within the county which are published outside of the county;

(2) Responding to inquiries initiated by a potential policyholder; or

(3) Issuing or renewing coverage as required by federal or state law, including RSA 420-G.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.02); ss by #12565, eff 8-1-18

Ins 2701.05 Reasonable Access to Health Care Services.

(a) To constitute reasonable access to health care services, a provider network shall supply access consistent with the geographic accessibility standards in Ins 2701.06 to the services listed in Ins 2701.07.

(b) To be deemed adequate for each of the listed services, the network shall include, within the applicable geographic area, a sufficient number of providers for which the service in question is within their scope of practice. In addition to physicians, providers may include nurse practitioners, osteopaths, social workers, psychologists, naturopaths, midwives, physician assistants, clinical nurse specialists, dentists, dental hygienists, or any provider trained and appropriately licensed and, when required, adequately supervised by a physician in compliance with New Hampshire laws and rules.

(c) To constitute reasonable access to health services, the network shall include providers whose services are integral to care in a hospital, ambulatory surgery center, or similar facility, specifically those services provided by anesthesiologists, pathologists, emergency physicians, and radiologists. When a carrier is unable to assure that an in-network provider of those services is always accessible at an in-network facility, the carrier shall assure that any necessary out-of-network services are provided with no additional cost share to the member, beyond member responsibility were those services provided by an in-network provider.

(d) Access to medically necessary health care services through the use of telemedicine or telehealth may be used to satisfy the network adequacy geographic access requirements when an acceptable standard of care can be met by the provider offering the service.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.03); ss by #12565, eff 8-1-18

Ins 2701.06 Standards for Geographic Accessibility.

(a) Geographic access standards shall be calculated based on population densities of persons under the age of 65. Geographic access standards shall be measured in terms of distance or travel times for a person under normal conditions from specific zip codes.

(b) A carrier shall meet the service specific requirement by county for persons living in one of the 2 zip codes for the following counties:

(1) Coos – Lancaster 03584 or Berlin 03570;

(2) Carroll – Conway 03813 or Wolfeboro 03894;

(3) Belknap – Laconia 03246 or Alton 03809;

(4) Sullivan – Claremont 03743 or Newport 03773;

(5) Strafford – Rochester 03867 or Dover 03820;

(6) Cheshire – Keene 03431 or Jaffrey 03452;

(7) Hillsborough – Nashua 03060 or Manchester 03103; and

(8) Rockingham – Portsmouth 03801 or Derry 03038.

(c) A carrier shall meet the service specific requirement for Merrimack County for persons living in the Concord 03301 zip code.

(d) A carrier shall meet the service specific requirement for Grafton County for persons living in 2 of the following zip codes:

(1) Littleton 03561;

(2) Plymouth 03264; or

(3) Lebanon 03748.

(e) Geographic access standards are based on the following county groupings: “Rural”, “Middle”, and “Urban”. Maximum travel distances or times are based on the service type, county, and specific zip code within the county as follows:

(1) For urban counties, including Strafford, Hillsborough, and Rockingham counties:

a. Ten miles or 15 minutes driving time for core services;

b. Twenty miles or 30 minutes driving time for common services; and

c. Forty miles or one hour driving time for specialized services;

(2) For middle counties, including Merrimack, Belknap, Cheshire, Grafton, Carroll, and Sullivan counties:

a. Twenty miles or 40 minutes driving time for core services;

b. Forty miles or 80 minutes driving time for common services; and

c. Seventy miles or 2 hours driving time for specialized services; and

(3) For rural counties, including Coos county:

a. Thirty miles or one hour driving time for core services;

b. Eighty miles or 2 hours driving time for common services; and

c. One hundred twenty-five miles or 2½ hours driving time for specialized services.

Source. #7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.04); ss by #12565, eff 8-1-18

Ins 2701.07 Classification of Services as “Core”, “Common”, and “Specialized”.

(a) The purpose of this section is to classify services into 3 categories, core, common, and specialized, for the purposes of network adequacy reviews.

(b) The following services shall be classified as “Core” services for purposes of network adequacy review:

(1) Alcohol or drug treatment in an ambulatory setting for any of the following:

a. Crisis intervention;

b. Detoxification; or

c. Medical or somatic treatment;

(2) Alcohol or drug assessment;

(3) Alcohol or drug case management;

(4) Alcohol or drug services group counseling by clinician;

(5) Alcohol or drug intensive outpatient treatment;

(6) Alcohol or drug methadone or equivalent administration;

(7) Alcohol or drug subacute detox;

(8) Alcohol or drug treatment medication training and support;

(9) Ambulance;

(10) Behavioral health (BH) or Substance use disorder (SUD) comprehensive community support services;

(11) BH or SUD comprehensive medication services;

(12) Behavioral health counseling and therapy, or screening to determine eligibility for admission to a treatment program;

(13) Behavioral health partial hospitalization;

(14) Behavioral health short term residential;

(15) Chiropractic;

(16) Contraceptive services;

(17) Dental diagnostic services;

(18) Dental preventive services;

(19) Dental restorative services;

(20) Diagnostic physical therapy (PT) evaluation;

(21) Individual or group counseling for mental health (MH) or SUD;

(22) Mammogram;

(23) PT procedures not requiring specialized equipment;

(24) Preventive and associated routine care, adult;

(25) Preventive and associated routine care, pediatric;

(26) Routine electrocardiogram (EKG);

(27) Routine immunizations and injections, adult;

(28) Routine immunizations and injections, pediatric;

(29) Screening and assessment services for MH or SUD;

(30) Suture of non-life-threatening wound;

(31) Therapeutic behavioral services provided in segments defined by number of minutes or on a per diem basis;

(32) Urgent care; and

(33) Venipuncture or collection of capillary blood.

(1) Allergen immunotherapy;

(2) Ankle X-ray;

(3) Appling splints;

(4) Asthma or bronchial care;

(5) Audiologic function tests;

(6) Biopsy of skin lesions;

(7) Cardiac monitoring or stress testing;

(8) Cardioversion;

(9) Cataract surgery;

(10) Chemotherapy;

(11) Chest X-ray;

(12) Complex closure of wounds;

(13) Corpus uteri biopsy or endometrial sampling;

(14) Cystoscopy;

(15) Dental adjunctive general services;

(16) Dental endodontics;

(17) Dental implant service;

(18) Dental oral and maxillofacial surgery;

(19) Dental orthodontics;

(20) Dental periodontics;

(21) Dental prosthodontics which are removable;

(22) Destruction of skin lesions;

(23) Developmental, hearing, and vision testing, pediatric;

(24) Diagnosis and therapy for rheumatic disease;

(25) Electroencephalography (EEG);

(26) Echocardiography;

(27) Electromyography;

(28) Endoscopy;

(29) Excision of lesions, benign;

(30) Eye care medical treatment;

(31) Eye exam;

(32) Gastrointestinal endoscopy;

(33) General psychiatric care on an inpatient basis;

(34) Incision and drainage, deep abscess;

(35) Injection of eye drug;

(36) Injection of spine;

(37) Injection of tendon or joint;

(38) Insertion or removal of intrauterine contraceptive device;

(39) Knee arthroscopy;

(40) Laparoscopic surgery;

(41) Laryngoscopy;

(42) Nasal endoscopy;

(43) Non-routine venipuncture;

(44) Occupational therapy;

(45) Osteopathic manipulation;

(46) Paring or cutting benign lesion;

(47) Partial mastectomy;

(48) Peripherally inserted central catheter (PICC);

(49) Psychiatric diagnostic evaluation with medical services;

(50) Renal dialysis;

(51) Routine endoscopy;

(52) Routine pre-natal care;

(53) Skin graft;

(54) Speech therapy;

(55) Spinal injection or nerve block;

(56) Surgical debridement of nails;

(57) Thoracentesis;

(58) Wax or foreign body removal from ear;

(59) Wound debridement; and

(61) X-ray absorptiometry or bone density study.

(d) The following services shall be classified as “Specialized” services for purposes of network adequacy review:

(1) Alcohol or drug acute detox;

(2) Allergy testing;

(3) Amputation of toe or foot;

(4) Arthrodesis;

(5) Biopsy or excision of lymph nodes;

(6) Bone biopsy or procedure to obtain tissue;

(7) Breast repair or reconstruction;

(8) Bronchoscopy;

(9) Cardiac catheterization;

(10) Complete mastectomy;

(11) Complex endoscopy;

(12) Dental prosthodontics which are fixed;

(13) Draw blood off cardiovascular venous device;

(14) Emergency endotracheal intubation;

(15) Excision of lesions, malignant;

(16) Hysterectomy;

(17) Incision and drainage, skin or wound;

(18) Insertion of central venous catheter;

(19) Low back disk surgery;

(20) Magnetic resonance imaging (MRI) of lower extremity;

(21) Radiation therapy;

(22) Radiation treatment;

(23) Radiation treatment management;

(24) Repair of shoulder joint;

(25) Replacement of aortic valve;

(26) Routine obstetrical care with vaginal delivery;

(27) Spinal bone autograft or allograft;

(28) Spinal instrumentation;

(29) Surgical laparoscopy;

(30) Surgical vascular endoscopy;

(31) Tibia fracture treatment;

(32) Total hip replacement;

(33) Total knee replacement; and

(34) Treatment of ankle fracture.

(e) All other covered services shall be available from providers within New England.

(f) Prescription medications from a retail pharmacy shall be available within the time and distance standards equal to those associated with the “Core” services for a specific county.

Source. #7701, eff 8-1-02; ss by #9399, eff 3-1-09; ss by #9722, eff 8-1-10 (from Ins 2701.05); ss by #12565, eff 8-1-18

Ins 2701.08 Exceptions.

(a) The department shall grant a carrier an exception to the standards for geographic accessibility in Ins 2701.06 where:

(1) A health carrier demonstrates that an insufficient number of qualified providers or facilities are available in the county to meet the geographic accessibility standards contained in Ins 2701.06;

(2) A health carrier demonstrates that the carrier’s failure to develop a provider network in a given county that is sufficient in number and type of providers to meet all of the standards in Ins 2701.06 is due to the refusal of a local provider to accept a commercially reasonable rate, fee, term, or condition and that the health carrier has taken steps to effectively mitigate the detrimental impact on covered persons;

(3) A health carrier demonstrates that the required service can be obtained through the use of telemedicine or telehealth from an in-network participating provider;

(4) A health carrier arranges to pay for the required service from an out-of-network provider, and the member is informed prior to the treatment that they can access services from the provider with no additional cost sharing beyond the benefit patient responsibility to an in-network provider; or

(5) A health carrier has requested and been granted a waiver under Ins 2701.14 with respect to another component of the geographic accessibility standard.

(b) The department shall grant a carrier an exception excluding one or more of the services listed in Ins 2701.07 from the network adequacy analysis where a health carrier can establish that the service in question is not a covered service for the health benefit plan to which the network applies and that exclusion of the service is appropriate for that coverage.

Source. #7701, eff 8-1-02; ss by #9399, eff 3-1-09 ss by #9722, eff 8-1-10 (from Ins 2701.06); ss by #12565, eff 8-1-18

Ins 2701.09 Standards for Waiting Times for Appointments and Access to After-Hours Care.

(a) Standard waiting times for appointments shall be measured from the initial request for an appointment.

(b) For behavioral health services, the carrier shall ensure that covered persons may obtain an initial appointment with an in-network provider within:

(1) Six hours for a non-life-threatening emergency;

(2) Forty-eight hours for urgent care; and

(3) Ten business days for an initial or evaluation visit.

(c) For primary care provider services, the carrier shall ensure that covered persons may obtain an initial appointment with an in-network provider within:

(1) Forty-eight hours for urgent care; and

(2) Thirty days for other routine care, including an initial or evaluation visit.

(d) For substance use disorder services for which prior authorization requirements are governed by RSA 420-J:17, health carriers shall comply with the requirements of that section.

(e) For services not governed by RSA 420-J:17, health carriers shall ensure that all covered persons have access to a utilization reviewer to make prior approval or pre-authorization decisions if required under the terms of the coverage.

Source. #9722, eff 8-1-10 (from Ins 2701.07); ss by #12565, eff 8-1-18 (formerly Ins 2701.07)

Ins 2701.10 Choice of and Access to Providers of Specialty Care.

(a) Each health carrier shall establish policies and procedures through which a member with a condition that requires care from a specialist may obtain a referral to a network specialist or specialist group practice, subject to the utilization review procedures used by the health carrier. For purposes of this provision, “referral” means a referral for care to be provided by a network specialist or specialist group practice that authorizes a visit or series of visits with the specialist or specialist group practice for either a specific time period or a limited number of visits and which is provided according to a treatment plan developed by the covered person’s primary care provider, a specialist, the covered person, and the plan. The carrier shall not require an additional referral to the same specialist or specialist group practice within 6 months, when the patient is expected by the referring provider to need care for at least this period of time. The carrier shall accept a referral that is made to a specialist group practice and shall not require the referring provider to specify an individual practitioner in the referral.

(b) Each health carrier shall ensure that covered persons may obtain a referral to a health care provider outside of the health carrier’s network when the health carrier does not have a health care provider with appropriate training and experience within its network who can meet the particular health care needs of the covered person. Services provided by out-of-network providers shall be subject to the utilization review procedures used by the health carrier. The covered person shall not be responsible for any additional costs incurred by the health carrier under this paragraph other than any applicable co-payment, coinsurance, or deductible.

Source. #9722, eff 8-1-10 (from Ins 2701.08); ss by #12565, eff 8-1-18 (formerly Ins 2701.08)

Ins 2701.11 Reporting Requirement.

(a) Each health carrier shall, by July 1 or at the time its plans and rates for the upcoming plan year are filed with the department for review, include a network provider listing for each of the health benefit plans that the carrier offers in this state using a template provided by the commissioner. The network adequacy filing shall include a certification of compliance with the requirements of this part and shall be signed by an authorized representative of the company. The carrier shall certify that the provider listing is accurate with provider contracts effective at the time of the submission. If there are anticipated losses of in-network providers that will take place within the following 60 days, the carrier shall disclose this with the network filing. The carrier may indicate that a potential contract dispute and the anticipated provider losses are confidential, and the department shall not release this information if so designated. The carrier shall identify any services or locations in which the provider contract excludes services the provider typically performs and that are a covered benefit.

