Committee Summary for House Commerce and Consumer Affairs (02/17/2026)

Bill/Time	Type	Title	Sponsor
HB1231 00:01:57.360 - 8:59:58 AM	Public Hearing	requiring health care providers to disclose medical services billed to the patient's insurance carrier.	Dunn, Ron(R)[A]2025
HB1347 00:32:58.320 - 9:30:59 AM	Public Hearing	relative to health care provider networks and referrals.	Tellez, Trinidad(D)[F]2025
HB1813 00:54:25.040 - 9:52:26 AM	Public Hearing	relative to changes to health carrier contracts with providers.	Miles, Julie(R)[A-]2025
HB1638 01:45:03.280 - 10:43:04 AM	Public Hearing	creating a bypass mechanism for health insurer step therapy protocols when medically necessary.	Nagel, David(D)[C]2025
HB1406 03:54:04.800 - 12:52:05 PM	Public Hearing	prohibiting health carriers from using artificial intelligence to change the clinical judgment of a provider.	Gregg, Alicia(D)[D-]2025
HB1554 04:50:14.320 - 1:48:15 PM	Public Hearing	requiring insurance carriers to provide peer-to-peer review at any stage of prior authorization and mandating disclosure of reviewer credentials.	Miles, Julie(R)[A-]2025
HB1656 05:24:26.638 - 2:22:27 PM	Public Hearing	relative to insurance coverage for pelvic health therapy.	Beauchemin, Paige(D)[F]2025

HB1231: Representative Wayne McDonald, Rockingham County District 16, Londonderry Information Only00:01:57.360 - 8:59:58 AM; Introduced the bill on behalf of the prime sponsor, Representative Ron Dunn, who was unavailable due to a work commitment. Stated he is not a co-sponsor and has limited involvement, but is willing to answer questions. Noted upcoming testimony from others, including a constituent from Londonderry.
HB1231: Janet Hudelawa, 5 Stony Point Drive, Londonderry Support00:02:57.519 - 9:00:58 AM; Shared her extensive background in healthcare, including hospital work, managing care for family members, and handling workers' compensation. Described personal experiences with billing issues, such as receiving incomplete records from hospitals and insurers, leading to unnecessary expenses and complications. Highlighted instances of incorrect billing for her mother's care and data breaches. Argued the bill is easily implementable with current technology, would empower patients to manage costs, and ensure accurate payments by insurers. Suggested an amendment to shorten the timeline for disclosure due to insurer and Medicare reporting delays. Expressed frustration with hospital refusals to provide detailed billing without an attorney.
HB1231: Christian Ramsey, New Hampshire Hospital Association Oppose00:11:53.760 - 9:09:54 AM; Opposed HB 1231, stating that most required information is already available via Explanation of Benefits (EOB) from insurers and itemized bills under RSA 151:2-a upon request, which include CPT codes. Explained hospitals lack insurer-specific payment details within the bill's 15-day timeframe, as claims adjudication takes longer (up to 45 days for commercial, 21 for Medicare). Noted operational challenges like reprogramming systems, mailing paper statements for non-portal users, and increased costs without benefits. Supported transparency but recommended changes to EOBs instead. Urged finding the bill inexpedient to legislate.
HB1231: Ben Bradley, New Hampshire Hospital Association Information Only00:20:17.760 - 9:18:18 AM; Provided reference to RSA 151:2-a, clarifying that providers must supply itemized statements within 30 days upon request, listing services, dates, and costs. Noted the statute allows non-itemized bills with an offer for free itemized versions on request. Offered to assist Janet Hudelawa in obtaining her records.
HB1347: Alexandra Snowski, New Hampshire Attorney General's Office, Consumer Protection and Antitrust Bureau Support00:32:58.320 - 9:30:59 AM; Supported HB 1347 to ensure consumers can access referrals to healthcare facilities from preferred independent primary care physicians. Suggested aligning enforcement with the Consumer Protection Act for a $10,000 max penalty per violation, subpoena power, and consistency. Raised concerns about revoking nonprofit status without due process, recommending referrals to the Charitable Trust Unit instead.
