Committee Summary for Senate Health and Human Services (01/28/2026)

Bill/Time	Type	Title	Sponsor
SB606 2024-? (amendment limiting to Medicaid) 00:04:46.560 - 8:03:42 AM	Public Hearing	relative to insurance coverage for biomarker testing.	Birdsell, Regina(R)[B-]2025
SB606 2024-? (limiting to Medicaid) 00:30:18.240 - 8:29:14 AM	Public Hearing	relative to insurance coverage for biomarker testing.	Birdsell, Regina(R)[B-]2025
SB480 00:42:54.480 - 8:41:50 AM	Public Hearing	limiting certain prior authorization requirements for physical therapy, occupational therapy, and similar rehabilitative services.	Prentiss, Suzanne(D)[F]2025
SB550 01:54:00.480 - 9:52:56 AM	Public Hearing	relative to insurance coverage for services provided by naturopathy providers.	Rochefort, David(R)[B-]2025
SB646 02:21:19.760 - 10:20:15 AM	Public Hearing	relative to mental health standards of care.	Rochefort, David(R)[B-]2025

SB606 2024-? (amendment limiting to Medicaid): Senator Regina Birdsell, District 19 (Derry, Hampstead, Windham) Support00:04:46.560 - 8:03:42 AM; Senator Birdsell introduced SB 606, explaining that biomarkers are analyses of patient specimens to guide precision medicine, particularly for cancer but also other conditions like autoimmune diseases, heart disease, and Alzheimer's. She noted the amendment limits coverage to Medicaid recipients only, allowing data collection on costs and potential savings from early targeted treatments. This approach addresses past pushback on costs from commercial insurers and could justify broader mandates if savings are demonstrated.
SB606 2024-? (amendment limiting to Medicaid): Dr. Jonathan Ballard, Chief Medical Officer, NH DHHS; Henry Litman, Medicaid Director Information Only00:09:08.880 - 8:08:04 AM; Dr. Ballard and Mr. Litman provided information on current Medicaid coverage of some biomarkers, determined by CMS medical necessity standards from the 2021 Federal Register, emphasizing services that are reasonable, necessary, safe, effective, and not exceeding patient needs. The amendment aligns with these standards by having Medicaid determine necessity rather than providers, ensures compliance for federal matching funds (50-90%), and delays implementation to the next budget period. They discussed fiscal estimates: low end $520,000 total ($167,000 state share), high end $1.87 million total ($600,000 state share), based on actuarial analysis. They referenced Florida's proactive coverage of hundreds of biomarkers and noted potential long-term savings through precision medicine, though upfront costs are expected, with benefits possibly accruing outside Medicaid.
SB606 2024-? (amendment limiting to Medicaid): Mike Rullo, Director of Government Relations, American Cancer Society Support00:21:04.640 - 8:20:00 AM; Mike Rullo supported SB 606 as submitted or amended, emphasizing barriers to biomarker testing for Medicaid recipients and underserved communities, which limits access to precision medicine and better outcomes. He clarified testing is not universal but guided by evidence, shared a patient story of avoiding invasive surgery via testing, and noted 26 states have similar policies with actuarial analyses showing potential cost savings. He expressed willingness to work on the amendment but concern over delaying implementation and the need for medical necessity definitions to ensure compliance.
SB606 2024-? (amendment limiting to Medicaid): Michelle Heaton, Director of Life and Health, NH Insurance Department Information Only00:29:01.520 - 8:27:57 AM; Michelle Heaton noted the original bill impacted insurance but the amendment limits it to Medicaid, suggesting removal of references to RSA 420-J to avoid confusion. With insurance out of scope, she had no further comments but offered to answer questions.
