Relative to health carrier credentialing requirements.
Summary
HB 275 would amend New Hampshire’s managed care law to address who pays for extra credentialing requirements imposed by health carriers. Under current law, a health carrier may use its own credentialing standards and may choose not to contract with a provider even if the provider meets those standards. This bill would preserve that discretion, but add that if a carrier requires a provider to complete any additional program or certification as part of credentialing or provider eligibility, the carrier must bear the cost of that requirement.
In practical terms, the bill shifts financial responsibility for carrier-mandated credentialing add-ons away from health care professionals and onto insurers or managed care organizations. The fiscal note suggests the bill could lead to indeterminable increases in revenue and costs over time, likely through higher insurance premiums and corresponding increases in insurance premium tax revenue, while state direct expenditures remain at zero. Counties and municipalities that purchase health insurance could also face higher premium costs.
Impact
The bill would amend RSA 420-J:4, VI, the section governing managed care credentialing verification procedures, by adding a cost-allocation rule for additional programs or certifications required by a health carrier. It does not require carriers to credential every provider who meets minimum standards, but it would make carriers responsible for paying for any extra certification or program they require as part of their provider selection process. The main affected parties are health carriers, health care professionals seeking credentialing, and public or private purchasers of health insurance who could experience premium effects.
Sentiment
The available materials suggest the bill is generally framed as a provider-cost relief measure, with the policy goal of preventing health carriers from shifting the expense of mandatory credentialing requirements onto clinicians. There is no recorded vote or committee transcript in the provided materials, so there is no documented floor debate or formal opposition in the record here. The fiscal note, however, reflects a cautious administrative view that the bill could increase insurance costs and premiums, which may temper support among insurers and public purchasers.
Contention
The main point of contention is the bill’s undefined phrase “any additional program or certification,” which the Insurance Department says is not clearly defined and could create uncertainty in implementation. Supporters are likely to view the bill as a fairness measure that stops carriers from imposing unfunded credentialing burdens on providers, while insurers may object that it could force them to absorb costs for certifications they require to manage network quality and risk. Another concern raised in the fiscal note is that those added costs could be passed through in the form of higher premiums, affecting employers, public entities, and other premium payers.
Removing fees and charges for governmental records under the right-to-know law and reinstating potential liability for disclosure of information exempt from disclosure.