HB1347: Representative John Trate, Hillsborough District 40, Manchester (prime sponsor) Support00:37:45.599 - 9:35:46 AM; As a family physician and health services researcher, introduced the bill to prohibit health systems from denying specialist referrals from independent primary care providers if the specialist accepts the patient's insurance. Described the issue of systems requiring patients to switch to employed PCPs for access, disrupting continuity of care and harming outcomes. Cited AMA policy against such practices, emphasizing patient autonomy, ethics, and benefits like reduced costs. Proposed an amendment for clarity and suggested forming a study committee with stakeholders (House, Senate, Insurance Dept., AG's office, industry) to assess scope and solutions, as enforcement and oversight are unclear.
HB1347: Ben Bradley, New Hampshire Hospital Association Oppose00:45:17.119 - 9:43:18 AM; Ben Bradley from the New Hampshire Hospital Association opposes HB 1347, which prohibits providers from refusing referrals, imposes a $100,000 civil fine per violation, and removes nonprofit status for violating facilities. He argues that providers with capacity will accept referrals, but mandates are problematic. Concerns include ethical refusals when expertise doesn't match patient needs or when providers feel unsafe; mandates would increase wait times by overburdening providers; and the bill targets facilities rather than individual providers making decisions, potentially rendering it defective. The association appreciates efforts to improve access but opposes the mandate due to risks of longer waits and overburdened providers.
HB1347: Kathy Stratton, New Hampshire Medical Society Support00:48:37.760 - 9:46:38 AM; Kathy Stratton, CEO of the New Hampshire Medical Society, supports HB 1347 as amended. She describes it as a patient-centered proposal ensuring access to scarce specialty care when medically necessary, regardless of primary care provider. It respects patient choices in selecting providers based on trust, convenience, and preferences, whether in large systems or independent practices. The society has heard from small independent primary care physicians that this is a real issue affecting patients. The bill promotes equal access, removes barriers, and supports continuity of care, which improves outcomes and reduces costs. It does not require specialists to accept out-of-network patients, interfere with clinical judgment, or mandate referrals, but ensures equitable access to necessary services. She encourages an Ought to Pass recommendation as amended or interim study.
HB1347: Kate Han, New Hampshire Association of Counties Oppose00:51:39.760 - 9:49:40 AM; Kate Han represents the New Hampshire Association of Counties, overseeing 11 county nursing homes, three of which have atypical beds for higher-level care: Cheshire, Merrimack, and Strafford County. She opposes HB 1347, noting it could force acceptance of patients into available regular beds if atypical beds are full, complicating operations. County nursing homes often have waitlists over 100 people long, like Cheshire's 108. The bill's interaction with waitlists and bed availability is unclear, potentially overriding clinical appropriateness. She supports an interim study to ensure decisions consider insurance, clinical needs, and availability, and mentions exempting nursing homes as an option.
HB1813: Representative Julie Miles, Hillsborough County District 12, Merrimack Support00:54:25.040 - 9:52:26 AM; Representative Julie Miles, a nurse and legislator from Merrimack, supports HB 1813 to protect patients from disruptions caused by insurance carriers' unilateral mid-year changes to provider contracts via manuals, policies, or rules. These changes can suddenly deem services non-covered or add restrictions, delaying care, as seen in hospitals with imaging rules or behavioral health visit limits. While some updates are necessary, many are cost-saving strategies. Providers get 60 days' notice but face challenges adapting, leading to denied claims and patient impacts. Providers can't easily exit contracts without harming patients. The bill limits changes to quarterly schedules, requires clear marking of modifications, and mandates transparency for changes saving over $500,000 via good faith estimates to the Department of Insurance. This promotes stability, communication, and continuity without altering core contracts or rates, ultimately controlling costs and improving outcomes.
HB1813: Michelle Heim, New Hampshire Insurance Department Oppose01:00:34.480 - 9:58:35 AM; Michelle Heim, Director of Life and Health at the New Hampshire Insurance Department, opposes HB 1813, which amends RSA 420-J:8 on health carrier-provider contracting. The department does not regulate contracts but ensures consumer protections, including the existing 60-day notice for amendments. The bill limits changes to four times a year on a fixed schedule, which could hinder carriers' responses to CPT code changes or regulations, complicating efficient operations. Contracts are negotiated by sophisticated parties, and the department avoids involvement. The reporting requirement for changes over $500,000 is difficult to anticipate and assess, with unclear purpose beyond posting on the website. It may increase administrative costs for carriers and limit adjustments. The department's fiscal note is indeterminable, and assessing compliance would be complex; they would likely just post reports without further action. Focus should be on other transparency efforts benefiting consumers and providers.