(b) The network adequacy filing prepared by the health carrier shall use a template provided by the commissioner which shall describe and contain the following:

(1) A description of the network associated with each health benefit plan offered by the carrier, including a list of the network providers as follows:

a. For each plan, required information shall include:

1. Plan identifier;

2. Network name; and

3. New Hampshire hospitals in network;

b. For each provider, required information shall include:

1. Provider name;

2. Carrier specific provider identifier number;

3. National provider identifier (NPI) number;

4. Provider address; and

5. Indication of any services included in the network adequacy requirement that are exclusively provided through telemedicine or telehealth; and

c. For each network, required information shall include:

1. Network name;

2. Network ID; and

3. Network URL;

(2) The health carrier’s procedures for making referrals within and outside its network;

(3) The health carrier’s process for monitoring and assuring on an ongoing basis the sufficiency of its network to meet the health care needs of persons who enroll in managed care plans;

(4) The health carrier’s method of informing covered persons of the requirements and procedures for gaining access to network providers, including but not limited to the following:

a. The process for choosing and changing network providers;

b. The process for providing and approving emergency, urgent, and specialty care;

c. The identity of all of the plan’s participating providers and facilities, including a specification of those participating providers, if any, that are accessible only at a reduced benefit level; and

d. Whether and when referral options are restricted to less than all providers in the network who are qualified to provide covered specialty services;

(5) The health carrier’s system for ensuring the coordination of care for covered persons referred to specialty providers, for covered persons using ancillary services, including social services, behavioral health services, and other community resources, and for ensuring appropriate discharge planning;

(6) The health carrier’s process for enabling covered persons to change primary care providers; and

(7) The health carrier’s proposed plan for providing care in the event of contract termination between the health carrier and any of its participating providers or in the event of the health carrier’s insolvency or other inability to continue operations, explaining how impacted covered persons will be notified of the contract termination, or the health carrier’s insolvency or other cessation of operations, and transferred to other providers in a timely manner.

(c) If the identical provider network is associated with more than one health benefit plan, a single network adequacy filing shall be prepared for that network, and a single health care certification of compliance report shall be filed. The network adequacy report shall identify all health benefit plans using the identical provider network.

(d) In addition to the annual network adequacy filing, a carrier shall notify the commissioner in writing, including identifying the providers, within 10 days of any of the following events:

(1) The net loss of 10% or more of its total number of primary care providers in any county within any 30-day period;

(2) The net loss of 10% or more of its total number of providers performing individual or group counseling for mental health or substance use disorders in any county within any 30-day period;

(3) The loss of one or more network hospitals; or

(4) In the carrier’s estimation, the product network is no longer meeting a network adequacy standard with respect to one or more counties.

(e) The carrier shall supply the commissioner with a new provider file within ten days of a request by the commissioner.

(f) A carrier introducing a new product with a new network shall submit the network adequacy report in conjunction with the rate and form filing, reflecting the network contracts in place as of the date of filing. If the network associated with the new product is unchanged except for typical minor changes that take place over time as providers move in and out of regions, the carrier is not required to submit a network filing but shall identify the previously submitted network associated with the new product.

Source. #12565, eff 8-1-18 (formerly Ins 2701.09)

Ins 2701.12 Provider Directories.

(a) For each of its network plans, a health carrier shall electronically post and maintain a current and accurate provider directory in accordance with the following requirements and with the information and search functions described in (c) below:

(1) In making the directory available electronically, the health carrier shall ensure that the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab, without creating or accessing an account or entering a policy or contract number;

(2) The health carrier shall update the provider directory for each network plan at least monthly;

(3) The health carrier shall periodically audit its provider directories for accuracy and retain documentation of such an audit to be made available to the commissioner upon request;

(4) For each network plan, a health carrier shall include, in an electronic directory, the following information stated in plain language:

a. A description of the criteria the carrier used to build its provider network;

b. If applicable, a description of the criteria the carrier used to tier providers;

c. If applicable, a description of the different provider tiers or levels in the network and, for each provider, hospital, or other type of facility in the network, identification of the tier in which each is placed; and

d. If applicable, disclosure that a specific provider is a network plan provider only for the specific services listed with the disclosure;

(5) A health carrier shall clearly indicate which provider directory applies to which network plan, including the specific name of the network plan as marketed and issued in this state;

(6) A health carrier shall include a customer service email address and telephone number or electronic link that covered persons or the general public may use to notify the health carrier of inaccurate provider directory information; and

(7) For the information required pursuant to (b), (c), and (d) below, a health carrier shall indicate in the directory the source of the information and any limitations, if applicable.

(b) For each network plan, the health carrier’s electronic provider directory shall include the following information in a searchable format:

(1) For health care professionals:

a. Name;

b. Gender;

c. Participating office location(s);

d. Specialty, if applicable;

e. Medical group affiliations, if applicable;

f. Facility affiliations, if applicable;

g. Participating facility affiliations, if applicable;

h. Languages spoken other than English, if applicable; and

i. Whether accepting new patients;

(2) For hospitals:

a. Hospital name;

b. Hospital type, for example, acute, rehabilitation, children’s, cancer, etc.;

c. Participating hospital location; and

d. Hospital accreditation status; and

(3) For facilities other than hospitals:

a. Facility name;

b. Facility type;

c. Types of services performed; and

d. Participating facility location(s).

(c) For each network plan, a health carrier shall make available in its electronic provider directory, the following information:

(1) For health care professionals:

a. Contact information;

b. Board certification(s); and

c. Languages spoken other than English by clinical staff, if applicable; and

(2) For hospitals and other facilities, a telephone number.

(d) Each directory shall include a date and a customer service telephone number and be accompanied by a disclosure by the health carrier that the information in the directory is accurate as of the date of printing and that covered persons or prospective covered persons should consult the carrier’s electronic provider directory or call the customer service number to obtain current provider directory information.

Source. #12565, eff 8-1-18

Ins 2701.13 Enforcement. If the commissioner determines that a health carrier has not contracted with a sufficient number of participating providers to assure that covered persons have accessible health care services in a geographic area or that a health carrier’s health care certification of compliance report does not assure reasonable access to covered benefits, the commissioner shall issue an order requiring the health carrier to institute a corrective action, or shall use other enforcement powers under RSA 420-J to ensure that covered persons have access to covered benefits.

Source. #12565, eff 8-1-18 (formerly Ins 2701.10)

Ins 2701.14 Waiver of Rules.

(a) The commissioner, upon the commissioner’s own initiative or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and:

(1) Applying the rule provision would cause confusion or would be misleading to

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

(e) The commissioner shall report publicly any waiver granted on the department’s website at https://www.nh.gov/insurance/.

Source. #12565, eff 8-1-18

PART Ins 2702 PARITY IN MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS

Statutory Authority: RSA 400-A:15, I.; RSA 415:18-a, VIII

Ins 2702.01 Purpose. The purpose of these rules is to implement the requirements of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), as amended, for group health insurance coverage that is provided to employers.

Source. #9809, eff 11-8-10; ss by #12685, eff 12-3-18

Ins 2702.02 Scope and Applicability. The requirements of this part shall apply to all health insurance issuers offering health insurance coverage in connection with a group health insurance plan that provides coverage to a group employer.

Source. #9809, eff 11-8-10; ss by #12685, eff 12-3-18

Ins 2702.03 Definitions.

(a) “Group health insurance coverage” means, for the purpose of Ins 2702, health coverage sold under RSA 420-G:2 IV.

(b) “Mental health benefits” means benefits with respect to services for mental health conditions, as defined under the terms of group health insurance coverage, and in accordance with applicable federal and state law.

(c) “Substance use disorder benefits” means benefits with respect to services for substance use disorders, as defined under the terms of the group health insurance coverage, and in accordance with applicable federal and state law.

Source. #9809, eff 11-8-10; ss by #12685, eff 12-3-18

Ins 2702.04 Parity Requirements. Group health insurance coverage offered by an insurer in connection with a group health plan issued to an employer and that provides health coverage sold under RSA420-G:2, IX must offer mental health and substance use disorder benefits coverage as required under RSA 415:18-a in compliance with the federal MHPAEA of 2008, as amended, and federal regulations adopted thereunder.

Source. #9809, eff 11-8-10; ss by #12685, eff 12-3-18

Ins 2702.05 Waiver of Rules.

(a) The commissioner, upon the commissioner’s own initiative or upon request by an insurer, shall waive any requirement of this part if such waiver does not contradict the objective or intent of the rule and:

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

Source. #9809, eff 11-8-10; ss by #12685, eff 12-3-18

PART Ins 2703 EXTERNAL REVIEW

Statutory Authority: RSA 400-A:15 and RSA 420-J:12

REVISION NOTE:

Document #14595, effective 5-22-26, repealed Section Ins 2703.06 in Part Ins 2703, titled “Expedited External Review”, and adopted new text. Document #14595, effective 5-22-26, also repealed Section Ins 2703.08 in Part Ins 2703, titled “External Review Reporting Requirements”, and adopted new text.

Ins 2703.01 Applicability and Scope.

(a) Except as provided in (b) below, the external review requirements set forth in this part shall apply to all health carriers that makes an adverse determination concerning a covered person.

(b) The external review requirements set forth in this part shall not apply to determinations relating to health care services, items, or drugs available under the coverages of programs listed below:

(1) Long-term care insurance, as defined by RSA 415-D:3, V;

(2) Coverage under a plan through Medicare, Medicaid, and the state Children’s Health Insurance Program, under Title XXI of the Social Security Act, including services provided under these programs but through a contracted health carrier;

(3) Health care services provided to inmates by the department of corrections;

(4) The federal employees health benefits program;

(5) Coverage issued under chapter 55 of title 10 of the United States Code regarding medical and dental care for members of the Armed Forces;

(6) Coverage issued as supplemental to liability insurance, workers’ compensation or similar insurance, automobile medical-payment insurance, or any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis; or

(7) Health care services provided pursuant to a health plan not regulated by the state, such as self-funded plans administered by an administrative services organization or third-party administrator.

(c) The external review procedures set forth in this chapter shall not be utilized to adjudicate claims or allegations of health care provider malpractice, professional negligence, or other professional fault against participating providers or medical directors.

Source. #7539, eff 8-1-01; ss by 8862, eff 5-1-07 (from 2703.02); ss by#10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.02 Definitions. For the purpose of this part:

(a) "Adverse determination" means “adverse determination” as defined in RSA 420-J:3, I;

(b) “Authorized representative” means authorized representative” as defined in RSA 420-J:3 III;

(d) “Coverage denial” means a denial, reduction, or termination by a health carrier of a requested health care service, supply, or drug, or a denial of payment for such, which is made on the basis of a finding by the health carrier that the requested service, supply, or drug is specifically excluded from coverage under the terms of the covered person’s health benefit plan and is therefore not a covered benefit;

(e) “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan;

(f) “Department” means the insurance department;

(g) “Disclose” means to release, transfer, or otherwise divulge protected health information to any person other than the individual who is the subject of the protected health information;

(h) “Final adverse determination” means an adverse determination that has been upheld by a health carrier, or its designee utilization review organization, at the completion of the health carrier’s standard, second level grievance review process as set forth in RSA 420-J:5, V or expedited, second level grievance review process as set forth in RSA 420-J:5, V(e)(1);

(i) "Health care services" means "health care services" or "health services" as defined in RSA 420-J:20, XXII namely "services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury or disease." This term includes "health services";

(j) "Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services;

(k) “Health information” means information or data, whether oral or recorded in any form or medium, and personal facts or information about events or relationships that relates to:

(1) The past, present, or future physical, mental, or behavioral health or condition of an individual or a member of the individual’s family;

(2) The provision of health care services to an individual; or

(3) Payment for the provision of health care services to an individual;

(l) "Independent review organization" means “independent review organization” as defined in RSA 420-J:3, XXIII-a;

(m) “Protected health information” means health information:

(1) That identifies an individual who is the subject of the information; or

(2) With respect to which there is a reasonable basis to believe that the information could be used to identify an individual;

(n) “Utilization review” means a set of formal techniques designed to monitor the use of, or evaluate the clinical necessity, appropriateness, efficacy, or efficiency of, health care services, procedures, or settings. Techniques can include ambulatory review, prospective review, second opinion, concurrent review, or retrospective review; and

(o) “Utilization review organization” means an entity that conducts utilization review, other than a health carrier performing a review for its own health plans.

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07 (from Ins 2703.01); ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.03 The Right to External Review.

(a) A covered person shall have the right to independent external review of an adverse determination made by a health carrier as provided in RSA 420-J:5-a.

(b) Coverage denials concerning requested health care services, items, or drugs that could not be considered a covered benefit under any circumstance shall not be eligible for external review. However, a covered person may receive external review of a benefit denial if it is also an adverse determination.

(1) Experimental or investigational treatments, where the health carrier denies requested care because the covered person’s health benefit plan does not cover experimental or investigational treatment, but the covered person requests external review on the basis that the treatment in question is not experimental or investigational;

(2) Cosmetic procedures, where the health carrier denies requested care because the covered person’s health benefit plan does not cover cosmetic procedures, but the covered person requests external review on the basis that the service is needed for medical rather than cosmetic reasons;

(3) Access to out-of-network health care professionals or providers, where the health carrier denies a referral because treatment by out-of-network professionals or providers is not covered unless the appropriate clinical expertise is not available within the health carrier’s network, but the covered person requests external review on the basis that the health carrier’s provider network does not include professionals or providers with the appropriate clinical expertise;

(4) Coverage for drugs that are not on the formulary, but the covered person requests external review on the basis that the specific drug is medically necessary and there is no alternative drug available on the formulary; and

(5) Coverage for health services necessary to diagnose a medical condition, such as infertility, even if interventions to overcome the condition, such as interventions to achieve pregnancy, are excluded from coverage.

(d) In addition to the appeal rights that exist upon completion of internal review, a covered person shall have the right to independent external review when, pursuant to the provisions of RSA 420-J:5-a, I(b), the health carrier agrees to submit the determination to independent external review prior to completion of internal review.

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07; ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.04 Notice of Right to External Review.

(a) Health carriers shall prominently display on the carrier’s website notice of the right to external review and shall ensure the covered person received written notice electronically or by mail of the right to external review in each of the following circumstances:

(1) At the time the policy, certificate, membership booklet, or other evidence of coverage is provided to covered persons;

(2) At the time the final adverse determination is provided to covered persons upon completion of internal grievance review or expedited internal grievance review;

(3) Pursuant to the provision of RSA 420-J:5-a, I(b), if the health carrier has agreed to submit the determination to independent external review prior to completion of internal review; and

(4) If the covered person has requested standard or expedited internal grievance review, and the health carrier has failed to issue a decision within the required time frames, at the expiration of the time period for issuing the decision.

