HB 705 — relative to health care cost transparency.

HB 705 - ASVERSION INTRODUCEDADOPTED SESSIONBY 25-0576BOTH 05/08BODIES HOUSE26Mar2025... BILL 705 AN ACT relative to health care cost transparency.

1090h 8Jan2026...

0126EBA SESSION 25-0576 05/08 HOUSE BILL 705 AN ACT relative to health care cost transparency.

Commerce and Consumer Affairs ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS This bill requires health carriersplans to disclose specific costpricing information regarding covered items and servicesservices. under a health benefit plan.

The bill is acontingent requestupon finalization of thefederal insuranceguidance department.under Presidential Executive Order 14221.

HB 705 - ASVERSION INTRODUCEDADOPTED 25-0576BY 05/08BOTH STATEBODIES OF26Mar2025... NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty Five AN ACT relative to health care cost transparency.

1090h 8Jan2026...

0126EBA 25-0576 05/08 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty Five AN ACT relative to health care cost transparency.

Amend RSA 420-J by inserting after section 1926 the following new subdivision:

Transparency in Coverage 420-J:20420-J:27 Definitions.

“Billing code” means the code used by a health carrier or provider to identify health care items or services for purposes of billing, adjudicating, and paying claims for a covered item or service, including the current procedural terminology (CPT) code, healthcarehealth care common procedure coding system (HCPCS) code, diagnosis-related group (DRG) code, national drug code (NDC), or other common payer identifier.

“Health plan” means health carriers, third party administrators, and any other entity that is subject to claims data submission requirements under RSA 420-G:11 IV.

VI.

However, to the extent that the total amount of any nonproduct-specific and product-specific rebates, discounts, chargebacks, fees, or other price concessions is not known to the health carrier at the time of file publication, then the carrier shall allocate such rebates, discounts, chargebacks, fees, and other price concessions by using a good faith, reasonable estimate of the average price concessions based on the rebates, discounts, HB 705 - VERSION ADOPTED BY BOTH BODIES - Page 2 - chargebacks, fees, and other price concessions received over a time period prior to the current reporting period and of equal duration to the current reporting period.

HB 705 - AS INTRODUCED - Page 2 - VI.

“Items or services” means all encounters, procedures, medical tests, supplies, prescription drugs, durable medical equipment, and fees, including facility fees, provided or assessed in connection with the provision of health care.

“Machine-readable“Items file”or services” means aall digitalencounters, representationprocedures, ofmedical datatests, orsupplies, informationprescription indrugs, adurable filemedical thatequipment, canand befees, importedincluding orfacility readfees, byprovided aor computerassessed systemin forconnection furtherwith processingthe withoutprovision humanof intervention,health whilecare. ensuring no semantic meaning is lost.

“National“Machine-readable drugfile” code” means thea uniquedigital 10-representation of data or 11-digitinformation 3-segmentin numbera assignedfile bythat thecan Unitedbe Statesimported Foodor andread Drugby Administrationa (FDA),computer whichsystem providesfor afurther universalprocessing productwithout identifierhuman forintervention, drugswhile inensuring theno Unitedsemantic States.meaning is lost.

“Negotiated“National rate”drug code” means the amountunique a10- healthor carrier11-digit has3-segment contractuallynumber agreedassigned toby paythe anUnited in-networkStates provider,Food including an in-network pharmacy or other prescription drug dispenser, for covered items and services,Drug whetherAdministration directly(FDA), orwhich indirectly,provides includinga throughuniversal aproduct third-partyidentifier administratorfor ordrugs pharmacyin benefitthe manager.United States.

“Out-of-network“Negotiated allowedrate” amount” means the maximum amount a health carrier willhas contractually agreed to pay foran ain-network provider, including an in-network pharmacy or other prescription drug dispenser, for covered itemitems and services, whether directly or serviceindirectly, furnishedincluding bythrough ana out-of-networkthird-party provider.administrator or pharmacy benefit manager.

“Out-of-network allowed amount” means the maximum amount a health carrier will pay for a covered item or service furnished by an out-of-network provider.

XII.

420-J:21420-J:28 Scope.

This subdivision establishes price transparency requirements for health carriers for the timely disclosure of information about costs related to covered items and services under a health benefit plan.

These disclosure requirements shall apply to all health plans.

A health carrierplan shall make available on an Internet website the information required under RSA 420-J:22420-J:29 in 3 machine-readable files, in accordance with the method and format requirements described in RSA 420-J:23,420-J:30, and updated as required under RSA 420-J:23,420-J:30, III.

420-J:22420-J:29 Required Information.

The machine-readable files made available to the public by a health carrierplan shall include:

An in-network rate machine-readable file that includes the required information under this paragraph for all covered items and services, except for prescription drugs that are subject to a fee-for-service reimbursement arrangement, which shall be reported in the prescription drug HB 705 - VERSION ADOPTED BY BOTH BODIES - Page 3 - machine-readable file pursuant to paragraph III.

HB 705 - AS INTRODUCED - Page 3 - (a) For each coverage option offered by a health carrier,plan, the name and the 14-digit health insurance oversight system (HIOS) identifier, or, if the 14-digit HIOS identifier is not available, the 5- digit HIOS identifier, or if no HIOS identifier is available, the employer identification number (EIN).

If a health carrierplan does not use negotiated rates for provider reimbursement, then the carrier shall disclose derived amounts to the extent these amounts are already calculated in the normal course of business.

If the health carrierplan uses underlying fee schedule rates for calculating cost sharing, then the carrier shall include the underlying fee schedule rates in addition to the negotiated rate or derived amount.

(a) For each coverage option offered by a health carrier,plan, the name and the 14-digit HIOS identifier, or, if the 14-digit HIOS identifier is not available, the 5-5-digit digit HIOS identifier, or, if no HIOS identifier is available, the EIN.

(c) Unique out-of-network allowed amounts and billed charges with respect to covered items or services furnished by out-of-network providers during the 90-day time period that begins 180 days prior to the publication date of the machine-readable file, except that a health carrierplan shall HB 705 - VERSION ADOPTED BY BOTH BODIES - Page 4 - omit such data in relation to a particular item or service and provider when compliance with this HB 705 - AS INTRODUCED - Page 4 - paragraph would require the carrier to report payment of out-of-network allowed amounts in connection with fewer than 20 different claims for payments under a single plan or coverage.

Consistent with RSA 420-J:25420-J:32, II, nothing in this paragraph requires the disclosure of information that would violate any applicable health information privacy law.

(a) For each coverage option offered by a health carrier,plan, the name and the 14-digit HIOS identifier, or, if the 14-digit HIOS identifier is not available, the 5-digit HIOS identifier, or, if no HIOS identifier is available, the EIN.

(2) ReflectedAssociated as a dollar amount, with respectthe toNPI, eachTIN, NDCand thatplace isof furnishedservice bycode anfor each in-network provider, including aneach in-network pharmacy or other prescription drug dispenser.

(3) Associated with the 90-day time period that begins 180 days prior to the publication date of the machine-readable file for each provider-specific historical net price that applies to each NDC, except that a health carrierplan shall omit such data in relation to a particular NDC and provider when compliance with this paragraph would require the carrier to report payment of historical net prices calculated using fewer than 20 different claims for payment.

Consistent with RSA 420-J:25,420-J:32, II, nothing in this paragraph requires the disclosure of information that would violate any applicable health information privacy law.

420-J:23HB Required705 Method- andVERSION FormatADOPTED forBY DisclosingBOTH BODIES - Page 5 - 420-J:30 Required Reporting of Information to the Public;Commissioner in a Standardized Format;