New Hampshire 2026 Session Status: Passed Senate Bipartisan · 8 R · 1 D cosponsors

SB 476 — relative to consumer health care cost transparency.

Last action — Pending Motion OT3rdg; 03/26/2026; SJ 7

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill has passed the Senate. Introduced November 21, 2025. It now moves to the second chamber.

Next likely step: consideration and a floor vote in the House.

Odds of enactment

Moderate chance

Based on the sponsor, cosponsors, and committee posture, this bill has a moderate chance of becoming law.

Upgrade to see the exact probability and what's driving it.

A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Likely to advance 74% · high confidence

  • Passed Senate

    Current position in the legislative process.

  • 10 sponsors

    1 primary, 9 co-sponsors signed on.

  • Bipartisan support

    Sponsored across 2 parties (8 R · 1 D) — cross-party backing.

  • Cleared a recorded vote

    Passed 1 recorded vote so far.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Summary

relative to consumer health care cost transparency.

Bill Text

What changed in the latest version

105 added · 143 removed

Plain-language change summary

The amended version of Bill SB 476 introduces new requirements for the insurance department to enhance consumer access to healthcare pricing tools and billing information. It emphasizes the need for data transparency while ensuring that any health care data shared for regulatory purposes complies with strict privacy laws. This matters because it aims to help consumers make informed choices about their health care costs and improve overall price transparency in the healthcare system, potentially leading to lower costs and better service quality.