HB1813: Nick Bailis, Independent Healthcare Provider Oppose01:04:28.720 - 10:02:29 AM; Nick Bailis, a 40-year healthcare provider representing independent providers including Deli Enhanced Primary Care Group, opposes HB 1813. He argues healthcare lacks free market forces due to hospitals employing doctors, enabling self-referrals and high prices without competition—up to five times more than independents. Affordability is key to access, with healthcare debt causing bankruptcies. Independent providers are lower-cost but could be shut out without referral freedom, referencing the prior bill's importance. Hospitals drive costs; reforms allowing choice have kept NH premiums lower than Maine or Vermont. The bill would deter steering patients to lower-cost providers, harming affordability, especially for low-income and high-deductible patients. Examples include $700 vs. $5,000 MRIs. In non-emergency care, shopping saves thousands; the bill's quarterly change limits (e.g., 90 days notice) are onerous, preventing creative incentives for cost savings. Less regulation is needed; quality info is available online, and personal responsibility should guide elective care choices.
HB1813: Sabrina Dunlap, Anthem Blue Cross Blue Shield Oppose01:20:42.159 - 10:18:43 AM; Sabrina Dunlap opposes HB 1813, citing concerns from last year when a similar bill was found inexpedient in the Senate. She explains provider contracts include ancillary documents like manuals that require updates for regulatory changes, which is standard in contract law. Provider manuals guide claims, reimbursements, and utilization management, and updates to clinical guidelines are necessary for best practices with 60 days' notice as per statute. The bill's quarterly update requirement and redline changes are unworkable and overreaching for negotiated contracts between sophisticated parties. She references Maine's narrower, problematic law and clarifies no mid-year changes to member benefits occur via manuals. During Q&A, she affirms patient care is not disrupted by manual changes due to continuity statutes and explains current 60-day notice allows flexible updates, unlike the bill's rigid schedule.
HB1813: Ben Bradley, New Hampshire Hospital Association Support01:30:15.360 - 10:28:16 AM; Ben Bradley supports HB 1813, thanking Rep. Miles for sponsoring on behalf of hospitals. The bill amends RSA 420-J:8 for predictable standards on mid-contract changes. Hospitals face frequent unilateral carrier changes to agreements and manuals with material financial impacts, leaving providers with little recourse short of terminating contracts, which disrupts patients. The bill sets quarterly change cadences with 60-day notice on fixed dates (Jan 1, Apr 1, Jul 1, Oct 1) with exceptions for technical updates; requires tracked redline changes to reduce administrative burdens; and mandates good faith financial impact estimates over $500,000 for transparency without premium pressure. Similar to Maine's law, it addresses a top provider issue. In Q&A, he notes reintroduction despite Senate rejection as the issue persists.
HB1813: Peter Bragden, Harvard Pilgrim Healthcare Oppose01:36:34.400 - 10:34:35 AM; Peter Bragden opposes HB 1813, questioning legislative involvement in private contracts between carriers and providers, which already dictate change terms. The bill favors providers. As a small nonprofit operating in four states, quarterly changes burden systems, as seen in Maine where manual claim edits increase costs. It prevents timely fixes for errors like typos. The 60-day notice could extend to 150 days under quarterly limits. Estimating provider costs is impossible without their usage data. He suggests provider frustration stems from prior authorization in manuals for high-cost services, and the bill would hinder cost management and innovation. The manual is online with change histories showing infrequent updates.
HB1813: Paula Rogers Mayip Information Only01:41:53.520 - 10:39:54 AM; Paula Rogers Mayip provides neutral input, recalling similar past bills on provider manuals as integral to contracts. Manuals are voluminous and long-standing. She notes recent amplification of issues per Ben Bradley but lacks specifics. Understands Rep. Miles' aim for rhythm amid chaos but carriers like Anthem and Harvard Pilgrim see the current 60-day notice as sufficient. She's opposed but acknowledges both sides, leaving the decision to the committee.