(b) The notice of the right to external review shall be:

(1) In bold;

(2) Set out in at least 16 point type, and the remainder of the text in at least 12 point type; and

(3) Printed as follows:

“NOTICE OF RIGHT TO AN EXTERNAL APPEAL

OF YOUR HEALTH INSURER’S DECISION

You may have a legal right to have our decision reviewed by an organization that is independent and neutral after we have made our final decision or earlier if we agree. This process is called Independent External Review and is overseen by the New Hampshire Insurance Department. There is no cost to you for an external appeal.

YOU MUST ASK FOR THIS REVIEW NO LATER THAN 180

DAYS AFTER THE DATE OF OUR FINAL DENIAL DECISION

A request for independent external review may be completed electronically through a secure portal on the New Hampshire Insurance Department’s website https://www.insurance.nh.gov/consumers/health-insurance/independent-external-review.

To request an independent external review, consult the Managed Care Consumer Guide to External Appeal at https://www.insurance.nh.gov/sites/g/files/ehbemt861/files/imported-files/ex_rev_guide.pdf and fill out the Request for Independent External Appeal of a Health Care Decision at https://www.insurance.nh.gov/sites/g/files/ehbemt861/files/imported-files/external-health-review-application-form.pdf. Please attach all supporting documentation.

If your medical condition is such that waiting for the standard external review process to be completed would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function, you may be eligible for expedited external review.

You may file your completed Request for Independent External Appeal of a Health Care Decision by uploading to the Department’s secure online portal https://www.insurance.nh.gov/consumers/health-insurance/independent-external-review or by mailing or delivering the required documentation to:

Independent External Review

New Hampshire Insurance Department

21 South Fruit St., Suite 14

Concord, NH 03301

If you have any questions about the external review process, please call the New Hampshire Insurance Department at 1-800-852-3416 and ask to speak to a consumer assistant.”

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07; ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.05 Request for External Review.

(a) The commissioner shall develop and make available on the department’s website an application form for requesting external review consistent with RSA 420-J:5-a through 420-J:5-e and a consumer manual with directions for how to pursue external review of an adverse determination.

(b) A covered person shall be able to request an external review by the following methods:

(1) Uploading the completed request form for independent external appeal of a health care decision and supporting documentation to the department’s secure online portal at https://www.insurance.nh.gov/consumers/health-insurance/independent-external-review; and

(2) Mailing or delivering the completed request form for independent external appeal of a health care decision and supporting documentation to:

Independent External Review

New Hampshire Insurance Department

21 South Fruit St., Suite 14

Concord, NH 03301

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07; ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.06 Responsibilities of Health Carriers.

(a) The health carrier shall pay the cost of the external review to the independent review organization within 5 days of receiving notice of the acceptance of the external review.

(b) Failure by the health carrier or the covered person to provide the documents and information required in RSA 420-J:5-b, IV(a) or RSA 420-J:5-b, VII within the specified time frame shall not delay the conduct of the external review. If, upon receipt of a notice from the insurance department, the health carrier or its designee utilization review organization has failed to provide the documents and information within the specified time frame, the commissioner shall terminate the external review and reverse the adverse determination or final determination.

(c) Upon receipt of a notice of an independent review organization decision reversing an adverse determination, the health carrier shall approve the coverage that was the subject of the adverse determination and provide written confirmation of its approval to the insurance department within 48 hours of receipt of notice. The confirmation provided to the insurance department shall include a copy of the claim redetermination notice.

(d) The health carrier may reconsider the adverse determination at any time prior to receiving the external review decision.

(e) Immediately upon making the decision to reverse its adverse determination, the health carrier shall notify the covered person, and if applicable, the covered person’s authorized representative, the selected independent review organization, and the commissioner in writing of its decision and shall approve the coverage that was the subject of the adverse determination or final adverse determination. The selected independent review organization shall terminate the external review upon receipt of the notice from the health carrier and verification that coverage was approved. The health carrier shall be entitled to a refund of half of the fee paid to the independent review organization if the carrier reverses its decision prior to the independent review organization’s decision on the external review request.

(f) If the expedited external review concerns a concurrent review determination, the service shall be continued pending the completion of the external review process. A covered person shall not be held liable to either the health plan, the hospital, the physician, or the services provider for the cost of services in excess of the applicable co-payment, coinsurance, or deductible incurred, pending the independent review organization's determination of an expedited external review.

Source. #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.07 Certification of Independent Review Organizations.

(a) An independent review organization seeking certification shall supply the following information in a form as adopted by the commissioner and made available on the department’s website:

(1) Name, address, and telephone number of the organization;

(2) The name, address, and telephone number of the chief executive officer;

(3) The tax status and federal employer tax identification number;

(4) The list of states where the organization is incorporated, licensed, certified, or otherwise authorized to conduct business;

(5) A description of the organizational structure that identifies and explains the lines of authority within the organization itself and if applicable within a holding company or parent subsidiary system;

(6) A description of the management of the organization, including the files and management responsibilities of the staff;

(7) A description of the contracted service providers and clinical peer reviewers, as well as a description of the procedures used to ensure the adequacy of the network of clinical peer reviewers retained by the organization and the procedures used to ensure that the peer reviewers are adequately trained and appropriately licensed;

(8) A list of all reviewers in the clinical peer review network including the name, license number, and clinical discipline of each reviewer;

(9) A description and copy of the quality assurance program established by the organizations, which specifically address the policies and procedures used to protect the confidentiality of medical and treatment records;

(10) The name of the medical director, and a description of the medical director's qualifications;

(11) A description of the procedures that will be used to ensure that standard and expedited appeals are conducted within the required time frames;

(12) A description of the current financial status of the organization, including the most recent certified financial statement;

(13) A list of fees that will be charged for independent review and an explanation of the methodology used to develop the fee schedule;

(14) A conflict of interest attestation signed by each owner, officer, director, medical director, or management employee of the applicant, which shall be supported by personal information including the name, address, telephone number, and the person's 10 year employment history;

(15) A statement verifying that any person subject to the requirement of filing a conflict of interest attestation has submitted a report of their history of legal actions, as well as a report of their affiliation with other health care corporations; and

(16) Evidence of accreditation by a nationally recognized private accrediting entity with established and maintained standards for independent review organizations.

(b) The application for certification shall be signed by the chief executive officer or the board chairman who shall attest to its accuracy.

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07; ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.08 Independent Review Organizations Requirements.

(a) The independent review organization shall retain all files, records, and data received or created in conjunction with external reviews conducted for at least 5 years.

(b) Any and all reports, records, files, or data received or created in conjunction with external reviews conducted shall be provided to the commissioner within 10 days of the request.

(c) An independent review organization and the commissioner shall not disclose protected health information regarding covered persons that is collected in the external appeal process and shall take reasonable steps to monitor the security of the confidential data.

(d) An independent review organization shall report any breach in confidentiality immediately to the commissioner. All aspects of both the standard external review process and the expedited external review process shall meet or exceed the minimum standards for state external review processes set forth in 45 CFR § 147.136.

Source. #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.09 General Provisions Regarding External Review.

(a) The commissioner shall periodically review the accreditation for all certified independent review organizations.

(b) Certified independent review organizations that fail to maintain their accreditation by a nationally recognized private accrediting entity with established and maintained standards for independent review organizations shall immediately report the loss of accreditation to the commissioner.

(c) An independent review organization shall establish and review annually policies and procedures that cover all aspects of both the standard external review process and the expedited external review process set forth in this part and shall include, at minimum, a quality assurance mechanism in place that ensures external reviews are conducted within the specified time frames of RSA 420-J:5-b and RSA 420-J:5-c and required notices are provided in a timely manner, the selection of an adequate number of qualified and impartial clinical reviewers, confidentiality of records and clinical review criteria, and that any person employed by or under contract with the independent review organization complies with the same requirements.

Source. #7539, eff 8-1-01; ss by #8862, eff 5-1-07; ss by #10918, eff 9-1-15; ss by #14595, eff 5-22-26, EXPIRES: 5-22-36

Ins 2703.10 Waiver of Rules.

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

Source. #14595, eff 5-22-26, EXPIRES: 5-22-36

PART Ins 2704 PHARMACY BENEFITS MANAGERS

Statutory Authority: RSA 400-A:15, I; RSA 415:26; RSA 402-N:2; RSA 420-J:7-b, X;

and RSA 420-J:12

Revision Note:

Document #13059, effective 6-29-20, readopted with amendments Part Ins 2704 titled “Prescription Prices for Pharmacists and Pharmacies” and changed the title to “Pharmacy Benefits Managers”. Document #13059 made extensive changes to the wording, format, structure, and numbering of rules in Part Ins 2704.

Document #13059 replaces the prior filing for rules in Part Ins 2704 filed in Document #12171, effective 2-24-17.

Ins 2704.01 Purpose. The purpose of this part is to provide for the regulation and registration of pharmacy benefits managers (PBMs) and to set forth rules which the commissioner deems necessary to carry out the provisions of RSA 402-N.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.02 Definitions.

(a) “Annual report” means a report of the data required to be submitted annually in accordance with RSA 402-N:6.

(b) "Commissioner" means the insurance commissioner.

(c) “Covered benefits” means those health care services and other medical services to which a covered person is entitled under the terms of a health benefit plan, including pharmacy benefits.

(d) “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.

(e) “Contracted copayment” means a fixed amount a covered person is responsible to pay for covered prescriptions as set forth in the health benefit plan, or the price for filling the prescription as contracted between the health carrier or its pharmacy benefits manager and the pharmacy, whichever is less.

(f) “Department” means the New Hampshire Insurance Department.

(g) “Health benefit plan” means a plan, policy, or certificate of insurance that constitutes health coverage as defined in RSA 420-G:2, IX.

(h) “Health carrier” means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the covered costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.

(i) “New Hampshire pharmacy board” means the board established in RSA 318:2.

(j) “Participating pharmacy” means a pharmacy that, under a contract with the health carrier or its contractor or subcontractor, including any pharmacy benefits manager, has agreed to provide pharmacy services to covered persons with an expectation of receiving payment, other than coinsurance, co-payments, or deductibles, directly or indirectly, from the health carrier.

(k) “Pharmacist” means a person defined in RSA 402-N:1, V.

(l) “Pharmacy benefits manager”' means a “pharmacy benefits manager” as defined in RSA 402-N:1, VIII.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.03 Registration.

(a) No person or entity shall manage the prescription drug coverage provided by a health carrier without registering with the department as a PBM. All PBMs shall complete and submit an application PBM-R “Application for Registration: Initial Application or Renewal Application” (May 2020), available at: https://www.nh.gov/insurance/companies/applications/index.htm.

(b) The registration application shall be completed and signed by an officer or authorized representative of the PBM and filed with the department along with a filing fee of $500.

(c) A PBM shall notify the commissioner in writing of any change in the information required to be filed under these rules, including a change of address or name, no later than 30 days after the change.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.04 Registration Renewal and Annual Reports.

(a) All PBMs shall submit a renewal fee of $100 and complete and submit a renewal application PBM-R “Application for Registration: Initial Application or Renewal Application” (May 2020), available at: https://www.nh.gov/insurance/companies/applications/index.htm, by March 1 each year.

(b) No registration shall be renewed unless the PBM has submitted an annual report as required by RSA 402-N:6, I.

(1) Carrier plan code or name;

(2) Health carrier’s National Association of Insurance Commissioners company code;

(3) Plan code as defined in Ins 4010.07(c);

(4) Total amount spent on drugs prior to rebates; and

(5) Aggregate amount of all rebates collected from pharmaceutical manufacturers that were

attributable to patient utilization in New Hampshire.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.05 Claims Processing.

(a) Every health carrier that provides prescription benefits as a covered benefit under a health benefit plan shall ensure that prescription benefit claims are adjusted and paid in accordance with the requirements of Ins 1001 and RSA 420-J:8-a.

(b) Any health carrier or PBM shall require all participating pharmacies to charge any covered person the lesser of:

(1) The pharmacy’s usual and customary price for filling the prescription; or

(2) The contracted copayment.

(c) The health carrier or PBM shall not be in violation of this section when the conditions set forth in RSA 420-J:8-a, IV exist or the claim has been submitted fraudulently or with inaccurate or misrepresented information.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.06 Complaint Process.

(a) Any pharmacy that fills prescriptions as a covered benefit under a health benefit plan and is adversely affected by the failure of a health carrier or a PBM to comply with RSA 420-J:7-b, X or RSA 415:26 may file a complaint with the commissioner.

(b) Complaints alleging violations of RSA 420-J:b, X or RSA 415:26 and received directly from pharmacies or referred from the New Hampshire pharmacy board to the commissioner shall be investigated by the commissioner in accordance with the provisions of RSA 400-A:16.

(c) The commissioner shall only investigate substantiated complaints that relate to a fully insured plan within the commissioner’s jurisdiction.

(d) A “substantiated complaint” means a complaint that includes all the following information:

(1) The name, address, and license number of the pharmacy filing the complaint;

(2) The name and license number of, and the contact information for, a pharmacist who supports the allegations in the complaint filed;

(3) Information concerning the prescription, including the name of the prescription dispensed and the quantity and dose of the prescription dispensed, with units expressed in terms of volume, number of tablets or capsules, weight, or in other measurement;

(4) The name of the health carrier and the name of the pharmacy benefits manager, if a pharmacy benefits manager is involved in the prescription claim made by the consumer;

(5) A legible copy of the front and back of the consumer’s insurance card for prescription benefits;

(6) The name of the subscriber to the health benefit plan, if that information is not shown on the consumer’s insurance card;

(7) The date the pharmacy dispensed the prescription to the consumer;

(8) The name of the consumer that requested coverage for the prescription at issue in the complaint; and

(9) Written evidence that supports the allegations of violation.

(e) The commissioner shall inform the pharmacy if the filed complaint is unsubstantiated and what missing information is needed.

(f) The commissioner shall hold any complaint that is not substantiated in pending status for 90 days from the date of the notice described in (e) to allow the pharmacy to submit required missing information. If missing information is not provided within 90 days of the date of the notice described in (e), the complaint that is not substantiated shall be closed.