SB606 2024-? (limiting to Medicaid): Jenny Han, Senior Public Policy Manager, Alzheimer's Association NH Support00:30:18.240 - 8:29:14 AM; Jenny Han echoes support from the American Cancer Society and expresses gratitude to Senator Birdsell and the committee for ongoing work on SB 606. She notes awareness of the amendment limiting coverage to Medicaid and looks forward to collaborating to ensure appropriate coverage. She highlights that over 26,500 individuals in New Hampshire live with Alzheimer's or dementia, facing barriers to timely diagnosis, which this bill would help address. As the population ages, the disease's impact on families, caregivers, healthcare systems, and the state budget will grow. Biomarker testing enables early detection, crucial for FDA-approved treatments that delay progression. Early diagnosis improves intervention, care planning, quality of life, and reduces long-term costs, potentially saving $63,000 per person. New Hampshire faces $363 million in Medicaid spending on Alzheimer's in 2025, expected to rise. She supports expanding medically necessary biomarker testing under the amendment to diagnose, treat, and manage the disease, preventing delays of up to two years that increase costs and reduce quality of life. She introduces advocates John Zimba and Kathy Harbor to share personal impacts and offers to answer questions.
SB606 2024-? (limiting to Medicaid): John Zimba, Epping Support00:34:00.480 - 8:32:56 AM; John Zimba shares his personal experience with his wife's Alzheimer's diagnosis six years ago on their anniversary, when she forgot the date and event despite reminders, indicating advanced disease. As her caregiver for three years until her death, he reflects on the four and a half years prior when symptoms like anxiety, sleeplessness, and migraines began around age 62. She consulted multiple specialists—primary care physician, gynecologist, rheumatologist, psychiatrist, geriatrician, and neurologist—who attributed issues to medication or menopause. He cannot confirm if biomarker testing would have changed the outcome a decade ago but believes it would have altered their journey, providing more time for legal and financial preparation, quality family time, and less spent on doctor visits with emotional highs and lows.
SB606 2024-? (limiting to Medicaid): Kathy Harbor, Hanover Support00:37:15.200 - 8:36:11 AM; Kathy Harbor recounts her late husband Andy's experience with younger-onset Alzheimer's, diagnosed at 59 after being abruptly fired from a job he excelled in, with no initial awareness of small behavioral changes due to the disease. It took nine months for a mild cognitive impairment diagnosis without biomarkers, and another two years for confirmation via biomarkers, by which time he had lost his job, disability eligibility, and health benefits, leaving the family isolated. She emphasizes that early, accurate diagnosis is essential for treatment and management, especially for Alzheimer's, which is often invisible in early stages. Biomarker testing makes it visible, enabling diagnosis, treatment to slow progression, and family planning. Recent FDA-approved tools, including blood-based tests, improve access, save money, and reduce healthcare system strain. Early diagnosis allows planning and access to new treatments effective only in early stages, but current waits and costs are barriers. With over 26,500 diagnosed New Hampshire families struggling and many undiagnosed, SB 606 removes financial barriers to biomarker testing for better care, support, and treatment access.
SB480: Senator Sharon Carson, District 5 Support00:42:54.480 - 8:41:50 AM; Senator Carson introduces SB 480, which limits prior authorization for the first 12 visits of a new episode of physical or occupational therapy, defined as treatment for a new condition or one untreated in the prior 60 days. It preserves insurers' ability to deny non-medically necessary claims post-review and maintains cost controls beyond initial visits. The bill aims to reduce administrative barriers, treatment delays, and paperwork interfering with timely care. No state appropriation is needed, though the Insurance Department may address costs to health plans. She acknowledges mandates can pressure plans and raise premiums but suggests potential savings for patients, providers, and plans. She's open to negotiating the 12-visit limit, as plans vary. Prior authorization delays care; personally, hip dysplasia diagnosis took weeks for physical therapy access due to workforce shortages, exacerbating pain. Interruptions for re-authorization worsen access issues. Physical therapy is cost-effective ($75-350 per session vs. $300-4,000 for evaluations or $10,000-100,000 for surgery) and often avoids surgery. The bill improves access, reduces bureaucracy, enhances outcomes, contains costs, and aligns with patient-centered care. She's worked with plans before and seeks consensus.