HB1638: Rep. Nagel, Prime Sponsor Support01:45:03.280 - 10:43:04 AM; Rep. Nagel introduces HB 1638 as Step Therapy Reform, sponsored by Susan Komen Foundation, NH Rare Disease Advisory Council, NORD, Med Society, New Futures, and Every Life Foundation. It's in 39 states and federal bills; NH is one of 11 without it. Step therapy originated from WHO's analgesic ladder for individualized care but insurers use rigid 'fail first' policies, ignoring patient-centered care, evidence gaps (only 3% clear answers per Cochrane), and lacking cost control evidence. It delays care, especially for rare diseases, complex cases, and metastatic cancer, increasing long-term costs. The bill creates appeals to bypass steps when medically necessary, using existing prior auth mechanisms for transparency, timelines, and exceptions for atypical populations and cancer, modeled on Maine's law. Requests interim study for work group.
HB1638: Nancy Beerman Support01:55:59.920 - 10:54:00 AM; Nancy Beerman, on NH Rare Disease Advisory Council (speaking personally), supports HB 1638, noting NH lags other New England states. Federal bill with Sen. Hassan stalled. Rare diseases affect 1 in 10 Americans, 95% untreatable; step therapy forces failing cheaper drugs first, causing harm like her daughter's severe reactions, ER visits, and delays (3-6 months for specialists). Denials ignore doctor prescriptions despite known conditions, leading to unnecessary suffering and costs. Urges passage post-interim study during Rare Disease Month.
HB1638: Angelica Katz, Susan G. Komen Support02:00:35.520 - 10:58:36 AM; Angelica Katz supports HB 1638 for guardrails on step therapy, especially eliminating it for metastatic cancer patients. Metastatic breast cancer spreads to bones/liver/brain, treatable but incurable with personalized therapies based on patient-provider decisions. Step therapy burdens with generalized protocols, delaying care; studies show 37% higher insurer costs and increased utilization from barriers. States like Maine show minimal premium impact. Aims to ensure consistent access to life-saving medicine without delays or poorer outcomes.
HB1638: Michelle Heden, NH Insurance Department Information Only02:04:22.480 - 11:02:23 AM; Michelle Heden is neutral on HB 1638, stating much is already covered in law, with revamps to INS 2000 rules streamlining utilization review. Clinical criteria must be evidence-based via P&T committees; step therapy falls under prior auth with streamlined processes, peer-to-peer, appeals, and 72-hour expedited reviews for serious conditions. External reviews are low (50-100/year) due to unawareness or giving up, but department educates consumers. Many denials stem from incomplete info; emphasizes existing remedies and offers study engagement to address gaps.
HB1638: Sabrina Dunlap, Anthem Blue Cross Blue Shield Oppose02:16:16.800 - 11:14:17 AM; Sabrina Dunlap opposes HB 1638 as written, fearing it ends step therapy, but open to work group refinements based on other states. Management considers cost, efficacy, side effects, and drug history; shares personal rare disease experience with biologics' unknowns. Specialty drugs drive costs; willing to collaborate by September for workable language.
HB1638: Holly Stevens, NAMI New Hampshire Support02:18:10.080 - 11:16:11 AM; Holly Stevens supports HB 1638; NAMI improves lives via support/education/advocacy for mental illness. Finding medications is challenging; they're non-interchangeable, patient-specific. Step therapy delays access, worsens symptoms, increases ED visits, hospitalizations, suicidality, homelessness. Overrides needed for clinically indicated meds; external review is cumbersome. Decisions should be patient-doctor, not insurer-driven, especially with life risks.
HB1638: Sam Burgess, New Futures Support02:22:23.439 - 11:20:24 AM; Sam Burgess supports HB 1638 reforms; step therapy manages costs, but clinical judgment prioritizes outcomes. AMA: 93% physicians report delays, 25% serious adverse events, 82% therapy abandonment. Cancer delays raise death risk 6-13%. Bill allows evidence-based overrides, not banning step therapy. 39 states have exemptions without premium differences (per 2022 analysis). Ensures medical standards over insurer incentives; requests interim study.