(g) Any consumer may file a complaint with the commissioner. Consumer complaints shall be investigated in accordance with RSA 400-A:15-e.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.07 Enforcement. A PBM shall be subject to the provisions of RSA 402-N:2, III for the following reasons:

(a) Failure to comply with any provisions of this part or of RSA 402-N;

(b) Failure to comply with any lawful order of the commissioner;

(d) Filing an application or any necessary forms with the department which contain fraudulent information or omissions;

(e) Misappropriation, conversion, illegal withholding, or refusal to pay over, upon proper demand, any monies that belong to a person otherwise entitled to them and that have been entrusted to the PBM;

(f) Evidence that an owner, principal, officer, partner, manager, director, trustee, or the PBM itself has:

(1) Had an insurance license or an application for an insurance license in any state denied, suspended, or revoked;

(2) Been the subject of a fine, penalty, order, withdrawal, or informal settlement with any state insurance department; or

(3) Pled guilty or no contest to any felony or misdemeanor; or

(g) Failure to meet any qualification for which registration would have been refused had such failure then existed and been known to the Department.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.08 Reporting to the New Hampshire Board of Pharmacy.

(a) The commissioner shall prepare public reports with regard to the complaints received from pharmacies or the New Hampshire board of pharmacy under this part.

(b) The public report shall contain the following information:

(1) A unique numerical identifier for each complaint received;

(2) The name, address, and license number of the pharmacy filing the complaint;

(3) The name and license number of the pharmacist who supports the allegations in the complaint filed;

(4) The name of the health carrier and the name of the PBM, if a PBM is involved in the prescription claim made by the consumer;

(5) The date the complaint was received;

(6) The nature of the complaint received, to include the prescription at issue, the facts concerning the complaint, and the section of rule or law that is alleged to have been violated;

(7) The status of the investigation or an indication that the complaint is in pending status, awaiting information from the pharmacy;

(8) The date of the final resolution of the complaint, if the complaint has been resolved; and

(9) A description of the final resolution of the complaint, to include the legal and factual findings of the commissioner as to the alleged violation.

(c) The report shall be posted electronically on the department’s website at http://www.nh.gov/insurance/ at least quarterly and shall also be transmitted to the New Hampshire board of pharmacy.

(d) The commissioner shall provide to any complaining pharmacy, upon request, a report of the status of complaints filed by that pharmacy, which shall contain the information set forth in (b) above.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.09 Confidentiality. In accordance with RSA 400-A:16, III, RSA 402-N:6, II, and except as otherwise provided in this part, all information collected, obtained, or otherwise in the control or possession of the commissioner from any source relating to any investigation pursuant to this part shall be confidential by law and privileged, shall not be subject to RSA 91-A, shall not be subject to subpoena, and shall not be subject to discovery or admissible as evidence in any private civil action.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.10 Periodic Audit.

(a) The commissioner shall examine a PBM pursuant to RSA 400-A:37 and RSA 402-N:7. The cost of the audit shall be paid by the PBM pursuant to RSA 402-N:7. Audits shall include premium collection, claims processing, and marketing practices.

(b) The PBM shall have continuing access to all books and records in order to fulfill its contractual obligations.

(1) Be owned by the health carrier or the PBM;

(2) Conform to the standards of insurance record keeping required of insurers subject to filing an annual audited financial statement pursuant to RSA 400-A:36;

(3) Be retained for 5 years from the date of their creation; and

(4) Be subject to examination by the commissioner or the insurer for which the records are kept.

(d) Upon termination of an agreement between the PBM and the health carrier pursuant to the termination provisions in the agreement, the records may be transferred to a new PBM in lieu of the required 5 year retention. If such a transfer occurs, the new PBM shall acknowledge in writing receipt and responsibility for the transferred records.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.11 Inquiry by Commissioner.

(a) The commissioner shall address any inquiries to the PBM concerning its PBM business. The PBM shall reply in writing within 10 working days to any inquiry made by the commissioner pursuant to RSA 400-A:16, II.

(b) A PBM shall keep all complaints on file for a period of 5 years. Complaint information shall be made available to the department by the PBM upon the commissioner's request.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

Ins 2704.12 Waiver of Rules.

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

(e) Any waiver granted shall expire no later than the end of the registration period. Upon renewal of the registration, the applicant may request another waiver.

Source. (See Revision Note at part heading for Ins 2704) #13059, eff 6-29-20

PART Ins 2705 UNIFORM PRIOR AUTHORIZATION FORMS AND ELECTRONIC STANDARD FOR PRESCRIPTION DRUG BENEFITS

Statutory Authority: RSA 400-A:15, I; RSA 420-E:4-a, III; and RSA 420-J:7-b, IV-c (c)

Ins 2705.01 Purpose. The purpose of these rules is to provide administrative simplification in the prior authorization process for prescription drugs, to encourage the use of electronic prior authorization technology, and to support adoption by health insurers, pharmacy benefits managers, and utilization review entities of nationally recognized standards or processes for electronic prior authorization of prescription drugs.

Source. #12125, eff 3-8-17

Ins 2705.02 Scope.

(a) These rules shall apply to:

(1) All health carriers, health maintenance organizations, health services corporations, and preferred provider programs in the state of New Hampshire in connection with managed care coverage governed by RSA 420-J or when using a utilization review entity subject to RSA 420-E;

(2) Any pharmacy benefits manager with which any of the aforementioned entities contracts to perform prior authorization services for prescription drug benefits; and

(3) All utilization review entities.

(b) These rules shall not apply to the Medicaid managed care program under RSA 126-A:5, XIX.

Source. #12125, eff 3-8-17

Ins 2705.03 Definitions.

(a) “Carrier clinical review criteria” means written criteria that use nationally accepted standards of medical practice consistent with RSA 420-J:6 VI, and that have been adopted and made public by a health insurer, pharmacy benefits manager, or utilization review entity for determining the circumstances in which use of a particular prescription drug is appropriate.

(b) “Electronic prior authorization” (ePA) means prior authorization processes conducted through a health carrier’s web portal or any other secure electronic manner of transmission.

(d) “Health insurer” means those health insurance companies subject to this rule pursuant to Ins 2705.02(a)(1).

(e) “Health maintenance organization” means “health maintenance organization” as defined in RSA 420-B:1.

(f) “Health services corporation” means “health services corporation” as defined in RSA 420-A:1.

(g) “Pharmacy benefits manager” means a person who performs pharmacy benefits management services, including a person acting on behalf of a pharmacy benefits manager in a contractual or employment relationship in the performance of pharmacy benefits management services for a covered entity. “Pharmacy benefits management” means the administration of prescription drug benefits provided by a covered entity under the terms and conditions of the contract between the pharmacy benefits manager and the covered entity and the provision of mail order pharmacy services.

(h) “Preferred provider program” means a program in which a health insurer contracts with or designates preferred providers as defined in RSA 420-C:2.

(i) “Prescribing provider” means any person who is lawfully entitled to prescribe, administer, dispense, or distribute prescription drugs to patients.

(j) “Prescription drug” means:

(1) A drug dispensed from a pharmacy directly to the consumer which, under federal law, is required, prior to being dispensed or delivered, to be labeled with any of the following statements:

a. “Caution: federal law prohibits dispensing without prescription”;

b. “Caution: federal law restricts this drug to use by or on the order of the licensed veterinarian”; or

c. “RX only”; or

(2) A drug which is required by any applicable federal or state law or regulation to be dispensed on prescription only and that is dispensed from a pharmacy directly to the consumer.

(k) “Prior authorization” means utilization review conducted prior to a patient’s service or course of treatment.

(l) “Uniform prior authorization forms” means the forms set forth in Ins 2705.04(a) and to be used by health insurers, pharmacy benefits managers, and utilization review entities for prior authorization of prescription drugs pursuant to RSA 420-J:7-b, IV-c (b) and RSA 420-E:4-a, II. “Uniform prior authorization forms” includes both the versions of the forms that are prepopulated pursuant to Ins 2705.04(c) and those that are not prepopulated.

(m) “Utilization review entity” means any person, partnership, or corporation which provides utilization review services subject to RSA 420-E.

Source. #12125, eff 3-8-17

Ins 2705.04 Format of Uniform Prior Authorization Forms.

(a) The appearance of the uniform prior authorization forms shall be as illustrated in Appendix B.

(b) Health insurers, pharmacy benefits managers, and utilization review entities shall reproduce and accept the uniform prior authorization forms without changes except as provided in (c) below.

(c) Health insurers shall ensure that Section A “Destination of Request” of the uniform prior authorization forms is prepopulated before the forms are made available and accessible online pursuant to Ins 2705.05(a).

(d) The uniform prior authorization forms shall be completed as follows:

(1) Section A shall be pre-populated pursuant to paragraph (c) above, with the following information:

a. Insurer or Pharmacy Benefits Manager (PBM) Name – company to which the form shall be submitted;

b. Phone # – phone number for contacting the company regarding prior authorization;

c. Fax # – secure fax number for submitting the request; and

d. Electronic Prior Authorization Webpage – webpage for submitting prior authorization requests electronically, as applicable;

(2) Section B shall be completed by the prescribing provider to indicate the type of request being made by checking the appropriate box(es) to indicate:

a. Whether the request is being made for the first time or is a request for continuation or renewal of an existing prior authorization; and

b. Whether expedited review is being requested and, if so, the treating provider shall initial to make the following attestation:

“By initialing here, I, as the treating provider, attest to the fact that this request meets the URAC (Utilization Review Accreditation Commission) health accreditation standards for urgent care in that adherence to the standard timelines: a) could seriously jeopardize the life or health of the patient or the ability of the patient to regain maximum function; or b) would subject the patient to severe pain that cannot be adequately managed without the treatment being requested”;

(3) Section C shall be completed by the prescribing provider to provide identifying information about the patient for whom the drug is being requested as follows:

a. Patient’s Full Name – first, middle, and last name (or middle initial) of patient

and any suffix;

b. DOB – patient’s month, day, and year of birth;

c. Member ID # - patient’s insurer or PBM member identification number as displayed on the patient’s insurance card; and

d. Group # - patient’s insurer or PBM group number as displayed on the patient’s insurance card;

(4) Section D shall be completed by the prescribing provider to provide identifying and contact information for the prescribing provider as follows:

a. Prescribing Provider – name of the provider prescribing the medication being requested;

b. Phone # – phone number for contacting the prescribing provider regarding the prior authorization request;

c. Address – mailing address for sending prior authorization determinations to the prescribing provider;

d. Secure Fax # – secure fax number for sending prior authorization determinations to the prescribing provider;

e. Specialty – the prescribing provider’s specialty (if multiple, include the specialty relevant to the request);

f. Prescribing Provider NPI # - the prescribing provider’s National Provider Identifier number;

g. Prescribing Provider DEA # - the number assigned to the prescribing provider by the U.S. Drug Enforcement Administration allowing the provider to write prescriptions for controlled substances;

h. Prescriber Point of Contact (POC) Name – a person in the provider’s office (if different than the prescribing provider) that can be contacted regarding the prior authorization request;

i. POC Phone # – phone number for contacting the POC regarding the prior authorization request;

j. POC Secure Fax # – secure fax number for sending prior authorization determinations to the POC;

k. POC Email – email address for contacting the POC regarding the prior authorization request (not required); and

l. Signature / Date – form must be signed and dated by the prescribing provider or an authorized designee;

(5) Section E shall be completed by the prescribing provider to provide information about the patient’s diagnosis and the medication being requested as follows:

a. Primary Diagnosis Related to the Medication Request – patient’s diagnosis related to which the medication is being requested;

b. Medication Requested – medication name;

c. Strength – medication strength being prescribed;

d. Quantity – quantity of the medication being prescribed;

e. Dosing Schedule – frequency of administration of medication being prescribed;

f. Length of Therapy – duration prescribed for medication;

g. Date of Prescription – date medication was prescribed;

h. Current Treatment – indicate if this is an ongoing treatment and, if it is, the date it was started; and

i. Dispense as Written (DAW) Specified – indicate if an alternate version or medication is not to be substituted for the requested medication; if yes, provide rationale for DAW by checking the appropriate box(es) as listed below and providing additional information as required:

“1. Alternate therapies contraindicated or previously tried (please provide more information in Section F);

2. Complex patient with one or more chronic conditions (including, for example, psychiatric condition, diabetes) is stable on current drug(s); high risk of significant adverse clinical outcome with medication change (specify anticipated significant adverse clinical outcome in space below);

3. Medical need for increase in current dosage, strength and / or frequency (specify in space below: (1) dosage, strength(s) and / or frequency(s) tried; (2) medical reason);

4. Absence of appropriate formulation or indication of the drug (specify in space below); and

5. Other (specify in space below)”; and

(6) Section F shall be completed by the prescribing provider to provide information about the patient’s health and treatment if it is relevant to the medication being requested as follows:

a. Drug Allergies - patient’s current drug allergies;

b. Height - patient’s current height;

c. Weight - patient’s current weight;

d. Relevant Lab Values/Test Results – the name, results, and date of any laboratory or other tests that are relevant to the request;

e. Previous Medications and/or Non-Pharmacologic Therapies Tried /Failed – any alternate prescription drug or non-pharmacologic therapies tried by the patient for the same purpose for which the requested medication is being prescribed, to include (as relevant) medication or therapy name; strength; dosing schedule prescribed; date prescribed/started; date stopped; and description of adverse reaction or failure;

f. Contraindications to alternate therapies – the name of any alternate therapy that cannot be used because it may be harmful and description of the contraindication(s); and

h. Additional information – the prescribing provider may provide any additional information to support this request.

Source. #12125, eff 3-8-17

Ins 2705.05 Use of Uniform Prior Authorization Forms and Electronic Standard for Prescription Drug Benefits.

(a) Health insurers shall ensure that the version of the uniform prior authorization form that they have prepopulated pursuant to Ins 2705.04(c) is available and accessible in a centralized location online.

(b) Except as provided in (c) below, health insurers, pharmacy benefits managers, and utilization review entities shall treat the information submitted via uniform prior authorization forms as sufficient information upon which a decision regarding the prior authorization request shall be made as follows:

(1) Health insurers, pharmacy benefits managers, and utilization review entities shall not require prescribing providers to provide information in excess of the information required on the uniform prior authorization forms; and

(2) Health insurers, pharmacy benefits managers, and utilization review entities shall not:

a. Require or allow prescribing providers to submit information on a form other than the uniform prior authorization forms, even if the other form contains the same information as the uniform prior authorization forms; or

b. Require or request that prescribing providers submit any form or information in addition to the uniform prior authorization forms.

