New Hampshire

At least one DPC practice appears to be operational in New Hampshire, no DPC laws are in place, and but Senate Bill 176 was introduced in 2014 but died in the hands of the commerce committee.  If you have aspirations of opening a DPC practice in New Hampshire, be sure to begin by reviewing the New Hampshire state insurance code (Title 37)and by being involved in renewed legislative efforts during the next session when the bill will likely be reintroduced. As in all states, DPC practices will need to structure contracts so that the relationship does not amount to unauthorized insurance (discussed by New Hampshire in Chapter 406B: Unauthorized Insurance).

Physician dispensing here is essentially prohibited. They are limited to providing a three day supply of medications for the “immediate needs” of the patient. “72 hours: In the ambulatory patient treatment areas of an institution, a medical practitioner may dispense drugs for the immediate needs of the patient but not to exceed a 72-hour supply and only if permitted by the institution.”

If you are marketing yourself to large employers, take note of the state's stop loss requirements.   The Health Maintenance Organization and Medical Discount Plan hurdles are significant and are described below.  In addition to these problems, larger DPC organizations should take note of Chapter 420-I: Prohibition of Exclusive Arrangements with Managed Care Insurers.  

The "Health Maintenance Organization" Problem

New Hampshire has a vaguer HMO definition than most states, and this poor definition can become a problem for DPC practices.  See below for details, here is a link to the entire HMO section of the code.  If your practice were defined as an HMO this would be fatal to your operations.

V. "Health care services'' means physician, hospitalization, laboratory, x-ray service and medical equipment and supplies, which may include but are not limited to: medical, surgical, and dental care; psychological, obstetrical, osteopathic, optometric, optic, podiatric, chiropractic, nursing, physical therapy services, and pharmaceutical services; health education; preventive medical, rehabilitative, and home health services; inpatient and outpatient hospital services, extended care, nursing home care, convalescent institutional care, laboratory and ambulance services, appliances, drugs, medicines, and supplies; and any other care, service, or treatment of disease, correction of defects, or the maintenance of the physical and mental well-being of enrolled participants. 
    VI. "Health maintenance organization'' means a public or private organization, organized under the laws of this state or the laws of another state which: 
       (a) Provides or otherwise makes available to enrolled participants health care services; 
       (b) Is compensated for the provision of one or more health care services to an enrolled participant on a primarily predetermined periodic rate basis; 
       (c) Provides physicians' services directly through physicians who are either employees or partners of such an organization, or under arrangements with one or more physicians or groups of physicians. 
    VII. "Provider'' means any physician, hospital or other institution, organization, or other person who furnishes health care services.

The "Medical Discount Plan" Problem

New Hampshire has several regulations worth reviewing when designing your DPC practice.  Chapter 415-I discusses how DPC physicians will likely be viewed as "Discount Medical Organizations."  Some of the most important sections are linked below.  If your practice were defined as a Medical Discount Plan you would be subject to these additional regulations; while unlikely fatal to your practice, they would be a nuisance, and remind us of the bad DPC law on the books in Oregon and West Virginia - only without the critical "NOT INSURANCE" protections.

415-I:3 Definitions.  "Discount medical plan organization'' means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount. "Discount medical plan organization'' is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or ancillary services at a discount and determines the charge to discount medical plan members. "Discount medical plan organization'' does not include a provider that offers discounts to its own patients without any cost or fee of any kind to the patient.   Be certain you review all the Medical Discount Plan language; some of the most problematic sections are listed below.

415-I:5 Registration Requirement.
415-I:6 Suspension and Revocation of Registration.
415-I:8 Fees; Refund Requirements; Bundling of Services.
415-I:9 Provider Agreements; Participating Provider Listing Requirements.