HB1406: Rep. Gray, Prime Sponsor Support03:54:04.800 - 12:52:05 PM; Rep. Gray introduces HB 1406 to counter AI by insurers overriding physician coding, denying 1 in 5 claims (up 17%), with 90% appeals overturned. AI processes in 1.2 seconds without context, lacking exams or nuance, perpetuating biases/errors for cost-cutting. Bill prohibits AI from changing provider codes based on clinical judgment, allows AI for admin/fraud/review flagging/recommendations with transparency via records for audits, deems violations unfair practices. Builds on CA/other states; ensures human accountability, protects patients/providers from opaque denials. Not anti-AI, pro-clinician decisions. In Q&A, clarifies clinicians can use AI as tool; bill targets insurer overrides, not helpful uses; addresses AI auto-changing codes for denials, rising lawsuits, empowers commissioner oversight to prevent court battles.
HB1406: Representative Mark Pearson, Kingston Support04:10:16.960 - 1:08:17 PM; Representative Pearson, chairman of DHHS oversight and CEO of a medical facility in Kingston, testified on the limitations of AI in healthcare. He shared that AI is a helpful tool but cannot substitute for clinician judgment, citing an example where AI gave a harmful diagnosis due to incomplete information. He emphasized that AI should not override human decisions, aligning with the bill's intent to prevent AI from making overriding decisions in insurance.
HB1406: Sharon Bossy Support04:14:04.720 - 1:12:05 PM; Sharon Bossy shared her personal experience with United Healthcare denying surgery for a large lump due to AI scanning and identifying it as a 'fatty lump' based on one word, despite her doctor's concerns about potential cancer. The denial delayed treatment until November, when the lump had grown significantly, making walking difficult. She criticized AI's use by insurers to avoid payments and distinguished it from doctors' use for diagnosis, urging the committee to take her experience seriously.
HB1406: Adam Thompson, Nashua, disabled veteran Support04:18:09.520 - 1:16:10 PM; Adam Thompson, a disabled veteran from Nashua, supported HB 1406, highlighting AI's benefits in streamlining healthcare but concerns when it overrides clinicians' judgment. He stressed that clinical decisions involve nuanced factors like patient history and context, especially for those with disabilities or complex conditions. The bill ensures AI assists but does not replace human oversight, preserving trust and accountability in the system. He urged passage to protect patients and maintain medical integrity.
HB1406: Andrew Horn, software engineer Support04:21:59.120 - 1:20:00 PM; Andrew Horn, a software engineer with experience at a Fortune 50 health insurance company and extensive AI knowledge, explained that AI systems are statistical predictors, not true reasoners, likening them to 'eloquent magic eight-balls.' He argued HB 1406 prevents disasters by requiring human accountability for denials, avoiding opaque 'black box' decisions that lead to lawsuits and erode trust. He addressed incentives for deniers, AI's opacity compared to even complex rules engines, and real-world lawsuits, emphasizing the need for legislation to ensure human review over AI in coverage decisions.
HB1406: Michelle Heaton, New Hampshire Insurance Department Information Only04:37:22.160 - 1:35:23 PM; Michelle Heaton, Director of Life and Health at the NH Insurance Department, supported proactive AI oversight but noted technical issues in the bill. The department has issued bulletins and is rulemaking to require human review for denials, with AI only assisting. She clarified the bill applies to managed care under 420-J, excluding Medicare, Medicaid, etc., and that cited lawsuits involve self-funded or ERISA plans outside state regulation. Existing laws mandate explained denials and appeals; she offered to help refine the bill to align with rules and national standards.
HB1406: Sabrina Dunlap, Anthem Oppose04:43:29.200 - 1:41:30 PM; Sabrina Dunlap, Senior Director of Government Relations for Anthem, opposes HB 1406. She explains that Anthem and other carriers do not use AI to deny claims or downcode; clinical decisions are made by humans with clinical training. AI is used for automation, approvals, and detecting fraud, which saves billions in the healthcare system. The bill's broad language could hinder beneficial AI uses. The Insurance Department has issued a 2024 bulletin on AI and is developing rules, making the bill unnecessary. She notes that providers also use AI for revenue maximization, so criticism should be balanced. Anthem hopes the committee finds the bill inexpedient to legislate.
HB1406: Paula Rogers, AHIP Information Only04:45:56.080 - 1:43:57 PM; Paula Rogers, representing America's Health Insurance Plans (AHIP), provides information on HB 1406. She was initially confused by the bill's focus on AI in claims processing rather than appeals. She discusses tensions between providers (upcoding) and payers (downcoding) using AI. She agrees that denials should involve human clinical review. Suggests the committee consider drafting language ensuring a clinically appropriate person reviews denials. Notes pressure to act quickly but hopes for a solution.