(c) Following receipt of uniform prior authorization forms that have been filled out and submitted, health insurers, pharmacy benefits managers, and utilization review entities may request that prescribing providers submit additional information to clarify information specifically requested on the uniform prior authorization forms only to the extent that:

(1) The prescribing provider provided information that conflicts with the records of the health insurer, pharmacy benefits manager, or utilization review entity; or

(2) The prescribing provider did not provide the information requested by the uniform prior authorization forms, including but not limited to clinical information that is needed in accordance with the carrier clinical review criteria and that would typically be supplied in Section F, except that prescribing providers shall not be required to complete Section A “Destination of Request” of the uniform prior authorization forms or ePA.

(d) Failure of a prescribing provider to complete section F or any portion thereof shall not be grounds for denial of prior authorization by a health insurer, pharmacy benefits manager, or utilization review entity, except to the extent the information not provided is required under the carrier clinical review criteria, and the health insurer, pharmacy benefits manager, or utilization review entity has inquired about the information in accordance with (c)(2) above.

Source. #12125, eff 3-8-17

Ins 2705.06 Standards for Electronic Prior Authorization Processes.

(a) The information collected by health insurers, pharmacy benefits managers, and utilization review entities via ePA, telephonically, or through any other manner of transmission shall be the same as the information collected via the uniform prior authorization forms except as specified in (b) below, or in accordance with a waiver granted under Ins 2705.09 below.

(b) Prescription drug prior authorization procedures conducted through ePA, telephonically, or through any other manner of transmission shall not require the prescribing provider to provide more information than is required by the uniform prior authorization forms, except that health insurers, pharmacy benefits managers, and utilization review entities may:

(1) Ask for the same information in a different manner via ePA, including converting questions on the uniform prior authorization forms that require free-form text into one or more questions with multiple choice or drop-down options;

(2) Ask for the following additional information via ePA:

a. Patient address; and

b. Patient gender;

(3) Eliminate Section A “Destination of Request” in ePA; and

(4) Ask for less information via ePA.

(c) Upon review of an ePA request and consistent with Ins 2705.05, a health insurer, pharmacy benefits manager, or utilization review entity may request additional clinical information or clarification necessary to render a decision on the ePA request. Such additional information may only be requested when it is required by the carrier clinical review criteria.

(d) ePA processes shall be completed via secure electronic transactions via secure web portals.

(e) ePA processes shall comply with all applicable state and federal laws, including but not limited to the Health Insurance Portability and Accountability Act of 1996.

Source. #12125, eff 3-8-17

Ins 2705.07 Outreach to Prescribing Providers. Health insurers, pharmacy benefits managers, and utilization review entities shall educate contracted and other prescribing providers about the uniform prior authorization forms, including in partnership with membership organizations that represent those prescribing providers.

Source. #12125, eff 3-8-17

Ins 2705.08 Revisions.

(a) Upon receipt of a rulemaking petition under RSA 541-A:4 asserting that one or more provisions in these rules prevents health insurers, pharmacy benefits managers, and utilization review entities from adopting nationally recognized standards or processes for electronic prior authorization of prescription drugs, including those provided by the National Council for Prescription Drug Programs or an equivalent organization, the commissioner shall consider amending Ins 2705 to eliminate such conflict.

(b) Upon receipt of a rulemaking petition under RSA 541-A:4 outlining the need for and proposed content of one or more additional prior authorization forms for specific types, classifications, or categories of prescription drugs, the commissioner shall consider amending Ins 2705 to create one or more medication-specific versions of the uniform prior authorization forms.

Source. #12125, eff 3-8-17

Ins 2705.09 Waivers to Support Use of National ePA Standards.

(a) Upon written request of a health insurer, pharmacy benefits manager, or utilization review entity, the department shall grant in writing a waiver of the requirements of one or more provisions of Ins 2705.06 upon a showing by the health insurer, pharmacy benefits manager, or utilization review entity, that:

(1) The health insurer, pharmacy benefits manager, or utilization review entity has adopted or plans to adopt the use of a nationally recognized standard for ePA of prescription drugs, including but not limited to standards provided by the National Council for Prescription Drug Programs or an equivalent organization;

(2) One or more provisions in these rules prevent the effective use of the nationally recognized standard;

(3) The modifications permitted under Ins 2705.06(b) do not effectively address the conflict between the rule and the national standard; and

(4) The waiver request outlines with specificity the requested modification to the uniform requirements of this part that will eliminate the conflict.

(b) A health insurer, pharmacy benefits manager, or utilization review entity that has been granted a waiver pursuant to (a) above shall comply with all provisions of Ins 2705 except as expressly described in the department’s written document granting the waiver.

Source. #12125, eff 3-8-17

PART Ins 2706 INDEPENDENT DISPUTE RESOLUTION FOR SURPRISE MEDICAL BILLS

Statutory Authority: RSA 420-J:12; RSA 420-J:8-e, XII (b); RSA 400-A:15

Ins 2706.01 Purpose. The purpose of this part is to implement the provisions of RSA 420-J, RSA 417-F, RSA 358-T, RSA 358-A:2, XIX, and RSA 417:4, XV(a)(15) wherein the general court, through Chapter 143 of the laws of 2024, has addressed surprise medical bills by creating standards and procedures for the protection of health insurance consumers and for dispute resolution between a health carrier and a nonparticipating provider or emergency facility regarding the fair value of health care items or services.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.02 Scope. This part shall apply to all health carriers, all self-funded health plans that opt in, all parties in the independent dispute resolution IDR process, and all independent dispute resolution entities. This part shall apply to coverage and reimbursement for out-of-network services provided on or after the 2026 effective date of this chapter.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.03 Definitions.

(a) For the purposes of this part, the definitions in RSA 420-J:3 shall apply whenever any word or phrase defined under RSA 420-J:3 is used in this part unless a more detailed definition appears in this section or in subsequent sections.

(b) With respect to the following words or phrases used in this part, the following definitions shall apply:

(1) “Batched qualified IDR items and services” means multiple qualified IDR items or services that are considered jointly as part of one payment determination by a certified IDR entity for purposes of the state IDR process in accordance with section Ins 2706.06 of this part;

(2) “Bundled payment arrangement” means an arrangement under which:

a. A provider or facility bills for multiple items or services furnished to a single patient under a single service code that represents multiple items or services, for example, a diagnosis related group (DRG) code; or

b. A health carrier or plan makes an initial payment or notice of denial of payment to a provider or facility under a single service code that represents multiple items or services furnished to a single patient, for example, a DRG code;

(3) “Business day” means any weekday that is not a federal holiday or a New Hampshire state holiday;

(4) “Emergency department of a hospital” means “emergency department of a hospital” as defined in 42 U.S.C. §300gg-111(a)(3)(A) and as further defined in 45 CFR§149.30;

(5) “Emergency medical condition” means “emergency medical condition” as defined in RSA 420-J:3, XV. The term includes the definitions in 42 U.S.C. §300gg-111(a)(3)(B) and 45 CFR §149.110(c)(1);

(6) “Emergency services” means “emergency services” as defined in RSA 420-J:3, XVI, namely “health care services, including mental use disorder treatment services, that meet the definition of emergency services 42 U.S.C. §300gg-111(a)(3)(C) and as further defined in 45 CFR §149.110(c)(2);

(7) “Episode of care” means the period of time during which all of the health care services that are needed to care for a patient’s clinical condition or to complete a procedure are delivered;

(8) “Independent freestanding emergency department” means “independent freestanding emergency department” as defined in 42 U.S.C. §300gg-111(a)(3)(D) and as further defined in 45 CFR §149.30;

(9) “Nonparticipating emergency facility” means “nonparticipating emergency facility” as defined in RSA 420-J:3, XXVI-a. The term includes the definition in 42 U.S.C. §300gg-111(a)(3)(F)(i) and as further defined in 45 CFR §149.30;

(10) “Nonparticipating provider” means “nonparticipating provider” as defined in RSA 420-J:3, XXVII-b. The term includes the definition in 42 U.S.C. §300gg-111(a)(3)(G)(i) and as further defined in 45 CFR §149.30;

(11) “Notice of denial of payment” means “notice of denial of payment” as defined in 45 CFR §149.30;

(12) “Out-of-network rate” means “out-of-network rate” as defined in 42 U.S.C. §300gg-111(a)(3)(K) and as further defined in 45 CFR §149.30;

(13) “Participating emergency facility” means “participating emergency facility” as defined in 42 U.S.C. §300gg-111(a)(3)(F)(ii) and as further defined in 45 CFR§149.30;

(14) “Participating health care facility” means “participating health care facility” as defined in 45 CFR §149.30;

(15) “Qualifying payment amount” or “QPA” means “qualifying payment amount” as defined in RSA 420-J:3 XXIX-a. The term includes the definition in 42 U.S.C. §300gg-111(a)(3)(E) and as further defined in 45 CFR§140(a)(16);

(16) “Recognized amount” means “recognized amount” as defined in 42 U.S.C. §300gg-111(a)(3)(H) and as further defined in 45 CFR §149.30;

(17) “Same or similar item or service” means “same or similar item or service” as defined in 45 CFR §149.140(a)(13);

(18) “Service code” means “service code” as defined in 45 CFR §149.140(a)(14);

(19) “Specified state law” means “specified state law” as defined in 42 U.S.C. §300gg-111(a)(3)(I) and as further defined in 45 CFR §149.30;

(20) “Treating provider” means “treating provider” as defined in 45 CFR§149.30; and

(21) “Visit” means “visit” as defined in 45 CFR §149.30.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.04 Option to Pursue Either the State or the Federal IDR Process.

(a) Under this part, a provider or facility that is party to a fair value dispute about items or services to which the prohibition on balance billing in RSA 358-T applies may choose to pursue either the state or the federal IDR process on a case-by-case basis.

(b) The authority of the commissioner to administer the state IDR process set out in this part shall arise on a case-by-case basis with respect to specific items or services as providers or facilities choose to invoke the state IDR process to determine the fair value of that item or service.

(c) The administration of this part shall not preempt or displace the authority or obligation of the secretary of the federal department of health and human services to administer the federal IDR process as provided under 42 U.S.C. section 300gg-111 whenever the provider or facility to which the prohibition on balance billing in RSA 358-T applies does not choose to invoke the state IDR process.

(d) If a provider or facility that is party to a fair value dispute about items or services to which the prohibition on balance billing in RSA 358-T applies invokes the state IDR process by submission of a notice of IDR initiation under Ins 2706.07(b)(2) below within the 4-day period following the 20th day of open negotiation, and is found eligible for the state IDR process by the commissioner, then both parties shall be precluded from accessing the federal IDR process under 42 U.S.C. section 300gg-111. If the provider or facility does not invoke the state IDR process set out in this part or is found ineligible for the state IDR process, then either the provider or facility or the health carrier or plan may make application for review pursuant to the federal IDR process under 42 U.S.C. section 300gg-111 after the expiration of 30 days of open negotiation as provided in 42 U.S.C. section 300gg-111(c)(1)(B).

(e) If a provider, facility, health carrier, or plan that is party to a fair value dispute invokes the federal IDR process by submission of a notice of IDR initiation as specified in 42 U.S.C. section 300gg-111(c)(1)(B) and has been found to be eligible for that IDR process, then both parties shall be precluded from accessing the state IDR process under this part with respect to determining the fair value of that item or service. If an item or service that is the subject of a fair value dispute is not eligible for the federal IDR process due solely to the applicability of a cooling off period as set out in 42 U.S.C. section 300gg-111(c)(5)(E)(ii) and in federal, in-force regulations promulgated thereunder, this item or service shall nonetheless be eligible for the state IDR process under this part.

(f) If a provider or facility initiates the state IDR process by submission of a notice of IDR initiation under Ins 2706.07(b)(2) and is found eligible for the state IDR process by the commissioner, then the disputing parties shall be limited to the state IDR process for determining the fair value of all other items and services that are part of the same episode of care, and both parties shall be precluded from accessing the federal IDR process under 42 U.S.C. section 300gg-111 with respect to all such items or services.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.05 Coverage and Notice Requirements.

(a) If a health carrier or a self-funded plan that has opted in is offering group or individual health benefit plans and provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department, the health carrier or plan shall cover emergency services, as defined in this part, and this coverage shall be provided in accordance with 45 CFR §149.110(b).

(b) If a health carrier or a self-funded plan that has opted in is offering group or individual health insurance coverage and provides or covers any benefits with respect to items and services, other than emergency services, furnished to a covered person, beneficiary, or enrollee by a nonparticipating provider with respect to a visit at a participating health care facility, unless the provider has satisfied the notice and consent criteria of 45 CFR §149.420(c) through (i) with respect to such items and services, the carrier or plan shall cover the items and services when furnished by a nonparticipating provider in accordance with 45 CFR §149.120 (c).

(c) When providing any paper or electronic remittance advice to a provider or facility that does not have a contractual relationship directly or indirectly with a health carrier or plan offering group or individual health insurance coverage with respect to the furnishing of the item or service under the plan or coverage in response to a claim for payment for health care items and services furnished by that provider or facility, the carrier or plan shall use claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs) pursuant to 45 CFR §162.1602 and §162.1603 and as specified in guidance issued by the federal secretaries of the Treasury, Labor, and Health and Human Services, or as required under any applicable adopted standards and operating rules under 45 CFR part 162.

(d) Cost sharing for services covered under (a) and (b) shall be calculated using the QPA, unless the billed amount or the allowed amount is less than the QPA. In such instances, cost sharing for services covered under (a) and (b) shall be calculated using the lesser of the billed amount or allowed amount.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.06 Methodology for Calculating Qualifying Payment Amount.

(a) For the purposes of this section, in addition to the definitions set forth in Ins 2706.03, the definitions set out in 45 CFR §149.140(a) shall apply.

(b) The methodology that health carriers or plans shall use for calculation of the median contracted rate shall be as set out in 45 CFR §149.140(b).

(c) The methodology that health carriers or plans shall use for calculation of the QPA shall be as set out in 45 CFR §149.140(c).

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.07 Notice Requirements Regarding the QPA.

