- Associated Press - Tuesday, December 9, 2014

CONCORD, N.H. (AP) - Revisions to New Hampshire’s rules for health care provider networks are going to take longer than state officials initially expected.

They thought updates could be in place for 2016, but health policy analyst Tyler Brannen said at a meeting Tuesday that 2017 is now the target date.

“We realize it’s a fairly lengthy timeline, but this is a significant change from what’s taken place in the past, so we want to do it right,” he said.

The state’s network adequacy standards have been in the spotlight since the Insurance Department approved Anthem Blue Cross and Blue Shield’s narrow network for individual health plans sold through the federal Affordable Care Act.

Concerns have eased since four more companies began selling plans, and each hospital is included in at least three provider networks, but officials say the rules are ripe for revision given how much health care has changed since the rules were enacted in 2001.

The department put together a working group this spring to explore developing new rules.

Under the developing framework, the requirements would focus on making sure consumers have adequate access to different types of services rather than providers. That shift better reflects changes in health care delivery, Brannen said. For example, nurse practitioners, besides doctors, also provide primary care.

Consumers would be guaranteed adequate access to “core services” such as primary care, pediatrics, urgent care, mental health care and substance abuse treatment within their community, though what constitutes a community has yet to be determined.

“Common services” such as radiation oncology, vision care and rehabilitation would be available within “moderate proximity,” while services such as heart surgery would be available within the state or near the border. The most specialized services, such as transplants, would be available within New England.

The standards also will recognize advances in telemedicine by allowing some services to be provided remotely, Brannen said. For example, some people might prefer to get mental health counseling or substance abuse treatment from home.


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