N.H. Admin. Code § Ins 2701.11

Current through Register No. 45, November 7, 2024

Section 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.

N.H. Admin. Code § Ins 2701.11

Derived From Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12565, Effective 8/1/2018, Expires 8/1/2028.