RSA 420-J:7 · Network Adequacy

420-J:7 Network Adequacy. –
I. A health carrier shall maintain a network that is sufficient in numbers, types, and geographic location of providers to ensure that all services to covered persons will be accessible without unreasonable delay.
II. The commissioner shall adopt rules under RSA 541-A for a health carrier's network adequacy. Such rules shall establish, but not be limited to:
(a) Waiting times for appointments for non-emergency care.
(b) Choice of and access to providers for specialty care, specifically addressing the needs of the chronically ill, mentally ill, persons with substance use disorder, developmentally disabled or those with a life threatening illness.
(c) Standards for geographic accessibility, which shall include standards for access to the provision of durable medical equipment requiring a prescription. However, such standards shall not restrict an insurer's ability to provide prescriptions for durable medical equipment that are shipped to the patient by postal service or other common or private carrier, and shall not apply to durable medical equipment devices used exclusively for the administration of medication.
(d) Hours of operation for the carrier, including any entities performing prior approval or pre-authorization functions.
(e) Standards for addressing in-network access to hospital based providers, such as anesthesiologists, radiologists, pathologists, and emergency medicine physicians.
III. The health carrier shall keep, at its place of business, a detailed description of the health carrier's compliance with rules adopted pursuant to RSA 420-J:7, II as well as its procedures for monitoring network adequacy.
IV. Annually, the health carrier shall submit a report to the commissioner demonstrating compliance with the rules for network adequacy.
V. The commissioner shall make available to the public information regarding each health carrier's managed care network.
Source. 1997, 345:1. 2008, 311:1, eff. Aug. 31, 2008. 2017, 214:1, eff. Jan. 1, 2018. 2018, 356:3, 4, eff. July 1, 2018. 2025, 191:21, eff. Sept. 13, 2025.