(a) In cases in which the recognized amount with respect to an item or service furnished by a nonparticipating provider or nonparticipating emergency facility is the QPA, the health carrier or plan shall provide in writing, with each initial payment or notice of denial of payment, to the provider or facility notice of the following:

(1) The QPA for each item or service involved;

(2) If the QPA is based on a downcoded service code or modifier:

a. A statement that the service code or modifier billed by the provider or facility was downcoded;

b. An explanation of why the claim was downcoded, which shall include a description of which service codes were altered, if any, and a description of which modifiers were altered, added, or removed, if any; and

c. The amount that would have been the QPA had the service code or modifier not been downcoded.

(3) A certification by the health carrier or plan that:

a. The QPA applies for purposes of the recognized amount; and

b. Each QPA shared with the provider or facility was determined in compliance with this section;

(b) The following notices shall be provided to the nonparticipating provider or nonparticipating emergency facility with the initial payment:

(1) Under New Hampshire law, the provider or facility has the option to pursue either the state or the federal IDR process for determining the fair value of the services rendered when agreement cannot be reached;

(2) Both the state and the federal IDR process shall be preceded by the completion of an open negotiation period;

(3) The choice to pursue the state IDR process precludes access to the federal IDR process for determining the fair value of the specific services rendered and vice versa;

(4) The choice whether to pursue the state IDR process or the federal IDR process shall be made by the provider or facility before sending the notice of open negotiation to the health carrier or plan;

(5) If the provider or facility wishes to initiate an open negotiation period for purposes of determining the out-of-network rate under either the state or the federal IDR process, the provider or facility shall convey the notice of open negotiation to the appropriate person or office at the health carrier or plan within 30 business days of receiving the initial payment or notice of denial of payment;

(6) Under the state IDR process, after 20-business-days of open negotiation have elapsed without resulting in an agreement on the amount of payment, the provider or facility may initiate the state IDR process within 4 business days after the end of the 20th business day of open negotiation; and

(7) Contact information, including a telephone number and email address, for the appropriate person or office to initiate open negotiations for purposes of determining an amount of payment for such item or service, the legal business name of the health carrier or the legal business name of the plan sponsor, if applicable, and the registration number assigned under Ins 2706.24, as well as the registration number assigned under 45 CFR §149.530, if the health carrier or plan is registered under 45 CFR§149.530.

(c) Upon the request of the provider or facility, the health carrier or plan shall provide the following within 5 business days:

(1) Information about whether the QPA for items and services involved included contracted rates that were not on a fee-for-service basis for those specific items and services and whether the QPA for those items and services was determined using underlying fee schedule rates or a derived amount;

(2) Indicate whether a health carrier or plan uses an eligible database under 45 CFR§149.140(c)(3) to determine the QPA, information to identify which database was used;

(3) Indicate whether a related service code was used to determine the QPA for an item or service billed under a new service code under 45 CFR §149.140 (c)(4 (i) or (ii), information to identify the related service code; and

(4) Indicate whether the health carrier’s or plan’s contracted rates include risk-sharing, bonus, penalty, or other incentive-based or retrospective payments or payment adjustments for the items and services involved, as applicable, that were excluded for purposes of calculating the QPA.

(d) In the case of a health carrier or plan that, pursuant to this subpart, uses an eligible database to determine the QPA for an item or service, the health carrier or plan is responsible for any costs associated with accessing such database.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.08 Negotiation Period.

(a) The provider or facility may initiate an open negotiation period for purposes of determining the out-of-network rate for a qualified IDR item or service within 30 business days of the day the provider or facility receives an initial payment or notice of denial of payment regarding the item or service.

(b) To initiate the open negotiation period, the provider or facility shall submit a written open negotiation notice utilizing the open negotiation form developed by the commissioner to the other party. The open negotiation form shall include the following:

(1) Information sufficient to identify the provider or facility, including the name and current contact information, including the legal business name, email address, phone number, and mailing address, as provided with the claim form submitted by the provider or facility, and the National Provider Identifier (NPI);

(2) Information sufficient to identify the health carrier or plan, including the health carrier’s or plan's registration number under the state IDR registry, as well as the registration number under the federal IDR registry, if the health carrier or plan is federally registered, the legal business name of the health carrier or plan, as well as the current contact information, name, email address, phone number, and mailing address, of the health carrier or plan as provided with the initial payment or notice of denial of payment;

(3) The name and contact information, including the legal business name, email address, phone number, and mailing address, for any third party representing the party submitting the open negotiation notice, and an attestation that the third party has the authority to act on behalf of the party it represents in the open negotiation;

(4) Information sufficient to identify the item or service, including:

a. The date(s) the item or service was furnished and;

b. The date(s) that the provider or facility received the initial payment or notice of denial of payment for the item or service from the health carrier or plan;

c. The type of item or service, specifically, whether the item or service is an emergency service as defined in 45 CFR §149.110(c)(2)(i) or (ii), a non-emergency service as described in 45 CFR §149.120(b);

d. Whether the service is a professional service or facility-based service;

e. The state where the item or service was furnished;

f. The claim number;

g. The service code; and

h. Information to identify the location where the item or service was furnished such as, place of service code or bill type code;

(5) The initial payment amount including $0 if, for example, payment is denied;

(6) The QPA, if provided with the initial payment or notice of denial of payment;

(7) An offer of an out-of-network rate for each item or service;

(8) A statement that the items and services do not qualify for the notice and consent exception described at 45 CFR §149.410(b) or §149.420(c) through (i);

(9) A statement that the provider or facility was a nonparticipating provider or nonparticipating emergency facility on the date the item or service was furnished;

(10) A description of the open negotiation period and the state IDR process to include the purpose of the open negotiation period, state IDR process, and key deadlines in the open negotiation period and federal IDR process; and

(11) A copy of the initial payment or notice of denial of payment or other remittance advice that is required to include the disclosures under this section, with respect to the item or service.

(c) The 20 business-day open negotiation period shall begin on the day on which the provider or facility sends the open negotiation notice and the remittance advice documentation to the other party.

(d) The health carrier or health plan receiving the notice of open negotiation shall provide the provider or facility the response to the open negotiation form along with supporting documentation as soon as possible, but no later than the 10th business day of the 20 business day open negotiation period. The response to the open negotiation form shall include the following:

(3) The name and contact information, including the legal business name, email address, phone number, and mailing address, for any third party representing the party submitting the open negotiation response notice, and an attestation that the third party has the authority to act on behalf of the party it represents in the open negotiation;

(4) Information sufficient to identify the item or service included in the open negotiation notice, including the date(s) the item or service was furnished and the claim number;

(5) A statement as to whether the health carrier or plan agrees that:

a. The initial payment amount, including $0 if, for example, payment is denied, and the QPA reflected in the open negotiation notice accurately reflect the initial payment amount and QPA disclosed with the initial payment for the item or service;

b. If the open negotiation notice indicates that the initial payment amount or QPA was not communicated by the health carrier or plan with the initial payment or notice of denial of payment or other remittance advice, the initial payment amount, including $0 if, for example, payment is denied; and/or QPA it believes to be correct; and

c. Documentation to support the statement, for example, the remittance advice confirming the qualifying payment amount;

(6) The amount of cost sharing imposed for the item or service, if any;

(7) A counteroffer for an out-of-network rate for each item or service or an acceptance of the other party's offer;

(8) With respect to each item or service, either a statement and supporting documentation that explains why the item or service is not subject to the state IDR process or a statement agreeing that the item or service is subject to the state IDR process;

(9) A statement as to whether any of the information provided in the open negotiation notice is inaccurate and the basis for the statement, as well as supporting documentation; and

(10) A statement confirming that the initial payment or notice of denial of payment or other remittance advice provided by the provider or facility with the open negotiation notice is accurate, and if inaccurate, a copy of the accurate initial payment or notice of denial of payment or other remittance advice required to include the disclosures under this section, with respect to the item or service.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.09 Initiation of the State Independent Dispute Resolution Process.

(a) If the parties fail to reach an agreement during the open negotiation period, the provider or facility may initiate the state IDR process.

(b) To initiate the state IDR process, a provider or facility shall submit a written notice of IDR initiation using the standard form developed by the commissioner and shall deliver the notice to the health carrier or plan and to the commissioner. The notice of IDR initiation and supporting documentation shall be submitted to the commissioner by using the New Hampshire Independent Dispute Resolution Portal which may be found on the insurance department website. The notice of IDR initiation shall be accompanied by a copy of the open negotiation notice and the open negotiation response notice, and the open negotiation response form, if one was submitted. The notice of IDR initiation form shall include the following:

(1) Information sufficient to identify the provider or facility, including the legal business name, email address, phone number, mailing address, the NPI, and Tax Identification Number (TIN);

(2) Information sufficient to identify the health carrier or plan, including the carrier's or plan's registration number under the state IDR registry, as well as the registration number under the federal IDR registry under 45 CFR §149.530, if the health carrier or plan is federally registered, the legal business name of the health carrier or plan, as well as the current contact information including the name, email address, phone number, and mailing address of the health carrier or plan as provided with the initial payment or notice of denial of payment;

(3) The name and contact information including the legal business name, email address, phone number, and mailing address for any third party representing the provider or facility, and an attestation that the third party has the authority to act on behalf of the party it represents in the state IDR process;

(4) Information sufficient to identify whether the dispute being initiated includes batched or bundled qualified IDR items or services;

(5) Information sufficient to identify the qualified IDR item or service that is the subject of the notice of IDR initiation, including:

a. The date(s) the qualified IDR item or service was furnished;

b. The date(s) that the provider or facility received the initial payment or notice of denial of payment for such item or service from the health carrier or plan;

c. The date the open negotiation period began;

d. The type of item or service (specifically, whether the qualified IDR item or service is an emergency service as defined in 45 CFR §149.110(c)(2)(i) or (ii), a non-emergency service as described in 45 CFR §149.120(b);

e. Whether the service is a professional service or facility-based service;

f. The State where the item or service was furnished;

g. The claim number;

h. The service code; and

i. Information to identify the location the item or service was furnished, including place of service code or bill type code;

(6) The initial payment amount, including $0 if, for example, payment is denied;

(7) The QPA, if provided with the initial payment or notice of denial of payment;

(8) A statement that the items and services do not qualify for the notice and consent exception described at 45 CFR §149.410(b) or §149.420(c) through (i);

(9) A statement that the provider or facility was a nonparticipating provider or nonparticipating emergency facility, on the date the item or service was furnished;

(10) Attestation that the item or service under dispute is a qualified IDR item or service, and the basis for the attestation;

(11) A copy of the initial payment or notice of denial of payment or other remittance advice with respect to the item or service; and

(12) A statement describing the key aspects of the claim, such as patient acuity or level of training of the provider or facility that furnished the qualified IDR item or service, discussed by the parties during open negotiation that relate to the payment for the disputed claim, whether the reasons for initiating the state IDR process are different from the aspects of the claim discussed during the open negotiation period, and an explanation of why the party is initiating the state IDR process, including any of the permissible considerations that serve as the party's basis for initiating the state IDR process.

(c) The IDR initiation form and attachments shall be submitted within 4 business days beginning on the 21st business day after the start of the open negotiation period.

(d) The date of initiation of the state IDR process shall be the date of receipt of the notice of IDR initiation and attachments by the commissioner.

(e) The state IDR process is not available with respect to an item or service if the provider or facility provided notice and received consent under 45 CFR §149.410(b) or 45 CFR§149.420(c) through (i).

(f) Within 3 business days after the date of IDR initiation, a written IDR response form and supporting documentation shall be submitted by the health carrier or plan to the provider or facility and to the commissioner by using the New Hampshire Independent Dispute Resolution Portal which may be found on the Insurance Department website. The applicant shall provide the following on the form:

(1) Information sufficient to identify the provider or facility including the legal business name, email address, phone number, mailing address, and the NPI;

(2) Information sufficient to identify the health carrier or plan, including:

a. The carrier's or plan's registration number under the State IDR Registry;

b. The registration number under the federal IDR Registry under 45 CFR §149.530, if the health carrier or plan is federally registered, or an attestation that the health carrier or plan was not federally registered prior to the date that it submitted the notice;

c. The legal business name of the health carrier or plan, as well as the current contact information, name, email address, phone number, and mailing address, of the health carrier or plan as provided with the initial payment or notice of denial of payment;

d. The plan type, for example, self-insured or fully-insured; and

e. The TIN, or in the case of a plan that does not have a TIN, the TIN of the plan sponsor;

(3) The name and contact information, including the legal business name, email address, phone number, and mailing address for any third party representing the health carrier or plan, and an attestation that the third party has the authority to act on behalf of the party it represents in the state IDR process;

(4) Information sufficient to identify each item or service included in the notice of IDR initiation, including the date(s) the item or service was furnished, the date(s) that the initial payment or notice of denial of payment for such item or service was sent to the provider or facility by the health carrier or plan, and the claim number;

(5) A statement as to whether the health carrier or plan agrees that the initial payment, including $0 if, for example, payment is denied, and the QPA reflected in the notice of IDR initiation is accurate for the item or service that is the subject of the dispute, and if not, the initial payment amount, including $0 if, for example, payment is denied, or the QPA it believes to be correct, and documentation to support the statement, for example, the remittance advice confirming the QPA;

(6) The amount of cost sharing imposed for the item or service, if any;

(7) With respect to each item or service that is the subject of the dispute, either an attestation that the item or service is a qualified IDR item or service, or, for each item or service that the health carrier or plan asserts is not a qualified IDR item or service or is otherwise not eligible for resolution through the state IDR process, an explanation and documentation to support the statement;

(8) A statement confirming that the initial payment or notice of denial of payment or other remittance advice provided to the provider or facility is accurate, and if inaccurate, a copy of the accurate initial payment or notice of denial of payment or other remittance advice with respect to the item or service; and

(9) A statement as to whether any of the information provided in the notice of IDR initiation is inaccurate and the basis for the statement as well as any supporting documentation.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.10 Determination of Eligibility for IDR and Selection of Certified IDR Entity.

(a) Upon receipt of the notice of IDR initiation, the commissioner shall, within 5 business days of receipt of the notice, determine whether the dispute as to fair value of the out-of- network items or services is eligible for resolution through the state IDR process under RSA 420-J, RSA 417-F, RSA 417:4 XV(a)(15) and in accordance with the provisions of this part.

(b) If the dispute is not eligible for resolution under this part, the commissioner shall promptly notify the parties of this determination.

(c) If the dispute is determined to be eligible for resolution under RSA 420-J, RSA 417-F, RSA 417:4 XV(a)(15) and in accordance with the provisions of this part, the commissioner shall:

(1) Immediately notify the parties that the case has been accepted for state IDR review and that the parties shall have 3 business days to negotiate and agree upon a preferred certified IDR entity and notify the commissioner of the joint selection.

