New Hampshire Administrative Code

To avoid unnecessary cumulative evidence in any proceeding, the hearing officer may limit the number of witnesses or the time for testimony upon a particular issue in the course of any hearing. Notes N.H. Admin. Code § Ins 206.16 Derived from Volume XL Number 33, Filed August 13,…

(a) Settlements between the parties shall be encouraged in accordance with RSA 541-A:38. Notes N.H. Admin. Code § Ins 207.01 #9052-B, eff 1-2-08; ss by #9650-B, eff 2-5-10 Amended by Volume XL Number 33, Filed August 13, 2020, Proposed by #13073-A, Effective 7/27/2020.

(a) Any licensee may voluntarily surrender his or her license by returning it to the department, accompanied by a signed letter stating that the licensee intends to surrender his or her license. (b) A licensee who reapplies for licensure in New Hampshire after a voluntary surrend…

(a) At any time prior to the issuance of the decision on the merits, the hearing officer, on the hearing officer's own motion or on the motion of any party, shall reopen the record to receive relevant, material, and non-duplicative testimony, evidence, arguments, or exhibits not …

(a) If, pursuant to Ins 203.01(c), the commissioner has appointed a natural person other than the deputy commissioner to preside at a hearing as hearing officer, the following procedures shall apply: (1) The hearing officer shall submit to the commissioner, within 35 days after t…

Within 30 days of any final order, the commissioner, based upon the existing record, may reconsider, revise, or reverse any final action on the commissioner's own motion. If reconsideration is based upon the existing record, prior notice shall not be given to the parties. If the …

(a) A motion for reconsideration shall be filed within 30 days of the final decision. (b) A motion for reconsideration shall: (1) Identify each error of fact, error of reasoning, or error of law which the moving party wishes to have reconsidered; (2) Describe how each error cause…

(a) A stay of department action shall be specifically requested. The mere filing of a motion for reconsideration shall not operate as a stay of any order, but a motion for stay may be combined with a motion for reconsideration. (b) If the commissioner, acting on the commissioner'…

The department shall keep a decision or order on file in its records for at least 6 years following the date of the final decision or the date of the decision on any appeal, unless the director of the division of records management and archives of the department of state sets a d…

(a) Ins 208 contains requirements for proceedings before the department under RSA 420-J:8-e to determine whether a fee charged for health care services submitted to an insurance carrier for payment represents a commercially reasonable value, based on payments for similar services…

(a) In the event of a dispute between a health care provider and an insurance carrier relative to the reasonable value of a service under RSA 329:31-b, either the provider or the insurance carrier may petition for a hearing under RSA 400-A:17 and Ins 208. (b) The petitioner shall…

(a) Within 10 days of the filing of the petition for a hearing, the responding party shall file a response to the petition. (b) The respondent shall file an original and 2 copies of the response, and the response shall set forth the following information: (1) The rate the respond…

An order scheduling a prehearing conference shall be issued within 10 days of the filing of the response to the petition. Notes N.H. Admin. Code § Ins 208.04 Derived from Volume XL Number 33, Filed August 13, 2020, Proposed by #13073-A, Effective 7/27/2020.

(a) At least 7 days before the prehearing conference, all parties shall file with the hearing clerk and serve on the other parties prehearing statements. (b) Prehearing statements shall include, by numbered paragraphs, a detailed, comprehensive, and good faith statement, setting …

(a) At any time prior to the issuance of the decision on the merits, the department may file a motion to intervene as a party. Such motion shall be in writing and served upon the parties. (b) If the department is allowed to intervene after the close of the record, the hearing off…

(a) Any person may request a declaratory ruling from the department on matters within its jurisdiction by filing an original and 4 copies of the petition, and the petition for declaratory ruling shall set forth the following information: (1) The exact ruling being requested, incl…

(a) If examination of a petition for declaratory ruling reveals that other persons would be substantially affected by the proposed ruling, the department shall require service of the petition on such persons and advise them that they may file a reply. (b) The petitioner and any p…

A rule of the department or any amendment or repeal thereof shall be adopted by the commissioner after notice and opportunity for hearing in accordance with RSA 541-A. Rules may be proposed by any person pursuant to RSA 541-A:4 or by the agency. Notes N.H. Admin. Code § Ins 210.0…

(a) The department shall commence rulemaking by drafting a proposed rule or by accepting as a proposed rule the draft of a rule proposed by any person pursuant to Ins 209 and Ins 210.03. (b) With respect to any proposed rule, the department shall conduct rulemaking and adoption p…

Petitions from interested persons requesting adoption, amendment, or repeal of a rule shall be received and disposed of in the following manner: (a) Petitions shall be submitted to the commissioner by letter; (b) Petitions shall contain the following: (1) The date of the petition…

(a) Pursuant to the provisions of RSA 541-A, the department shall conduct a public hearing on all proposed rules. (b) The public hearing shall afford all interested persons opportunity to testify. (c) The presiding officer at a public hearing in a rulemaking proceeding shall be t…

(a) Pursuant to the provisions of RSA 541-A, the department shall maintain a current listing of all persons having made a request for advance notice of the rulemaking proceedings. (b) The department shall charge a fee of $.25 per page as the copy fee for providing proposed depart…

The department shall provide, if requested by any person at any time before 30 days after the final adoption of the rule, an explanation of the rule, including: (a) A concise statement of the principal reasons for and against the adoption of the rule in its final form; and (b) An…