SB480: Michelle Heaton, Director of Life and Health, NH Insurance Department Information Only00:51:10.720 - 8:50:06 AM; Michelle Heaton understands SB 480's motivations to remove barriers but concerns it may cause unintended consequences. Prior authorization ensures effective treatments, cost containment, patient safety, and coverage certainty. As written, it prohibits prior authorization for initial visits but allows post-service denials for non-medically necessary care, potentially leaving patients in limbo—providers might absorb costs due to contracts, not billing patients. Recent reforms via SB 561 (effective Jan 1, 2025) streamline processes: electronic prior authorizations must be decided in 14 days (72 hours urgent), with inaction deeming approval; peer-to-peer reviews are now available anytime, not just post-denial. Data reporting starts April 1 on a transparency website. Utilization review rules are being updated for rulemaking soon. These efforts reduce barriers without new legislation; changes could be incorporated into rules. She offers coordination and answers questions.
SB480: Mark Mayu, Physical Therapist Support00:59:13.920 - 8:58:09 AM; Mark Mayu, with 35 years as a physical therapist in New Hampshire, describes the prior authorization ordeal: after injury or surgery, a patient gets a referral, evaluation deems therapy necessary (two providers agree), but a third-party insurer reviews the plan, delaying start by 1-2 weeks. Patients leave in pain without guidance. Approvals for 4-6 visits require re-authorization, repeating paperwork and peer reviews. This is routine, not hypothetical. SB 480 is evidence-based: 85-90% of episodes complete in 12 visits, so gatekeeping is unnecessary. Delays cause complications, prolonged disability, higher costs, and more interventions. Administrative burdens add billions nationally in waste without improving care. In New Hampshire, with access constrained by shortages and distances, delays compound barriers. The bill restores clinical decisions to professionals, centers patients, and is fiscally responsible. He urges support, considering personal stakes.
SB480: Amanda Packard, Physical Therapist, Portsmouth Regional Hospital Support01:05:47.440 - 9:04:43 AM; Amanda Packard, a physical therapist with 26 years at Portsmouth Regional Hospital, supports SB 480. She argues that prior authorization for the first 12 physical therapy visits does not prevent waste but adds unnecessary administrative costs that often exceed the care costs. She highlights that most episodes of care resolve within 12 visits, and delays lead to 83% of patients abandoning treatment, worsening outcomes. Physical therapy reduces opioids, injections, surgeries, and disability claims. She emphasizes timely access, using the example of slipping on ice needing immediate care without interruptions after initial approvals of only four visits.
SB480: Tracy Adams, Physical Therapist, President NH Chapter APTA Support01:16:16.880 - 9:15:12 AM; Tracy Adams, a physical therapist for 35 years and 11 in New Hampshire, newly elected president of the NH Chapter of the American Physical Therapy Association, supports SB 480. She provides the APTA report on administrative burdens and shares examples from her North Carolina experience where authorizations for four visits halted therapy, causing delays. Nationally, 85-90% of PT episodes end within 12 visits; locally, 90% of NH therapists report delays, and 41% note adverse events like falls during waits. She notes 80% of outpatient clinics dedicate staff to authorizations, diverting from patient care, especially burdensome for rural and small clinics. The bill ensures timely access without interruption and reduces administrative burden.
SB480: Lynn Maloney, Physical Therapist, Rural Hospital Southwestern NH Support01:24:50.239 - 9:23:46 AM; Lynn Maloney, a physical therapist licensed 41 years and working 32 in New Hampshire at a rural hospital in southwestern NH, supports SB 480. She discusses recent legislation's limitations, citing a July 1 change by a local insurer altering site-of-service for PT, OT, and speech therapy, favoring private practices over hospitals. In rural areas (two-thirds of NH), options are limited; patients referred to hospital PT get only five visits versus 12 for private practices, despite no alternatives. The manual process involves faxes and calls via third-party vendors, increasing administrative burden and staff costs. This inequality limits access and raises costs in rural settings.
SB480: Miles Morno, Physical Therapist, Littleton Support01:30:19.600 - 9:29:15 AM; Miles Morno from Littleton, NH, echoes colleagues' support for SB 480. As a critical access hospital in rural Littleton, administrative burdens from prior authorizations tax staff; after four visits, therapists submit paperwork or conduct peer-to-peer reviews during lunch, reducing patient care time. This is particularly challenging in rural rehab departments.
