Relative to licensing requirements for health care facilities that operate on a membership-based business model.
Summary
HB 548 would create a special regulatory framework for health care facilities that operate on a membership-based or direct-pay model. It exempts those facilities from the existing moratorium on new licenses and increased bed capacity for certain nursing homes, skilled nursing facilities, intermediate care facilities, and rehabilitation facilities. It also removes these facilities from some of the current licensing policies that require providers to serve patients regardless of payment source and to maintain assistance plans for uninsured or financially distressed patients.
The bill further establishes a new patients’ bill of rights for direct-pay and membership-based facilities. Those rights largely mirror standard patient protections in state law, including dignity, informed consent, privacy, access to records, freedom from abuse and restraints, communication with family, and nondiscrimination. The bill also directs the Department of Health and Human Services to study the impact of direct-pay models on New Hampshire’s health care system, with particular attention to the state’s direct primary care law.
Impact
HB 548 would amend RSA 151 to carve out direct-pay and membership-based facilities from portions of the state’s health facility licensing and patient-rights framework. In practical terms, it would allow certain facilities to avoid the licensing moratorium and some of the service-access requirements that apply to other licensed facilities, while still subjecting them to a tailored patient-rights section. The bill would also require DHHS to complete a study and report findings to legislative leaders by June 30, 2026. The fiscal note says the bill could have indeterminable impacts on licensing-fee revenue and state expenditures, depending on how many facilities seek licensure and what resources the study requires.
Sentiment
The available vote history suggests the bill was controversial but had meaningful support: on March 27, 2025, it advanced on an OTPA vote by 200-157. That margin indicates a divided chamber rather than broad consensus. No committee transcript was provided, so the discussion record does not show detailed arguments, but the vote pattern suggests legislators were split between supporting expanded flexibility for direct-pay care models and concerns about weakening existing licensing and access protections.
Contention
The main point of contention is whether direct-pay and membership-based facilities should be exempt from rules designed to ensure broad access to care and to limit growth in certain facility types. Supporters are likely to view the bill as encouraging innovation, consumer choice, and alternative payment models, while opponents may worry that exempting these facilities from nondiscrimination-by-payment rules and the licensing moratorium could reduce protections for vulnerable patients or shift costs and access burdens elsewhere in the system. The study requirement reflects unresolved questions about the broader effects of direct primary care and other direct-pay models on the state health care market.