HB1554: Representative Julie Miles, Hillsborough County District 12 Support04:50:14.320 - 1:48:15 PM; Representative Julie Miles introduces and supports HB 1554, which strengthens peer-to-peer review in prior authorization. It ensures treating clinicians can speak directly with qualified peers at insurance companies, addressing gaps in current law like timing restrictions, specialty mismatches, and lack of transparency (e.g., reviewer's name, license, NPI). The bill allows peer-to-peer at any stage, including after appeals start, without mandating approvals or duplicating appeals. It complements SB 561 (2024) by clarifying qualifications, timeliness, and transparency. Emphasizes that patients deserve clinical dialogue without barriers, reducing delays and costs. Notes low utilization of external reviews (50-100/year), highlighting the need for better peer-to-peer access.
HB1554: Michelle Heaton, New Hampshire Insurance Department Information Only04:55:42.320 - 1:53:43 PM; Michelle Heaton, Director of Life and Health at the New Hampshire Insurance Department, provides information on HB 1554. SB 561 (effective Jan 1, 2025) expanded peer-to-peer to any time before or after denial, with INS 2000 rules forthcoming to detail the process. Concerns include potential inefficiencies if peer-to-peer is delayed until late stages like appeals or external review, as it could prolong processes. Encourages early requests for efficiency and patient access. Notes rules will address reviewer qualifications (same/similar specialty). Acknowledges the bill aims to ensure peer-to-peer throughout the process, with no known prohibition during appeals, but operational logistics could complicate 'any time' access.
HB1554: Sabrina Dunlap, Anthem Oppose05:09:28.480 - 2:07:29 PM; Sabrina Dunlap, representing Anthem Blue Cross Blue Shield, opposes HB 1554. She emphasizes SB 561's robust prior authorization framework, including peer-to-peer available before determination or after denial within two business days, with licensed NH medical directors. The bill's intent to allow peer-to-peer at any time, including during appeals and external reviews, is unclear and operationally complicated due to required different reviewers at each stage and existing processes. Stakeholders compromised on SB 561; this bill downplays that progress without clear need.
HB1554: Paula Rogers, AHIP Information Only05:14:57.200 - 2:12:58 PM; Paula Rogers, representing AHIP, provides closing information on HB 1554. Suggests ensuring peer-to-peer occurs after denial but before or during appeals to avoid pulling appeals prematurely. Raises concerns about the bill's new requirement for reviewers to be actively practicing in the same/similar specialty, potentially straining carrier panels and increasing costs, as current law allows broader expertise. Notes consumers often unaware of appeal processes, leading to unnecessary legislation; suggests bolder notifications in plan documents and EOBs.
HB1656: Michelle Heaton, New Hampshire Insurance Department Oppose05:24:26.638 - 2:22:27 PM; Michelle Heaton from the New Hampshire Insurance Department opposes HB 1656. Prior research, including claims analysis and carrier outreach, showed pelvic floor therapy is available and covered, with in-network providers and paid claims. The bill creates a new benefit mandate, requiring defrayal under ACA federal guidance, meaning the state would pay for it in the exchange. No evidence of coverage issues justifies the mandate.
HB1656: Sabrina Dunlap, Anthem Oppose05:26:27.360 - 2:24:28 PM; Sabrina Dunlap, representing Anthem, opposes HB 1656. Anthem already covers pelvic floor therapy, as confirmed recently. Questions the bill's necessity and origin, as coverage is in place.

Hunt, John(Chairman)(R)[B+]2025	Post, Lisa(Clerk)(R)[A]2025	Potucek, John(V Chairman)(R)[A-]2025
Butler, Billie(D)	Salvi, Santosh(D)[CT]2025	Chourasia, Manoj(D)[F]2025
Ammon, Keith(R)[A]2025	Herbert, Christopher(D)[D-]2025	Osborne, Jason(R)[A+]2025
Thackston, Dick(R)[B+]2025	Walsh, Lilli(R)[B]2025	Porcelli, Susan(R)[B]2025
Spier, Carry(D)[D-]2025	Burroughs, Anita(D)[F]2025	McAleer, Chris(D)[D-]2025
Sullivan, Jared(D)[D]2025	Miles, Julie(R)[A-]2025	Presa, Adam(R)[B]2025