(a) The commissioner, upon the commissioner's own initiative or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and: (1) Applying the rule provision would cause confusion or would be mi…

The purpose of this chapter is to implement RSA 420-E wherein the general court has provided for the licensure of medical utilization review entities, oversight by the state of the procedures used by such entities, and a requirement that such entities adhere to prescribed minimum…

(a) This chapter shall apply to any medical utilization review entity, as defined under Ins 2001.03(b)(8), that performs medical utilization review services with respect to beneficiaries whose insurance policies or certificates or other evidence of health care expense coverage we…

(a) For the purposes of this part, the definitions appearing under RSA 420-E:1 shall apply whenever any word or phrase defined under RSA 420-E:1 is used in this part. (b) With respect to the following words or phrases used in this part, but which are not defined under RSA 420-E:1…

(a) No utilization review entity, other than an exempt organization, shall perform utilization review services unless the entity has received a license from the commissioner. (b) To obtain a medical utilization review license, the utilization review entity shall make application …

(a) In order to renew a medical utilization review license, the utilization review entity shall make application for renewal to the commissioner by completing and submitting an application form prescribed by the commissioner for this purpose under Ins 2001.07. The renewal applica…

No information required to obtain a utilization review license shall be withheld by an applicant on the grounds that it is proprietary or otherwise confidential. Any information deemed confidential by the applicant may be submitted under separate cover, accompanied by a statement…

(a) The applicant for a medical utilization review license or for the renewal of such license shall provide the following on Form INS-MURL-APP-1 Application for License as a Medical Utilization Review Facility: (1) The exact name of the utilization review entity for which applica…

Should any medical utilization review entity that is licensed by the commissioner pursuant to this part propose to undergo a change in name, the licensee shall, by letter to the commissioner, request that its license or registration be transferred to the licensee's or the organiz…

(a) The application fee that shall accompany the application for a medical utilization review license submitted pursuant to Ins 2001.04(b) shall be $500.00. (b) The annual renewal fee that shall accompany an application for the renewal of a medical utilization review license subm…

(a) No claim for benefits shall be denied or payment reduced on the basis of an adverse medical utilization review determination except in accordance with RSA 420-E:4. (b) All hospital preadmission review programs shall include specific provisions concerning immediate hospitaliza…

The manner and intent of notifications of claim benefit determinations shall be in accordance with the requirements of RSA 420-E:4. Notes N.H. Admin. Code § Ins 2001.11 #5931, eff 12-5-94, EXPIRED: 12-5-00 New. #7683, eff 6-1-02; ss by #9721-A, eff 6-11-10 Amended by Volume XXXVI…

(a) A medical utilization review entity shall maintain the number of telephone lines reasonably necessary to service the volume of calls which it may be expected to receive from beneficiaries and health care providers. The medical utilization review entity shall ensure that an ad…

A medical utilization review entity shall establish an appeal process for addressing beneficiary and provider complaints and requests for reconsiderations. No license shall be issued pursuant to Ins 2001.04 unless and until a medical utilization review entity has established an a…

(a) Each utilization review entity shall have written procedures for assuring that patient-specific information obtained during the process of utilization review shall be: (1) Kept confidential in accordance with applicable laws and rules; (2) Used solely for the purposes of util…

When conducting routine prospective, concurrent, and retrospective utilization review, a medical utilization review entity shall be entitled to collect and review only the information necessary to certify the admission, procedure or treatment, length of stay, or frequency and dur…

(a) Medical utilization review entity personnel or exempt organization personnel who are not licensed health care providers shall not communicate with a beneficiary or provider except for the purpose of collecting and recording demographic data. Demographic data shall include inf…

(a) A prerequisite for the licensing of a medical utilization review entity shall be accreditation of the utilization review services performed by the utilization review entity from the URAC or the NCQA. (b) A licensed medical utilization review entity shall allow any licensed fa…

Any violations of these rules by a medical utilization review entity shall be subject to such denial, suspension, or revocation of license or administrative fine not to exceed $1,000 per violation, as may be applicable under RSA 420-E:8. Notes N.H. Admin. Code § Ins 2001.18 #7683…

(a) The commissioner, upon the commissioner's own initiative or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and: (1) Applying the rule provision would cause confusion or would be mi…

The purpose of this rule is to delineate a system for regulation of health maintenance organizations that is fair and efficient, and promotes their continued solvency. Notes N.H. Admin. Code § Ins 2201.01 #9335, eff 12-5-08 Amended by Volume XXXVI Number 41, Filed October 13, 201…

Ins 2201.02 Applicability and Scope. (a) No health maintenance organization shall, without being licensed in accordance with this part: (1) Provide or arrange for health care services to enrolled participants in exchange primarily for a prepaid per capita or aggregate fixed sum; …

Ins 2201.03 Definitions. (a) For the purposes of this part, the definitions appearing in RSA 420-B:1 shall apply. (b) With respect to the following words or phrases used in this part, not defined in RSA 420-B:1, the following definitions shall apply: (1) "Active recipient of ment…

Ins 2201.04 Certificate of Authority. (a) Any health maintenance organization seeking to do insurance business in this state shall complete and submit an original copy of the National Association of Insurance Commissioners (NAIC) Uniform Certificate of Authority Application (UCAA…