(2) Within one business day of receiving this notice of joint selection, the commissioner shall appoint the agreed upon certified IDR entity to the case and convey the case documentation to that entity.

(3) If no certified IDR entity is jointly selected within 3 business days of the commissioner’s notification to the parties that the case has been accepted for review under the state IDR process, the commissioner shall, on the first business day subsequent to the 3 business day period for joint selection, and using a randomized process, select and appoint a certified IDR entity to determine an out-of-network payment amount.

(4) Notify the IDR entity, conveying with the notice the case documentation to that entity, notify the health carrier or plan, and notify the provider or facility of the selection and appointment.

(5) The date of appointment of the certified IDR entity by the commissioner shall be treated as the date of initiation of the certified IDR entity review for purposes of the time periods in this section.

(d) The appointed certified IDR entity shall attest to the commissioner within 3 business days of the date of appointment that it meets the following requirements:

(1) The certified IDR entity does not have a conflict of interest as defined in 45 CFR§149.510(a)(2);

(2) The certified IDR entity will only assign personnel to a dispute and make decisions regarding hiring, compensation, termination, promotion, or other similar matters related to personnel assigned to the dispute in a manner that is not based upon the likelihood that the assigned personnel will support a particular party to the dispute; and

(3) The certified IDR entity will not assign any personnel to a dispute who would have any conflicts of interest, as defined at 45 CFR 149.510(a), regarding any party to the dispute or whose relationship with a party within the 1 year immediately preceding the assignment to the dispute would violate the restrictions on aiding or advising a former employer or principal in a manner similar to the restrictions set forth in 18 U.S.C. 207(b).

(e) If the certified IDR entity notifies the commissioner within 3 business days of the date of appointment of the certified IDR entity that it does not meet the eligibility requirements this section, or if the certified IDR entity does not respond within 3 business days after the date of appointment of the certified IDR entity:

(1) The commissioner shall randomly select another certified IDR entity consistent with the eligibility requirements of this section.

(2) The commissioner shall notify the parties of the new randomly selected certified IDR entity no later than 1 business day after the previously selected certified IDR entity notifies the commissioner that it has a conflict of interest or, if the previously selected certified IDR entity has failed to respond within 3 business days after the date of selection of the certified IDR entity, no later than 1 business day after the end of the 3- business-day period.

(3) The date of notification of the appointment of the new certified IDR entity shall be treated as the date of initiation of the certified IDR entity review for purposes of the time periods in this section.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.11 Request for Additional Information.

(a) The commissioner or the selected certified IDR entity may request additional information from either party to a dispute at any time, including for the purpose of assessing whether a conflict of interest exists, conducting an eligibility determination, or making a payment determination.

(b) Upon request, a party shall submit the additional information within 5 business days to the commissioner or the selected certified IDR entity, as applicable. Following a request for additional information, the time period for the applicable stage of the state IDR process shall be tolled until the earlier of the date either all of the requested information is provided or the 5-business-day period expires, and each subsequent timeframe in the state IDR process shall be determined based on the date of completion of the stage of the state IDR process that was tolled for provision of the requested information.

(c) If a party fails to submit the additional information as required, the related determination, including the eligibility determination, conflict-of-interest review, or payment determination will be made without the requested information unless a good-cause extension of the 5-business-day period, has been provided, and the party subsequently submits the additional information requested within the extended period.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.12 Authority to Continue Negotiations or Withdraw.

(a) If the parties to the state IDR process agree on an out-of-network rate for a qualified IDR item or service after assignment of the case to a certified IDR entity, but before the certified IDR entity has made its payment determination, the amount agreed to by the parties for the qualified IDR item or service shall be treated as the out-of-network rate for the qualified IDR item or service.

(b) To the extent the amount exceeds the initial payment amount and any cost sharing paid or required to be paid by the participant or beneficiary, or there was an initial denial of payment, payment shall be made directly by the health carrier or plan to the nonparticipating provider or facility not later than 30 business days after the agreement is reached.

(c) No party shall seek additional payment from the covered person or beneficiary, including instances in which the out-of-network rate exceeds the qualifying payment amount.

(d) The initiating party shall send a notification of withdrawal to the certified IDR entity and the commissioner as soon as possible, but no later than 3 business days after the date of the agreement. The notification shall include the dispute number, a statement of the out-of-network rate for the qualified IDR item or service, and signatures from authorized signatories for both parties.

(e) The certified IDR entity shall be entitled to retain the full fee that has been paid by the parties for any fair value dispute that has been assigned to the certified IDR entity and the dispute is withdrawn before the certified IDR entity has made its payment determination.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.13 Treatment of Batched Items and Services.

(a) In general, batched items and services may be submitted and considered jointly as part of one payment determination only if the qualified IDR items and services meet the following requirements:

(1) The qualified IDR items and services are billed by the same provider or group of providers or the same facility. Items and services are billed by the same provider or group of providers or the same facility, if the items or services are billed with the same NPI or TIN;

(2) Payment for the qualified IDR items and services is required to be made by the same health carrier or plan.

a. For group or individual health insurance coverage, this requirement is satisfied if the same health carrier or plan is required to make payment for the qualified IDR items and services, even if the qualified IDR items and services relate to claims from different group health plans or individual market policies;

b. For self-insured group health plans that have opted into the state IDR process, this requirement is satisfied if the same self-insured group health plan is required to make payment for the qualified IDR items and services, including when the plan makes payments through a third party administrator; and

c. The requirement is not satisfied if multiple self-insured group health plans are required to make payments for the qualified IDR items and services, even if those group health plans make payments through the same third party administrator;

(3) The qualified IDR items and services meet any of the following criteria under which multiple qualified IDR items and services relate to the treatment of a similar condition and therefore are permitted to be considered jointly as a single payment determination for purposes of encouraging efficiencies, including minimizing costs, in the state IDR process:

a. The qualified IDR items or services were furnished to a single patient during the same patient encounter. For purposes of this section, a “single patient encounter” means a patient encounter on one or more consecutive days during which the qualified IDR items or services were furnished to the same patient and billed on the same claim form;

b. The qualified IDR items and services were furnished to one or more patients and were billed under the same service code or a comparable code under a different procedural coding system, such as Current Procedural Terminology (CPT) codes with modifiers, if applicable, Healthcare Common Procedure Coding System (HCPCS) codes with modifiers, if applicable, or Diagnosis-Related Group (DRG) codes with modifiers, if applicable;

c. For anesthesiology, radiology, pathology, and laboratory qualified IDR items and services, the qualified IDR items and services were furnished to one or more patients and were billed under service codes belonging to the same Category I CPT code range, as specified in guidance published by the federal secretary of Health and Human Services; or

d. All the qualified IDR items and services were furnished within the same 30-business-day period.

(b) A certified IDR entity may consider up to 25 qualified IDR items and services jointly as batched items and services subject to a single fee. Batched items and services submitted and considered jointly shall be treated as a batched determination and subject to the fee schedule for batched determinations under this section. The fee for batched determinations may consist of a fixed batched fee for a batch of up to 25 line items and a fixed tiered fee for every additional 25 line items within a batched dispute beginning with the 26th line item.

(c) In the case of qualified IDR items and services billed by a provider or facility as part of a bundled payment arrangement relating to a single episode of care, or where a health carrier or plan makes or denies an initial payment as a bundled payment, the qualified IDR items and services may be submitted as part of one payment determination. Bundled payment arrangements submitted under this paragraph shall be subject to the rules for batched determinations and the certified IDR entity fee for single, batched determinations.

(d) Within 5 business days of the date of appointment, the appointed certified IDR entity shall review the information submitted in the notice of IDR initiation to determine whether qualified IDR items and services may properly be considered jointly as part of one payment determination as batched items and services or whether these items and services have been improperly batched under this section.

(e) If the certified IDR entity determines that items and services have been improperly batched, the entity shall notify the parties within the 5 business day review period, and the provider or facility shall have 5 business days to resubmit amended notice(s) of IDR initiation to the commissioner.

(f) The date of submission of the amended notice of IDR initiation to the commissioner shall be treated as the new IDR initiation date for purposes of the time periods in this part except that, upon determination by the commissioner that the amended notice of IDR initiation is eligible for resolution through the state IDR process under RSA 420-J, RSA 417-F, RSA 417:4 XV(a)(15) and in accordance with the provisions of this part, the commissioner shall immediately reassign the case to the IDR entity originally selected.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.14 Submission of Offers.

(a) The health carrier or plan and the provider or facility shall submit to the certified IDR entity their offers using the standard form developed by the commissioner no later than 10 business days after the date of appointment of the certified IDR entity.

(b) For providers and facilities, the offer shall include the following information:

(1) An offer of an out-of-network rate expressed as both a dollar amount and the corresponding percentage of the QPA represented by that dollar amount;

(2) Information on the size of the provider's practice or facility. Specifically, a provider shall specify whether the providers' practice has fewer than 20 employees, 20 to 50 employees, 51 to 100 employees, 101 to 500 employees, or more than 500 employees. For facilities, the facility shall specify whether the facility has 50 or fewer employees, 51 to 100 employees, 101 to 500 employees, or more than 500 employees;

(3) Information on the practice specialty or type;

(4) Any information relating to the offer that was submitted by either party, except that the information shall not include information on factors described in Ins 2706.15(d); and

(5) Information requested by the certified IDR entity relating to the offer.

(1) An offer of an out-of-network rate expressed as both a dollar amount and the corresponding percentage of the QPA represented by that dollar amount;

(2) Information on the coverage area of the health carrier or plan, the relevant geographic region for purposes of the QPA, whether the coverage is fully-insured or partially or fully self-insured;

(3) The QPA for the applicable year for the same or similar item or service as the qualified IDR item or service;

(4) Any information relating to the offer that was submitted by either party, except that the information shall not include information on factors described in Ins 2706.15(d); and

(5) Information requested by the certified IDR entity relating to the offer.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.15 Payment Determination for a Qualified IDR Item or Service.

(a) The certified IDR entity shall select the offer that the certified IDR entity determines best represents the fair value of the qualified IDR item or service as the out-of-network rate no later than 30 business days after the date of appointment of the certified IDR entity.

(b) In determining which offer to select, the certified IDR entity shall consider the qualifying payment amount(s) for the applicable year for the same or similar item or service. The certified IDR entity shall then consider information submitted by a party that relates to the following circumstances:

(1) The level of training, experience, and quality and outcomes measurements of the provider or facility that furnished the qualified IDR item or service, such as those endorsed by the consensus-based entity authorized in section 1890 of the Social Security Act;

(2) The market share held by the provider or facility or that of the health carrier or plan in the geographic region in which the qualified IDR item or service was provided;

(3) The acuity of the covered person or beneficiary receiving the qualified IDR item or service, or the complexity of furnishing the qualified IDR item or service to the covered person or beneficiary;

(4) The teaching status, case mix, and scope of services of the facility that furnished the qualified IDR item or service, if applicable;

(5) Demonstration of good faith efforts, or lack thereof, made by the provider or facility or the health carrier or plan to enter into network agreements with each other, and, if applicable, contracted rates between the provider or facility, as applicable, and the health carrier or plan, as applicable, during the previous 4 plan years;

(6) Information provided by a party in response to a request by the certified IDR entity; and

(7) Additional information submitted by a party that relates to the offer for the payment amount for the qualified IDR item or service that is the subject of the payment determination and that does not include information on factors described in paragraph (d) below.

(c) In weighing the considerations described in paragraph (b) above, the certified IDR entity shall evaluate whether the information is credible and relates to the offer submitted by either party for the payment amount for the qualified IDR item or service that is the subject of the payment determination. The certified IDR entity shall not give weight to information to the extent it is not credible, it does not relate to either party’s offer for the payment amount for the qualified IDR item or service, or it is already accounted for by the QPA under paragraph (b) above.

(d) In determining which offer to select, the certified IDR entity shall not consider:

(1) Usual and customary charges, including payment or reimbursement rates expressed as a proportion of usual and customary charges;

(2) The amount that would have been billed by the provider or facility with respect to the qualified IDR item or service had the provisions of RSA 358-T, 45 CFR149.410 and 149.420, as applicable, not applied; or

(3) The payment or reimbursement rate for items and services furnished by the provider or facility payable by a public payor, including:

a. Under the Medicare program under title XVIII of the Social Security Act;

b. The Medicaid program under title XIX of the Social Security Act;

c. The Children's Health Insurance Program under title XXI of the Social Security Act;

d. The TRICARE program under chapter 55 of title 10, United States Code;

e. Chapter 17 of title 38, United States Code; or

f. Demonstration projects under section 1115 of the Social Security Act.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.16 Written Decision.

(a) The certified IDR entity shall explain its determination in a written decision submitted to the parties and the commissioner.

(b) The written decision shall include an explanation of the determination, and shall include the following:

(1) Information the certified IDR entity determined demonstrated that the offer selected as the out-of-network rate is the offer that best represents the fair value of the qualified IDR item or service;

(2) The weight given to the qualifying payment amount and any additional credible information under Ins 2706.15 (b) (1)-(7);

(3) Whether the certified IDR entity relied on information described Ins 2706.15 (b)(1)-(7) above in selecting an offer; and

(4) If applicable, why the certified IDR entity concluded that the information described Ins 2706.15 (b)(1)-(7) was not already reflected in the qualifying payment amount.

(c) A determination made by a certified IDR entity is binding upon the parties, in the absence of fraud or evidence of intentional misrepresentation of material facts presented to the certified IDR entity regarding the claim.

(d) The decision shall be enforceable against the health carrier by the commissioner pursuant to the penalty provisions of RSA 420-J:14 and under the enforcement provisions of RSA 417.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.17 Payment.

(a) If the offer selected by the certified IDR entity is more than the sum of the initial payment, including any cost sharing paid or owed by the participant or beneficiary, the health carrier shall pay any additional amount due to the provider or facility not later than 30 calendar days after the determination by the certified IDR entity.

(b) If the offer selected by the certified IDR entity is less than the sum of the initial payment and any cost sharing paid by the participant or beneficiary, the provider or facility shall be liable to the health carrier or plan for the difference. The provider or facility shall pay the difference directly to the health carrier or plan not later than 30 calendar days after the determination by the certified IDR entity.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.18 Recordkeeping Requirements. The certified IDR entity shall maintain records of all claims and notices associated with the federal IDR process with respect to any determination for 6 years. The certified IDR entity shall make these records available for examination by the health carrier, plan, provider, or facility, or a state or federal oversight agency upon request, except to the extent the disclosure would violate either state or federal privacy law.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.19 Extension of Time Periods for Extenuating Circumstances.

