State Law

New Hampshire Admin. Code-Chapter Ins 2700-Part Ins 2701. Health and Dental Benefit Plan Network Adequacy

08/15/2023 New Hampshire Section 2701.05

Reasonable Access to Health Care Services

Network Adequacy

(a) To constitute reasonable access to health care services, a provider network shall supply access consistent with the geographic accessibility standards in Ins 2701.06 to the services listed in Ins 2701.07.

(b) To be deemed adequate for each of the listed services, the network shall include, within the applicable geographic area, a sufficient number of providers for which the service in question is within their scope of practice. In addition to physicians, providers may include nurse practitioners, osteopaths, social workers, psychologists, naturopaths, midwives, physician assistants, clinical nurse specialists, dentists, dental hygienists, or any provider trained and appropriately licensed and, when required, adequately supervised by a physician in compliance with New Hampshire laws and rules.

(c) To constitute reasonable access to health services, the network shall include providers whose services are integral to care in a hospital, ambulatory surgery center, or similar facility, specifically those services provided by anesthesiologists, pathologists, emergency physicians, and radiologists. When a carrier is unable to assure that an in-network provider of those services is always accessible at an in-network facility, the carrier shall assure that any necessary out-of-network services are provided with no additional cost share to the member, beyond member responsibility were those services provided by an in-network provider.

(d) Access to medically necessary health care services through the use of telemedicine or telehealth may be used to satisfy the network adequacy geographic access requirements when an acceptable standard of care can be met by the provider offering the service.