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The New Hampshire SBL

The New Hampshire SBL became effective July 1, 2018. New Hampshire Revised Statutes Annotated Title XXX 329:31-b(III). The relevant provisions of the New Hampshire law are:

  • Reimbursement is to be at a “commercially reasonable value.”
  • Parties must use best efforts to resolve the dispute prior to arbitration, but no required timeline is stated.
  • Good payment proofs can be considered in the arbitration process.

 

According to CMS,

New Hampshire does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with the New Hampshire Department of Insurance staff, CMS understands that NH RSA Title XXX 329:31-b(III) is a specified state law that will apply for purposes of determining the out-of-network rate with respect to anesthesiology, radiology, emergency medicine, or pathology services furnished to individuals in a managed care plan in New Hampshire by a health care provider in a hospital or ambulatory surgical center that is in-network. 1 The federal independent dispute resolution process under section 2799A-1(c) of the PHS Act and 45 CFR 149.510 will apply for purposes of determining the out-of-network rate with respect to any items and services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in New Hampshire by nonparticipating providers and nonparticipating emergency facilities to which NH RSA Title XXX 329:31-b(III) does not apply. The federal independent dispute resolution process under section 2799A-2(b) of the PHS Act and 45 CFR 149.520 will apply for purposes of determining the out-of-network rate with respect to services furnished to individuals in an insured group health plan, or group or individual health insurance coverage in New Hampshire by nonparticipating providers of air ambulance services. CMS will enforce the outcome of the federal independent dispute resolution process for such cases in New Hampshire.

Letter from CMS to Governor of New Hampshire, dated December 22, 2021.

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