(a) The time periods specified in this section, other than the time period for payment of the IDR entity fee and for payment by the health carrier or plan to the provider or facility, may be extended in extenuating circumstances at the commissioner's discretion if:

(1) With respect to a specific dispute, the commissioner determines that the parties or certified IDR entity cannot meet applicable timeframes due to matters beyond the control of one or both parties or the certified IDR entity, or for other good cause; or

(2) The commissioner determines that the parties or certified IDR entity cannot meet applicable timeframes due to systematic delays in processing disputes under the state IDR process, such as an unforeseen volume of disputes or state IDR system failures. Extensions provided due to systematic delays in processing disputes will be applied to the state IDR process timeframe(s) determined relevant by the commissioner. The commissioner shall post a public notice regarding any extensions of time periods pursuant to this paragraph.

(b) The certified IDR entity or either party may also submit a request for an extension due to extenuating circumstances to the commissioner. The requesting certified IDR entity or party shall attest that it will take prompt action to ensure that the certified IDR entity's payment determination under this section may be made as soon as administratively practicable under the circumstances.

(c) When an extension to a timeframe is granted, the time period for all applicable stages of the state IDR process shall be tolled until the extension period expires.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.20 Costs of the IDR Process.

(a) There shall be no administrative fee charged by the commissioner for the department’s administration of the state IDR process.

(1) If the state certified IDR entity is also federally certified, then the fees charged by the certified IDR entity shall be the same as the published fees that the entity currently charges under the federal IDR process as provided for in 45 CFR§149.510(e)(2)(vii) and (viii) for all single determinations, all batched determinations, and all tiered fees for every additional 25 line items within a batched dispute beginning with the 26th line item; and

(2) If the state certified IDR entity is not also a federally certified IDR entity, then the entity shall submit a proposed fee structure to the commissioner and the commissioner shall set a rate within the federal certified IDR entity fee ranges established under 45 CFR §149.510(e)(2)(vii) and (viii).

(b) Each party to an IDR process under this section shall submit to the selected IDR entity, together with its submission of an offer of an out-of-network rate, one half of the certified IDR entity’s fee.

(c) If any party does not timely submit its half of the certified IDR entity's fee, then the certified IDR entity shall promptly notify that party that, if the fee is not paid within 5 business days of the date of the notice, the IDR entity will, without further consideration, select the offer of the party that has paid its half of the fee as the out-of-network rate and notify the parties of its determination.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.21 Certification of IDR Entities Under the State IDR Process. The commissioner shall certify any IDR entity for purposes of the state IDR process that demonstrates that it is certified as an IDR entity under the federal IDR process set out in 42 U.S.C. §300gg-111(c)(4) and as provided in 45 CFR §149.510 (e) or demonstrates to the satisfaction of the commissioner that it meets the requirements of 45 CFR §149.510 (e).

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.22 Revocation of Certification of a Certified IDR Entity. The commissioner shall revoke the certification of a certified IDR entity if, as a result of an audit or otherwise, the commissioner determines the following:

(a) The certified IDR entity has a pattern or practice of noncompliance with any requirements of this section;

(b) The certified IDR entity is operating in a manner that hinders the efficient and effective administration of the state IDR process;

(d) The certified IDR entity has committed or participated in fraudulent or abusive activities, including submission of false or fraudulent data to commissioner;

(e) The certified IDR entity lacks the financial viability to provide arbitration under the state IDR process;

(f) The certified IDR entity has failed to comply with requests from the commissioner made as part of an audit, including failing to submit all records of the certified IDR entity that pertain to its activities within the state IDR process; or

(g) The certified IDR entity is otherwise no longer fit or qualified to make determinations.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.23 Reporting of Information Relating to the State IDR Process. Within 90 business days of the end of the calendar year, each certified IDR entity shall submit an annual report to the commissioner in a format as specified by the commissioner. The report shall include, but is not limited to, the following:

(a) The number of IDR cases appointed to the certified IDR entity by the commissioner during the preceding calendar year;

(b) The number of such cases where the case was withdrawn after being assigned to the IDR entity;

(c) The number of times during the year that the out-of-network rate determined, or agreed to, under this section has exceeded the QPA;

(d) With respect to each notice of IDR initiation for which such a determination was made, the following information:

(1) A description of the qualified IDR items and services included with respect to the notification, including the relevant billing and service codes and number of batched claims, if applicable;

(2) The amount of the offer submitted by the health carrier or plan and by the provider or facility expressed as a dollar amount and as a percentage of the QPA;

(3) Whether the offer selected by the certified IDR entity was the offer submitted by the health carrier or plan or by the provider or facility;

(4) The amount of the selected offer expressed as a dollar amount and as a percentage of the QPA;

(5) The practice specialty or type of each provider or facility, respectively, involved in furnishing each qualified IDR item or service;

(6) The number of business days elapsed between selection of the certified IDR entity and the determination of the out-of-network rate by the certified IDR entity; and

(7) The total amount of certified IDR entity fees paid to the certified IDR entity during the preceding calendar year.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.24 State IDR Registry of Health Carriers and Opting In Self-Funded Plans.

(a) The commissioner shall establish a state IDR registry consisting of the information described in paragraph below and shall assign a registration number for each health carrier or opting in self-funded plan. The information contained in the registry shall be made available to providers or facilities seeking to initiate an open negotiation or a fair value dispute through the state IDR process by posting the information on the department’s website.

(b) Each health carrier or opting in self-funded plan offering group or individual health insurance coverage subject to the state IDR process shall register with the state IDR registry. Initial registration shall be completed by the later of the date that is 30 business days after the 2026 effective date of the chapter or the date the health carrier or opting in self-funded plan begins offering a group health plan or individual health insurance coverage subject to the state IDR process.

(c) Health carriers or opting in self-funded plans offering group or individual health insurance coverage subject to the registration requirement shall include the following information with their registration:

(1) The legal business name, if any, of the health carrier or opting in self-funded plan and, if applicable, the legal business name of the group health plan sponsor;

(2) Whether the plan or coverage is a fully-insured group health plan, an opting in self-insured group health plan, individual health insurance coverage, or an FEHB plan that has adopted RSA 358-T as a specified state law;

(3) Contact information, including a telephone number and email address, for the appropriate person or office to initiate open negotiations for purposes of determining an amount of payment, including cost sharing, for such item or service;

(4) The 14-digit health insurance oversight system (HIOS) identifier, or if the 14-digit HIOS identifier has not been assigned, the 5-digit HIOS identifier, or if no HIOS identifier is available, the plan's or the plan sponsor's employer identification number (EIN) and the plan's plan number (PN), if a PN is available, or for FEHB carriers, the applicable contract number(s) and plan code(s); and

(5) Additional information needed to identify the health carrier or plan and the applicable federal and state requirements for determining appropriate out-of-network payment rates for items or services to which the protections against balance billing in RSA 358-T apply.

(d) A health carrier or opting in plan must timely report to the commissioner changes to the information required under this section within 30 business days after the information changes. A health carrier or opting in plan must confirm the accuracy of its registration annually in the fourth quarter of each calendar year.

(e) The requirements of paragraphs (c) (1) through (3) above may be performed by a third party administrator or service provider with authority to act on behalf of the health carrier or opting in plan offering group or individual health insurance coverage subject to the state IDR process. If the registration requirements are performed by such third party administrator or service provider, the health carrier or opting in plan offering group or individual health insurance coverage shall require that such third party administrator or service provider clearly delineate each health carrier or opting in plan offering group or individual health insurance coverage for which it has authority to act. If such third party administrator or service provider fails to provide the information in compliance with the requirements of paragraphs (c)(1) through (3) above, the plan or issuer shall be in violation of the requirements of this section.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.25 Option for Self-Funded Plans to Opt Into the State IDR Process. Self-funded group plans, government plans, and church plans not otherwise subject to this part shall have the opportunity to opt into the state IDR process and be subject to the provisions of this part. Plans wishing to opt in under this provision shall complete an opt in form and shall register under Ins 2706.24. Plans that have opted in under this provision may subsequently opt out by completing an opt out form.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

Ins 2706.26 Waiver of Rules.

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

(e) The commissioner shall report publicly any waiver granted on the department’s website at https://www.insurance.nh.gov.

Source. #14559, eff 4-22-26, EXPIRES: 4-22-36

APPENDIX

Rule	Specific State Statute the Rule Implements

Ins 2701.01	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.02	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.03	RSA 400-A:15, I; RSA 420-J:3; RSA 420-J:7, II
Ins 2701.04	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12; 45 CFR 156.230
Ins 2701.05	RSA 400-A:15, I; RSA 420-J:7, II(b); 45 CFR 156.235
Ins 2701.06	RSA 400-A:15, I; RSA 420-J:7, II(c)
Ins 2701.07	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.08	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.09	RSA 400-A:15, I; RSA 420-J:7, II(a)
Ins 2701.10	RSA 400-A:15, I; RSA 420-J:7, II(b); RSA 420-J:12
Ins 2701.11	RSA 400-A:15, I; RSA 420-J:7 III and IV; RSA 420-J:12
Ins 2701.12	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.13	RSA 400-A:15, I; RSA 420-J:7, II; RSA 420-J:12
Ins 2701.14	RSA 400-A:15, I; RSA 541-A:22, IV

Ins 2702.01	RSA 400-A:15, I; RSA 415:18-a, VIII; 29 USC 1185a (HR 1424-117)
Ins 2702.02	RSA 400-A:15, I; RSA 415:18-a, VIII; 29 USC 1185a (HR 1424-117)
Ins 2702.03	RSA 400-A:15, I; RSA 415:18-a, VIII; 29 USC 1185a (HR 1424-117)
Ins 2702.04	RSA 400-A:15, I; RSA 415:18-a, VIII; 29 USC 1185a (HR 1424-117)
Ins 2702.05	RSA 400-A:15, I; RSA 415:18-a, VIII; RSA 541-A:22, IV

Ins 2703.01	RSA 420-J:3; RSA 420-J:5-a through 5-e
Ins 2703.02	RSA 420-J:1; RSA 420-J:2; RSA 420-J:3, VIII
Ins 2703.03	RSA 420-J:5-a
Ins 2703.04	RSA 420-J:5
Ins 2703.05	RSA 420-J:5-b
Ins 2703.06	RSA 420-J:5-c
Ins 2703.07	RSA 420-J:5-d
Ins 2703.08	RSA 420-J:5-e
Ins 2703.09	RSA 420-J:5-e
Ins 2703.10	RSA 400-A:15, I; RSA 541-A:22, IV

Ins 2704.01	RSA 400-A:15, I; RSA 415:26; RSA 402-N:2; RSA 420-J:7-b, X; RSA 420-J:12
Ins 2704.02	RSA 318:1, XI; RSA 318:2; RSA 400-A:15, I; RSA 402-N:1; RSA 415:26; RSA 420-G:2, IX; RSA 420-J:3, XIX; RSA 420-J:7-b, X; RSA 420-J:12
Ins 2704.03	RSA 400-A:15, I; RSA 402-N:2
Ins 2704.04	RSA 400-A:15, I; RSA 402-N:2; RSA 402-N:6
Ins 2704.05	RSA 400-A:15, I; RSA 402-N:4; RSA 415:26; RSA 420-J:7-b, X; RSA 420-J:8-a, IV; RSA 420-J:12
Ins 2704.06	RSA 400-A:15, I; RSA 400-A:16; RSA 402-N:5RSA 415:26; RSA 420-J:7-b, X; RSA 420-J:12
Ins 2704.07	RSA 400-A:15, I; RSA 400-A:16; RSA 400-A:17-24; RSA 402-N:2; RSA 415:26; RSA 417; RSA 420-J:7-b, X; RSA 420-J:12; RSA 420-J:14
Ins 2704.08	RSA 400-A:15, I; RSA 402-N:5, II; RSA 415:26; RSA 420:J:7-b, X; RSA 420-J:12
Ins 2704.09	RSA 400-A:15, I; RSA 400-A:16, III; RSA 402-N:6, II; RSA 420-J:10-12
Ins 2704.10	RSA 400-A:15, I; RSA 400-A:37; RSA 402-N:2; RSA 402-N:7
Ins 2704.11	RSA 400-A:15, I; RSA 400-A:16, II; RSA 402-N:2
Ins 2704.12	RSA 400-A:15, I; RSA 541-A:22, IV

Ins 2705.01	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c (c)

Ins 2705.02	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c (c)
Ins 2705.03	RSA 400-A:15, I; 420-A:1; 420-B:1; 420-C:2; 420-E:4-a, II and III; 420-G:2; 420-J:7-b, IV-c (b) and (c)
Ins 2705.04	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c (c)
Ins 2705.05	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c
Ins 2705.06	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c ; Pub. L. 104-191, Stat. 1936
Ins 2705.07	RSA 400-A:15, I; 420-E:4-a, III; 420-J:7-b, IV-c
Ins 2705.08	RSA 400-A:15, I
Ins 2705.09	RSA 400-A:15, I

Ins 2706.01	RSA 420-J; RSA 417-F; RSA 417:4 XV(a)(15); RSA 400-A:15; RSA 358-T:4
Ins 2706.02	RSA 420-J; RSA 417-F; RSA 417:4 XV(a)(15); RSA 400-A:15
Ins 2706.03	RSA 358-T:1; RSA 420-J:3; RSA 420-J:12; RSA 400-A:15
Ins 2706.04	RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.05	RSA 420-J:8-e; RSA 420-J:8-g; RSA 420-J:8-h; RSA 420-J:12; RSA 400-A:15
Ins 2706.06	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:8-g; RSA 420-J:8-h; RSA 420-J:12; RSA 400-A:15
Ins 2706.07	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:8-g; RSA 420-J:8-h; RSA 420-J:12; RSA 400-A:15
Ins 2706.08	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.09	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.10	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.11	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.12	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.13	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.14	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.15	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.16	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.17	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.18	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.19	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.20	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.21	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.22	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.23	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.24	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.25	RSA 420-J:3; RSA 420-J:8-e; RSA 420-J:12; RSA 400-A:15
Ins 2706.26	RSA 400-A:15, I; RSA 541-A:22, IV