SB480: Sabrina Dunlap, Senior Director Government Relations, Anthem Blue Cross Blue Shield NH Oppose01:31:38.159 - 9:30:34 AM; Sabrina Dunlap from Anthem Blue Cross Blue Shield opposes SB 480 as written, arguing it interferes with their dynamic, tailored utilization management for PT, which is digital and requires no clinical documentation. No prior auth for the first visit; subsequent visits (4-30) are approved based on limited info, with extensions available. The bill mandates 12 visits, raising premiums for all, as seen in Maine's 2023 similar law increasing costs without reducing surgeries or injections. It applies only to fully insured plans, not self-insured. Recent reforms improved processes; turnaround is fast (minutes digitally, under legal limits). She flags vague bill language ('including but not limited to PT/OT') and short 60-day effective date. Anthem is open to stakeholder discussions.
SB480: Paula Rogers, representing AHIP Information Only01:39:14.639 - 9:38:10 AM; Paula Rogers reflects on past discussions about physical therapy concerns in the commerce committee and shares a personal story of how PT helped her avoid surgery for a herniated disc, saving costs. She notes recent legislative efforts on prior authorization standards and suggests uneven implementation may be causing frustrations for physical therapists. She advocates for better communication and stakeholder discussions involving the insurance department, carriers, and therapists to address delays, possibly due to workforce issues, and mentions potential improvements like different time frames.
SB480: Danielle Romero, Occupational Therapist, representing New Hampshire Occupational Therapy Association Support01:44:14.000 - 9:43:10 AM; Danielle Romero supports the bill on behalf of occupational therapists, emphasizing that OTs, PTs, and speech therapists are ethically bound to provide only medically necessary treatment. She shares her personal experience post-foot surgery, where clinics delay scheduling due to prior authorization waits, leading to gaps in care. She highlights burdens like therapists using lunch times for peer-to-peer reviews and rescheduling patients, which can cause patients to drop out of care, especially in orthopedic and neurological cases.
SB480: Peter Braggden, representing Harvard Pilgrim Healthcare Oppose01:47:49.920 - 9:46:45 AM; Peter Braggden opposes the bill as written due to overly broad language on rehabilitative and habilitative services, which could extend to undefined or new expensive services without insurer control. He acknowledges known issues with PT and OT prior authorizations but urges narrowing the bill to those specific therapies and is open to discussions.
SB480: Cam Leine, representing Anthem Information Only01:50:41.119 - 9:49:37 AM; Cam Leine provides information on Anthem's practices, stating that physical therapy evaluations are medically necessary for assessing impairments, requiring an initial visit to determine covered visits. He notes no immediate information on caps post-evaluation but offers to follow up.
SB550: David Roert, Senator, Senate District 1 Support01:54:00.480 - 9:52:56 AM; Senator David Roert sponsors the bill to change 'may' to 'shall' for group health insurance coverage of naturopathic providers, arguing the current system is 'sick care' rather than health care. He notes naturopathic doctors focus on prevention and early treatment, with only 25 in the state taking insurance, expecting minimal fiscal impact. The change is a small mandate allowing carriers to apply medical necessity standards, and mandated states have seen increased access without premium hikes.
SB550: Michelle Heat, Director of Life and Health, New Hampshire Insurance Department Information Only01:58:19.360 - 9:57:15 AM; Michelle Heat explains the bill amends group health insurance language as a 'soft mandate' for naturopathic providers delivering covered services, not self-funded plans like state employee or Medicare. She estimates minimal fiscal impact with possible slight increase in services due to greater availability, but indeterminable overall.
SB550: Nancy Cassidy Support01:59:55.119 - 9:58:51 AM; Nancy Cassidy testified in support of SB 550, sharing her personal experience with medical malpractice in 2016 that nearly cost her life. She sought alternative care from Dr. Michelle Half, a naturopath, starting in 2020, initially paying out of pocket for herself and her twins. After marrying, her husband's private insurance covered naturopathic care, allowing more frequent visits and acupuncture, which helped diagnose her Hashimoto's disease and manage pain, anxiety, depression, and surgical scars. Now divorced, she fears losing coverage by 2027 but hopes for insurance that covers naturopathic care if the bill passes.
SB550: Sabrina Dunlap, Director of Government Relations for Anthem Information Only02:01:56.000 - 10:00:52 AM; Sabrina Dunlap briefly stated that Anthem is neutral on SB 550 because they already cover naturopathic services.