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SB 476 - AS INTRODUCED SESSION 26-2035 05/08 SENATE BILL 476 AN ACT relative to consumer health care cost transparency.
SB 476 - AS AMENDED BY THE SENATE 03/26/2026 1236s SESSION 26-2035 05/08 SENATE BILL 476 AN ACT relative to consumer health care cost transparency.
Health and Human Services ───────────────────────────────────────────────────────────────── ANALYSIS This bill:
Health and Human Services ───────────────────────────────────────────────────────────────── AMENDED ANALYSIS This bill creates new requirements for the insurance department to give consumers access to health care price-transparency tools and billing information.
I.
Aligns state hospital transparency obligations with federal requirements and provides a good- faith estimate safe harbor.
II.
Requires health insurers to provide member-specific, pre-service out-of-pocket estimates through their existing federal Transparency in Coverage tools and secure APIs that can be accessed through the state’s HealthCost portal or enrollee-authorized applications.
III.
Expands authorized uses and governance of the comprehensive health care information system (CHIS/APCD), clarifies voluntary ERISA plan participation, and directs the insurance department to use existing infrastructure without building new state IT systems.
IV.
Directs the department of health and human services and insurance department to adopt administrative rules regarding implementation and provides for a cure period before enforcement.
SB 476 - AS INTRODUCED 26-2035 05/08 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT relative to consumer health care cost transparency.
SB 476 - AS AMENDED BY THE SENATE 03/26/2026 1236s 26-2035 05/08 STATE OF NEW HAMPSHIRE In the Year of Our Lord Two Thousand Twenty-Six AN ACT relative to consumer health care cost transparency.
1 New Section;
1 Health Statistics;
Hospitals;
Health Care Data;
Price Transparency;
Availability Of Data.
Alignment and Safe Harbor.
Amend RSA 126:28, III to read as follows:
Amend RSA 151 by inserting after section 12-c the following new section:
151:12-d Hospital Price Transparency;
Alignment and Safe Harbor.
I.
Each hospital shall maintain public transparency files and a patient-friendly shoppable services estimator in accordance with federal hospital price transparency requirements.
II.
A hospital that is in good-standing compliance with federal hospital price transparency requirements and that provides a patient-facing estimator, whether operated by the hospital or its vendor, is deemed to satisfy state transparency obligations under this section.
Hospitals may, at their option, expose read-only endpoints or deep links enabling the state’s consumer portal to direct patients to hospital estimators for shoppable services.
To [the insurance department,] the department of justice[,] or any other state or federal agency, and any agency's contractors, for review of health care matters within the agency's respective jurisdictional authority.
An agency or contractor receiving health care data under this section shall comply with all state and federal confidentiality, privacy, and security protections.
A hospital or ambulatory surgical center that provides an estimate in good faith shall not be subject to damages or penalties for a variance between the estimate and the final bill where the variance results from:
To the insurance department to ensure appropriate state regulation of insurance and health plans and to advance the insurance department's reporting on health care delivery or costs.
(a) Clinically necessary changes in scope;
The insurance department shall be provided with the complete data set.
(b) Factors outside the facility’s control;
The insurance department shall only disclose the data in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and 45 C.F.R.
or (c) Changes in the patient’s benefits or accumulators after the estimate is issued.
parts 160, 162, and 164.
V.
2 Portability, Availability, And Renewability Of Health Coverage;
The safe harbor provided for a good faith estimate under paragraph IV shall not apply to willful misrepresentation or deceptive practices.
Requested Information.
2 New Paragraph;
Amend RSA 420-G:14-a to read as follows:
Hospital Price Transparency;
420-G:14-a Requested Information.
Compliance Reporting.
Amend RSA 151:12-d by inserting after paragraph V the following new paragraph:
VI.
The department of health and human services shall publish an annual public dashboard summarizing hospital compliance with this section and federal hospital price transparency requirements.
3 New Paragraphs;
Comprehensive Health Care Information System;
Enhancements.
Amend RSA 420-G:11-a by inserting after paragraph II the following new paragraphs:
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III.
The commissioner shall maintain and promote a standardized opt-in mechanism for self- funded ERISA plans to contribute data through their third-party administrators.
IV.
In addition to existing uses, APCD data may be used to:
(a) Power the state’s consumer portal by linking to carrier estimators;
(b) Display de-identified allowed-amount benchmark ranges for the uninsured and for out-of-network, non-emergency care;
and SB 476 - AS INTRODUCED - Page 2 - (c) Support public reporting on price and quality variation, using risk-adjusted, de- identified data.
V.
Data submitters subject to administrative rules adopted under RSA 420-G shall continue monthly submissions using the state’s current data layouts.
The commissioner may align technical specifications with the most current APCD common data layout to reduce burden and improve interoperability.
VI.
The APCD advisory group established by the commissioner shall include at least one representative each of:
hospitals, carriers, self-funded employers, physicians, consumer advocates, and small businesses.
The group shall advise on consumer display standards, API performance, and safeguards to minimize duplicative reporting.
4 New Sections;
Insurance;
Comprehensive Health Care Information System;
Definitions;
HealthCost Consumer Portal;
Use of Existing Infrastructure;
Rulemaking.
Amend RSA 420-G by inserting after section 11-a the following new sections:
420-G:11-b Definitions for Price Transparency and Consumer Estimates.
In this chapter:
