Heated hearing on bill to remove 15‑mile limit around critical‑access hospitals exposes deep split on rural care

The Senate Health and Human Services committee heard extended testimony on House Bill 223, a proposal by Rep. John McClain to repeal the 15‑mile notice and review provision that applies to proposed health facilities located near federally designated critical access hospitals (CAHs).

Rep. McClain opened the hearing by describing a long‑running decline in rural access: hospital bankruptcies, suspended services and a steady loss of birthing units across the state. "Part of the problem is that we have fallen back into a position where we're now relying on the state's critical access hospitals as the almost exclusive provider of non‑primary care in the rural areas," he said, adding that the 15‑mile rule effectively bars most parts of the state from new ambulatory care development.

Supporters of the repeal urged the committee to allow private providers to try new models in rural markets. Nick Veil, CEO of Bedford Ambulatory Surgical Center and former state health commissioner, said the existing regime protects "franchises" and raises costs, leaving rural residents to pay higher prices: "The people who can least afford it...are paying the highest costs in the state," he said.

ConvenientMD representatives described repeated attempts to negotiate with local hospitals before opening clinics and said the current process is time‑consuming and costly. Ryan Hansen, senior vice president for ConvenientMD, said the state27s review can require a site lessee to sign a lease and build a clinic before services can be approved, then face a 30‑day objection window, followed by a third‑party economic review that can take six to nine months and cost tens of thousands of dollars. Convenience clinic witnesses and company leaders said Massachusetts uses transfer agreements to coordinate patient flow and information; they argued such partnerships can preserve continuity of care while expanding low‑cost access.

Hospital leaders and CAH advocates urged rejection of the bill. Jerry Kinneark, a retired physician who served on the SB 97 study committee that shaped current statute, said the notice and expert review process exists to prevent "cherry‑picking" of higher‑paying, low‑cost patients, which can change a hospital27s payer mix and push marginal CAHs into loss. "When outside facilities cherry pick the well paying uncomplicated patients, there's a significant negative economic impact on the critical access hospital," Kinneark said.

Littleton Regional Healthcare (LRH) described a local case in which ConvenientMD opened a clinic in 2019 after the critical‑access process was temporarily paused; LRH said the clinic caused lost volume, staffing challenges, and fragmentation of patient records. "We lost volume, we lost revenue, and we lost staff," Corinne Saperchi, LRH chief operating and nursing officer, told the committee, and she said records sharing remains incomplete and expensive to build.

The New Hampshire Hospital Association27s Ben Bradley said acute care hospitals statewide run a negative operating margin on average and that CAHs rely on higher‑paying services to subsidize emergency and maternity care. "This bill would increase the risk of closure of critical access hospitals or cessation of important services," Bradley said, recommending the committee find the bill inexpedient to legislate.

Committee members pressed both sides on practical details: whether the notification and review process has blocked new entrants (witnesses said some clinics have opened after a pause or after negotiation), how third‑party reviews are procured and paid (witnesses said costs are typically split between the applicant and the affected hospital and can run $50,0002475,000), and whether the process fosters or prevents partnerships. Several witnesses said hospitals and urgent‑care operators have successfully used transfer agreements and data‑sharing in other states; hospital witnesses said such arrangements require resources and trust to operate.

Why it matters: CAHs provide 24/7 emergency care and maternity services across rural New Hampshire. Proponents of repeal argued the statutory barrier prevents entrepreneurial entrants that could lower prices and expand access; opponents argued the law protects fragile hospitals whose payer mixes and thin margins otherwise would be damaged by new entrants.

What27s next: The committee heard broad testimony from hospital leaders, rural providers, and urgent‑care operators but did not take a vote at this hearing. Several members urged further study and stakeholder negotiation rather than an immediate repeal.