SB550: Dr. Michelle Half, President and Legislative Chair, New Hampshire Association of Naturopathic Doctors Support02:02:58.080 - 10:01:54 AM; Dr. Michelle Half supported SB 550, explaining that while individual insurance plans have mandated coverage since 2013, group plans do not, creating accessibility gaps. She detailed inconsistent coverage by insurers like Harvard Pilgrim, Cigna, Aetna, Anthem, and United Healthcare, causing confusion for patients. With only 25 naturopathic doctors currently taking insurance in NH, clearer mandates would encourage more to enroll and attract providers to address shortages. The bill would reduce administrative burdens and benefit thousands of patients. Naturopathic medicine has quadrupled in use over 20 years, is cost-effective by focusing on prevention and chronic disease (90% of expenditures), and could save insurers $20 million annually. She noted that other providers like MDs and chiropractors have mandated group coverage, seeking equal treatment for naturopathic doctors licensed in NH for 31 years.
SB550: Dr. Mat, Naturopathic Doctor Support02:08:28.960 - 10:07:24 AM; Dr. Mat supported SB 550, emphasizing naturopathic doctors' role in addressing chronic disease, which accounts for 90% of US healthcare expenditures. Over 22 years, 75% of his patients had chronic conditions after seeing multiple specialists without resolution, often feeling abandoned by conventional medicine. Naturopathic care is cost-effective, using lifestyle, dietary changes, stress management, and low-cost therapies like nutrients and botanicals, reducing medication and imaging needs. They see fewer patients for longer visits, teaching patients as 'doctors' means teacher. NDs practice safely with few complaints and straddle conventional and alternative worlds. Current partial coverage creates administrative burdens and confusion; equal insurance would make them more visible to take new patients amid shortages. It's a marketing opportunity for insurers as demand grows.
SB550: Maria Campbell Support02:14:03.199 - 10:12:59 AM; Maria Campbell supported SB 550, describing her four-year struggle with an undiagnosed chronic illness affecting her work and relationships. After seeing numerous specialists without answers, she married in 2023 and got Blue Cross Blue Shield coverage through her husband. She sought naturopathic care, receiving a list from the insurer but none local. By chance, she found Dr. Mat, who accepts Blue Cross, and was initially told on December 6, 2024, her visit would be covered. Her January 5, 2025, appointment was positive, but later calls revealed it wasn't covered, charging her $350, with uncertainty on reimbursement. Blood tests were mostly not covered, adding financial stress amid her reduced income. The inconsistent information from the insurer was overwhelming, preventing her from proceeding with care she believes would help.
SB646: Senator David Rochefort, Prime Sponsor, Senate District 1 Support02:21:19.760 - 10:20:15 AM; Senator Rochefort introduced SB 646FN briefly, highlighting the need for mental health system changes. Approached by a community mental health center (CMHC) covering a large area, he learned of billing issues where services are provided but not reimbursed by commercial payers, leading CMHCs to stop billing. The bill is a 'blunt instrument' mandating payment parity with Medicaid rates across the board for all mental health providers. He prefers a more targeted solution through ongoing discussions with providers and payers, held since fall, and requested the committee hold the bill to allow progress. If needed, they would proceed with the bill as a fallback.
SB646: DJ Bettencourt, Commissioner, New Hampshire Insurance Department, with Michelle Heaton Information Only02:25:18.640 - 10:24:14 AM; Commissioner Bettencourt thanked Senator Rochefort for facilitating discussions between carriers and providers on CMHC challenges. CMHCs are mandated to treat like emergency rooms but face reimbursement issues. Hosting meetings has fostered collaboration, with positive ongoing talks reported. He emphasized keeping the bill as incentive ('the stick') for progress. Michelle Heaton noted technical issues: placement in mental health statute affects all providers, not just CMHCs; tying to lower Medicaid rates could violate federal parity and lower commercial rates; suggested retaining Medicare for benchmarking due to its uniform rates vs. varying Medicaid. They offered to refine language and understood the goal of resolving reimbursement disputes.