“All-payer claims database” or “APCD” means the comprehensive health care information system operated by or for the insurance department in collaboration with the department of health and human services pursuant to RSA 420-G:11 and RSA 420-G:11-a.
[As authorized in accordance with RSA 420-G:14, the] The commissioner may request the submission of such information by carriers as is necessary to better understand the coverage history and choices of participants in the nongroup market, health costs, cost drivers, health care financing and delivery system.
The commissioner shall make every attempt to ensure the reasonableness of such request, both in terms of scope and timeframe, and to limit this request to information the commissioner deems necessary to better understand the dynamics of the [nongroup] health insurance market [and to assess the appropriateness of alternative sources of funding for the nongroup subsidy].
“Carrier” has the meaning set forth in RSA 420-G:2.
The commissioner shall request and health carriers shall supply information and data [no later than June 30 of] each year sufficient to report on the [small employer] health insurance market and the types of health coverage being purchased by individuals and employers by geographic area.
Such information shall be reported for the market as a whole and by market segment.
At the commissioner's discretion, such information may include, but not be limited to, information relating to premium rates and rating practices, prescription drug rebates, the number of groups and individuals insured, availability of coverage and benefit plans, trend, loss ratios, administration costs, and profitabilit[The commissioner shall file a report of the SB 476 - AS AMENDED BY THE SENATE - Page 2 - information by December 31 of each year with the president of the senate, the speaker of the house of representatives, the chairperson of the house commerce committee, and the chairperson of the senate banks and insurance committee.] The commissioner shall limit requests to the most essential data reasonably necessary to evaluate insurance market dynamics, health care cost drivers, and premium trends.
“Consumer price estimate” means a member-specific estimate of allowed charges, plan liability, and the member’s expected cost-sharing for a shoppable item or service, based on the member’s benefits and accumulators as of the time the estimate is produced.
[The commissioner shall request and health carriers shall supply information no later than June 30 of each year sufficient to report on the types of health coverage being purchased by individuals and employers by geographic area.
The report shall include specific details regarding the type of coverage, including, but not limited to, co-pays, out-of-pocket maximums, network restrictions, and deductibles.] The commissioner shall prescribe the format, time, and procedure for submitting data.
Any forms, templates, or guidance regarding the submission required by the section shall be exempt from the requirements of RSA 541-A.
“Hospital” means any entity licensed under RSA 151.
[The commissioner shall file the required reports by December 31 of each year with the senate president, the speaker of the house, and the chairpersons of the house and senate committees having jurisdiction over commerce issues.] All native information and data collected shall be confidential and exempt from disclosure under RSA 91-A.
The insurance department shall only disclose the data in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and 45 C.F.R.
parts 160, 162, and 164 to advance the purposes of this section.
“Shoppable service” means a health care service that can be scheduled in advance and for which federal rules require public, member-specific estimates.
The commissioner shall hold an annual public hearing concerning premium rates in the health insurance market and the factors, including health care costs and cost trends, that have contributed to rate increases during the prior year.
VI.
The purpose of the public hearing shall be to provide transparency regarding the factors influencing health insurance premiums and health care costs and to inform policymakers and consumers regarding market trends.
“Transparency in Coverage (TiC) APIs” means machine-readable files and price- comparison interfaces required of carriers under federal law.
The commissioner shall evaluate claims costs, administrative loads, and health carrier prThets.
commissioner shall identify the factors that contribute to cost increases affecting health insurance premiums and health care services in New Hampshire.
The commissioner shall identify variations in the price that health carriers pay for health care services and shall undertake further analysis to determine the cause of the observed price variations by utilizing the uniform hospital discharge data set, as described under RSA 126:25, the comprehensive health care information system as described in RSA 420-G:11-a, any other health care data collected by state government, including but not limited to Medicaid data, and other data sources as appropriate.
In advance of holding the public hearing, the commissioner may require any health insurer or third party administrator to produce documents and information deemed necessary and relevant to evaluate the factors that contribute to cost growth in health care services, increased utilization of health care, and health insurance premium costs.
The commissioner shall keep confidential all nonpublic documents and shall not disclose those documents without the consent of the health care provider or health care SB 476 - AS AMENDED BY THE SENATE - Page 3 - payer that produced the information or documents.
The commissioner may compel a health insurance carrier or third party administrator to testify at the annual public hearinThe commissioner may also invite representatives of health care providers to provide relevant information.
VI.(a) The commissioner shall prepare an annual report concerning premium rates in the health insurance market and the factors that have contributed to rate variations during prior years.
The annual report shall be designed to provide information which identifies and quantifies health care spending trends and the underlying factors that contributed to variations in health insurance premiums.
