New Hampshire

Find more information about Community Catalyst projects in New Hampshire.

Glossary of Terms

OVERVIEW:  New Hampshire does not mandate free care, but does require hospitals and other “health care charitable trusts” to report on their provision of free care and community benefits.  To report free care, the hospital must meet certain requirements such as having a written free care policy that is available to the public.  In addition, the state requires that health facilities applying for a certificate of need to add a service must meet certain free care requirements.  The requirements differ by service.

CITATION:
Certificate of Need Review of Proposed New Institutional Health Services
New Hampshire Revised Statutes §§ 151-C:1 to 151-C:16

Community Benefits
New Hampshire Revised Statutes §§ 7:32-c to 7:32-l

TERMINOLOGY:
Charity care
Free care (see Certificate of Need regulations)

REGULATORY OVERSIGHT:
The Director of Charitable Trusts, appointed by the office of the Attorney General, has oversight authority for health care charitable trusts and the provision of community benefit, which may include the provision of charity care.  See N.H. Rev. Stat. §§ 7:19; 7:20.

DEFINITIONS AND DISTINCTIONS: 
“Charity care” is defined as “health care services provided by a health care charitable trust for which the trust does not expect and has not expected payment and which health care services are not recognized as either a receivable or as revenue in the trust's financial statements.”  N.H. Rev. Stat. § 7:32-d(I).  Charity care does not include bad debt. N.H. Rev. Stat. § 7:32-h(1).

 “Health care charitable trusts” are defined as charitable trusts that are either organized to directly provide health care services (e.g. hospitals, community health services, other diagnostic or therapeutic facilities or services) or that operate as health insurers or health maintenance organizations (hereinafter “HMO”).  N.H. Rev. Stat. § 7:19-b(I)(d).   New Hampshire’s community benefits requirements are applicable to health care charitable trusts organized to provide direct health services.  N.H. Rev. Stat. §§ 7:32-c and 7:32-d.

FREE CARE AS A COMMUNITY BENEFIT:
Charity care, as defined above, may be counted as community benefit so long as it meets the following criteria:

• The trust provided charity care in accordance with a written charity care policy;
• The trust made the policy available to the public, and notice of the policy is prominently posted in the lobby, waiting room, or other public access areas or is otherwise provided to applicants receiving services in their homes or other locations; and
• The policy allows anyone to apply and receive a prompt decision on eligibility for charity care.  N.H. Rev. Stat. §§ 7:32-d(III)(a); 7:32-h.

ELIGIBILITY REQUIREMENTS: N/A

FINANCING SOURCE: N/A

SERVICES COVERED: N/A

NOTIFICATION REQUIREMENTS:
In order for charity care to be included as a community benefit, the health care charitable trust must make its written charity care policy available.  N.H. Rev. Stat. §§ 7:32-d(III)(a); 7:32-h.  The policy should provide an application and allow for a prompt decision on eligibility. Id.  Notice of the policy must be prominently displayed in the institution’s lobby, waiting rooms, or other areas of public access. Id. 

Both the trust and the Director of Charitable Trusts shall make the community benefits plan available to the public.  N.H. Rev. Stat. 7:32-g(I).  The trust shall give public notice of the availability and process for obtaining its community benefits plan at least annually and must display this notice prominently in areas of public access within its facility.   Id.

APPLICATION PROCESS:  N/A

GRIEVANCE/APPEAL PROCESS:  N/A

REPORTING REQUIREMENTS:
Every health care charitable trust that provides direct health services must develop and submit an annual community benefits plan to the Director of Charitable Trusts within 90 days of the start of the fiscal year.  N.H. Rev. Stat. §§ 7:32-e; 7:32-g(I).  The plan shall list all community benefits activities the trust plans to undertake, with a discrete category set aside for charity care.  N.H. Rev. Stat. § 7:32-e(III).  In the community benefits plan, the trust must also provide an estimate of the cost of each activity proposed in the plan, including charity care, and report on the unreimbursed cost of each activity undertaken in the previous year.  N.H. Rev. Stat. § 7:32-e(V)(a). The plan should also include the ratio of gross receipts from operations to net operating costs. N.H. Rev. Stat. § 7:32-e(V)(b).  Both the trust and the Director of Charitable Trusts shall make community benefits reports available to the general public, including online where practicable.  N.H. Rev. Stat. § 7:32-g(I). 

If, however, the total value of the health care charitable trust is under $100,000, it is exempt from these requirements.  N.H. Rev. Stat. § 7:32-j.  Health care charitable trusts may also apply for a three-year exemption from the requirements in the case of financial hardship.  Id.

PENALTIES FOR NONCOMPLIANCE:
A health care charitable trust that fails to timely file or provide public notice of its community benefits plans may be fined up to $1,000 (plus attorneys’ fees and costs) per violation.  N.H. Rev. Stat. § 7:32-g(III). 

OTHER:
Certificate of Need and the provision of free care.  New Hampshire law sets some standards around the provision of free and reduced-cost care for health care facilities and institutions applying for a Certificate of Need (hereinafter “CON”) to add new institutional health services.  See N.H. Rev. Stat. § 151-C:5; N.H. Code Admin. R. He-Hea 303.4 (requiring all CON applicants to demonstrate that their financial assistance plan will provide free care to the uninsured with household incomes at or under 150 percent FPL); N.H. Code Admin. R. He-Hea 602.04, 606.03 (requiring CON applicants for MRI scanners to maintain a written uncompensated care program that provides, at a minimum, free care to the uninsured with household incomes at or under 100 percent FPL); N.H. Code Admin. R. He-Hea  703.01 (requiring CON applicants for comprehensive physical rehabilitation services to state the amount they budget or plan to budget for the provision of free care); N.H. Code Admin. R. He-Hea 1903.09 (requiring CON applicants for ambulatory surgical facilities to have a written uncompensated care program that, at a minimum, provides free care to the uninsured with household incomes at or under 100 percent FPL); N.H. Code Admin. R. He-Hea 2003.03, 2006.03 (requiring CON applicants for fixed or mobile PET scanners to have a written uncompensated care program that provides, at a minimum, free care to the uninsured with household incomes up to 100 percent FPL); and N.H. Code Admin. R. 2103.01 (requiring CON applicants for long-term acute care hospital services to state the amount they budget or plan to budget for the provision of free care).

The standards for the provision of free care set forth in CON regulation differ by service.  Generally, however, the CON regulations require applicant institutions to include a copy of their written financial assistance plan for the uninsured and persons unable to pay for services in their CON applications.  N.H. Code Admin. R. He-Hea 303.04(c)(3) to 303.04(e).  At a minimum, the CON regulations require applicants’ financial assistance plans to include the following:

• Forms and written instructions on applying for financial assistance, which should be provided to anyone who expresses an inability to pay for care;
• Written procedures for determining eligibility for care, including a statement of the facility’s services and charges;
• Written procedures for appealing a denial of eligibility; and
• A description of the facility’s methods for communicating the availability of financial assistance to its patients (e.g., through posting, financial counselors).  Id.