SB646: Jim Nealis, summarizing for Roland Lambie Support02:30:33.280 - 10:29:29 AM; Jim Nealis summarized Roland Lambie's testimony, noting progress since last year but need to 'cross the goal line' with state involvement from Insurance Department and legislature. The bill, a blunt instrument drafted with Senator Rochefort, aims for workable solutions despite technical fixes needed. It sets a standard of care for mental illness, ensuring consistency across payment types. Focus is on CMHCs as mental health backbone; some carriers deny reimbursement for medically necessary case management and functional support services covered by Medicaid. This enforces existing parity, not new mandates, addressing uncompensated care (e.g., $10M state appropriation last year). It tackles 'structural stigma' in understanding CMHC care. Deadlines aid resolution; fiscal note may not apply as it's enforcement. Available experts can detail services.
SB646: Chris Kak, President and CEO of Community Partners Support02:38:26.880 - 10:37:22 AM; Chris Kak supports SB 646FN, emphasizing its role in ensuring access to medically necessary services for individuals with serious mental illness (SMI) under commercial insurance, similar to Medicaid coverage. He highlights his background in managed behavioral health care and the licensing process under RSA 420J. He explains that functional support services and targeted case management, which are community-based and evidence-based (part of Assertive Community Treatment teams), are deemed not medically necessary by commercial carriers despite adhering to accepted standards of medical practice. These services are crucial for SMI patients to navigate daily life and rehabilitation, not for convenience. Kak notes this is the fourth year of legislative efforts to level the playing field for SMI access regardless of insurance type.
SB646: Sabrina Dunlap, Senior Director of Government Relations for Anthem Oppose02:43:21.920 - 10:42:17 AM; Sabrina Dunlap opposes SB 646FN as drafted, arguing it's unnecessary given ongoing collaborations with community mental health centers (CHCs) to address challenges for the small population with commercial insurance (5-30% of CHC clients). She describes productive meetings with stakeholders, including Roland Lambie, focusing on adding three specific codes to contracts for coverage of functional support services. Dunlap clarifies that differences between Medicaid and commercial insurance stem from historical non-coverage of non-clinical services, not medical necessity issues. She references a 2024 Insurance Department bulletin identifying minimal gaps in codes and services. Anthem prioritizes mental health access, having reduced or eliminated co-pays for children, leading to high utilization. She urges continued constructive dialogue without legislation, noting Anthem's willingness to work with CHCs and other carriers.
SB646: Paula Rogers Information Only02:51:30.399 - 10:50:26 AM; Paula Rogers provides information on SB 646FN, distributing a handout from the Insurance Department bulletin that examines procedure codes for services in community mental health centers and the FastForward program. She notes that certain services traditionally not covered by commercial carriers are at issue, similar to challenges in last session's SB 128. Rogers encourages ongoing discussions among stakeholders, including the Insurance Department, HHS, CHCs, and care management programs, to address differences between public (Medicaid) and commercial insurance coverage. She discusses potential solutions like bundled payments and stresses the need to evaluate medical and clinical necessity, supervision by credentialed persons, and contracting details. Acknowledging legislative pressure, she suggests parties report progress or limitations to inform policy.
SB646: Holly Stevens, Director of Public Policy at NAMI New Hampshire Support02:55:47.040 - 10:54:43 AM; Holly Stevens supports SB 646FN on behalf of NAMI New Hampshire, which served over 55,000 individuals last year. She emphasizes representing patients impacted by mental illness, noting a lack of patient voices in prior discussions and requesting inclusion in ongoing conversations. Stevens describes how involuntarily hospitalized individuals conditionally discharged to CHCs must participate in services like case management and functional support, but commercial insurance often doesn't cover them, leading to out-of-pocket costs or rehospitalization. She shares a story of a former Riverbend patient who, upon gaining employment and commercial insurance, lost access to these services, accruing a $9,000 bill and decompensating mentally. Stevens argues these services are akin to rehabilitative care for physical conditions, framing the bill as a parity issue, and urges insurers to recognize their value despite challenges in engagement.

Rochefort, David(Chairman)(R)[B-]2025	Avard, Kevin(V Chairman)(R)[B]2025	Birdsell, Regina(R)[B-]2025
Prentiss, Suzanne(D)[F]2025	Long, Pat(D)[F]2025