The report may include, as appropriate, analysis of public policy options for increasing the efficiency of New Hampshire's health care financing and delivery system and controlling health care costs and premium variations.
The report shall be based to the highest extent possible on the commissioner's analysis of information and data available to the commissioner, including the testimony at the public hearing, and any other information or documents submitted in connection with the public hearing.
(b) The commissioner shall submit the annual report to the governor, the president of the senate, and the speaker of the house of representatives on or before December 31 of each year.
“Hospital price transparency requirements” means federal requirements for hospital machine-readable files and patient-friendly shoppable service displays.
In conjunction with the annual public hearing required under paragraph V and the report required under paragraph VI, the commissioner shall consider any pertinent work of other legislative commissions and inquires focused on related matters.
420-G:11-c HealthCost Consumer Portal;
VIII.
Use of Existing Infrastructure.
The commissioner shall help consumers make informed choices about health insurance by engaging in efforts to improve transparency in health insurance.
I.
IX.
The insurance department shall utilize the existing HealthCost public website to:
The department shall have the authority to receive all health data from any state agency to the extent reasonably necessary for the regulation of insurance markets and analysis of health care cost drivers affecting insurance premiums.
(a) Explain consumers’ rights;
Any health data received from another agency shall only be disclosed in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and 45 C.F.R.
(b) Route members directly to their carriers’ price-comparison tools;
parts 160, 162, and 164.
(c) Display non-member-specific benchmark ranges for uninsured consumers derived from the APCD;
3 Effective Date.
and (d) Host a directory of hospital estimators.
This act shall take effect January 1, 2027.
II.
The department shall not build or procure new state-hosted information technology systems for estimate calculation or price-comparison functions.
SB 476 - AS INTRODUCED - Page 3 - III.
Costs, if any, associated with vendor configuration, portal content updates, or API routing shall be paid by carriers and third-party administrators subject to RSA 420-J and hospitals licensed under RSA 151 through vendor-direct contracts or in-kind integration work.
No general fund appropriation or expenditure is authorized by this section.
IV.
The commissioner may accept non-state grants or gifts to support consumer education under this section, which may be expended without state match and without creating ongoing obligations.
420-G:11-d Rulemaking.
The insurance commissioner shall adopt rules under RSA 541-A to implement the requirements of RSA 420-G:11-a through 420-G:11-c, limited to harmonizing with federal formats, setting API access and security standards, specifying consumer-facing disclosures, and coordinating enforcement to avoid duplication.
Rulemaking under this section shall not require the departments to build new information technology systems.
5 New Section;
Health Insurance;
Member Price Estimates Through Existing Tools.
Amend RSA 420-J by inserting after section 7-e the following new section:
420-J:7-f Member Price Estimates Through Existing Tools.
I.
Each carrier shall ensure that an enrollee can obtain, without charge, a consumer price estimate for any shoppable service:
(a) Through the carrier’s existing self-service internet tool;
and (b) Via secure, standards-based application programming interfaces (APIs) made available to the state’s consumer portal and to third-party consumer applications authorized by the enrollee.
II.
Each estimate shall include:
(a) The provider’s billing NPI and service location;
(b) The carrier’s allowed amount;
(c) The plan’s expected payment;
(d) The enrollee’s expected out-of-pocket amount reflecting deductibles, copayments, and coinsurance accumulators as of the time of the request;
and (e) A notice that estimates are subject to change if clinical circumstances or benefit accumulators change.
III.
Nothing in this section requires the insurance department to build or host new technology infrastructure.
The commissioner shall leverage the existing HealthCost public portal to route consumers to carrier tools and APIs and to display plain-language guidance.
IV.
Compliance with federal transparency in coverage requirements for machine-readable files and price-comparison tools constitutes prima facie compliance with paragraphs I and II if the carrier enables API access for the state portal and enrollee-authorized tools and responds to API queries within commercially reasonable timeframes.
SB 476 - AS INTRODUCED - Page 4 - V.
The commissioner shall adopt rules, under RSA 541-A, to specify API access, privacy, security, and response-time standards that are consistent with federal requirements and do not impose duplicative formats or submissions.
6 New Sections;
Health Insurance;
Consumer Protections for Estimates.
Amend RSA 420-J by inserting after section 7-f the following new sections:
420-J:7-g Consumer Protections for Estimates.
I.
Every estimate delivered under RSA 420-J:7-f shall include plain-language disclosures on potential variance, network status, prior authorization, and facility versus professional billing.
II.
Upon a patient’s request for a scheduled, non-emergency service, a provider shall offer the CPT/HCPCS codes and service description used for the estimate to facilitate comparison.
III.
State and federal balance billing and surprise medical billing protections remain in full force and are unaffected by this chapter.
420-J:7-h Enforcement;
Cure First.
I.
For carriers, the insurance commissioner may enforce RSA 420-J:7-f and RSA 420-J:7-g under RSA 400-A and RSA 420-J.
Prior to any administrative penalty, the department shall provide notice and a 60-day cure period for first-time or technical violations.
II.
The department shall publish an annual public dashboard of carrier compliance with RSA 420-J:7-f through RSA 420-J:7-h.
7 Effective Date.
I.
Sections 2, 5, and 6 of this act shall take effect 12 months after its passage.
II.
The remainder of this act shall take effect 60 days after its passage.
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Action History

  1. Pending Motion OT3rdg; 03/26/2026; SJ 7

  2. Sen. McGough Moved Laid on Table, MA, VV; 03/26/2026; SJ 7

  3. The Chair rescinded OT3rdg, 03/26/2026; SJ 7

  4. Ought to Pass with Amendment #2026-1236s, RC 16Y-8N, MA; OT3rdg; 03/26/2026; SJ 7

  5. Sen. McGough Floor Amendment # 2026-1236s, DIV 16Y-8N, AA; 03/26/2026; SJ 7

  6. Sen. McGough Moved Ought to Pass; 03/26/2026; SJ 7

  7. Refer to Interim Study, MF, VV; 03/26/2026; SJ 7

  8. Special Order to the end of the Calendar, Without Objection, MA; 03/26/2026; SJ 7

  9. Committee Report: Referred to Interim Study, 03/26/2026, Vote 5-0; SC 11

  10. Special Order to 03/26/2026, Without Objection, MA; 03/12/2026 SJ 6

  11. Committee Report: Referred to Interim Study, 03/19/2026, Vote 5-0; SC 10

  12. Special Order to 03/19/2026, Without Objection, MA; 03/05/2026 SJ 5

  13. Committee Report: Referred to Interim Study, 03/05/2026, Vote 5-0; SC 8

  14. Special Order to the Next Session, Without Objection, MA; 02/19/2026; SJ 4

  15. SB 476 was Removed from the Consent Calendar; 02/19/2026; SJ 4

  16. Committee Report: Referred to Interim Study, 02/19/2026; Vote 5-0; CC; SC 6

  17. Hearing: 01/21/2026, Room 100, SH, 01:15 pm; SC 2

  18. Introduced 01/07/2026 and Referred to Health and Human Services; SJ 1

Sponsors

Sponsorship breakdown

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1 sponsors · 9 co-sponsors · 405 not signed on · 7 voted No

Sponsors (1)

Co-sponsors (9)

Not signed on (405)

405 members have not signed on to this bill.

Show all 405 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Ought to Pass w/Amendment

Passed 16 Yea · 8 Nay
Party YeaNayPresentNot Voting
Republican 16000
Democrat 0800
Total 16800
% of votes cast 67%33%0%0%
How each member voted (24)
Member Party Vote
Cindy Rosenwald Democrat Nay
David Watters Democrat Nay
Debra Altschiller Democrat Nay
Donovan Fenton Democrat Nay
Pat Long Democrat Nay
Rebecca Perkins Kwoka Democrat Nay
Suzanne Prentiss Democrat Nay
Tara Reardon Democrat Nay
Bill Gannon Republican Yea
Daniel Innis Republican Yea
Daryl Abbas Republican Yea
David Rochefort Republican Yea
Denise Ricciardi Republican Yea
Howard Pearl Republican Yea
James Gray Republican Yea
Keith Murphy Republican Yea
Kevin Avard Republican Yea
Mark McConkey Republican Yea
Regina Birdsell Republican Yea
Ruth Ward Republican Yea
Sharon Carson Republican Yea
Tim McGough Republican Yea
Timothy Lang Republican Yea
Victoria Sullivan Republican Yea

Official roll call →

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

What does SB 476 do?
relative to consumer health care cost transparency.
Who sponsors SB 476?
SB 476 is sponsored by Tim McGough (Republican), Julie Miles (Republican), Katelyn T Kuttab, Howard Pearl (Republican), Wayne MacDonald (Republican), Cindy Rosenwald (Democrat), Daniel Innis (Republican), Bill Gannon (Republican), Regina Birdsell (Republican), and Keith Ammon (Republican).
What is the current status of SB 476?
This bill has passed the Senate. Introduced November 21, 2025. It now moves to the second chamber.
Where can I track SB 476?
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