Representative McLean’s direct‑pay facilities bill pulled from HB 2 after extensive testimony; committee seeks further Senate policy work

Members of House Finance Division III heard substantial testimony and robust committee discussion on an amendment replicating HB 548 FN (membership‑based / direct‑pay health facilities), a policy that seeks to extend direct‑pay models to outpatient and facility settings.

Representative John (Joe) McLean (Manchester) (first reference in transcript as Representative McLean, sponsor) described the measure as aiming to “open up competition” in health care by allowing facility‑level direct‑pay or membership models similar to direct primary care. He framed it as a modest experiment — pointing to a long‑running example in Oklahoma — and said the bill includes a study provision to track impacts.

Opponents raised economic and structural concerns. David Ross, administrator of Hillsborough County Nursing Home and representing the New Hampshire Association of Counties, testified that the bill would remove a moratorium on nursing‑home beds for self‑pay facilities and could shift privately‑paying patients away from existing facilities that counties and Medicaid rely on to balance operational revenues. Ben Bradley of the New Hampshire Hospital Association testified that the bill may create a separate regulatory framework and bill of rights for some facilities, and he warned about potential loss of CMS conditions of participation and patient safeguards.

Committee discussion Members probed the potential impact on critical access hospitals, Medicaid funding flows and tax assessments (MET/NFQA). Some members questioned the Oklahoma example’s applicability to New Hampshire geography and payer mixes. Representative Stringham asked about tax implications and whether new facilities would pay existing health facility taxes; Representative Priess asked whether other states have adopted the model (the witnesses and sponsor indicated Oklahoma is the principal real‑world example). Several members said the policy deserved more deliberative policy committee time than the HB 2 budget process allowed.

Outcome After extended testimony and committee questioning the chair offered a procedural path: because HB 548 is a policy bill moving through the Senate, amending HB 2 to include it was not necessary. The committee voted to withdraw the amendment from HB 2; the sponsor acknowledged the concerns and confirmed the bill remains available for further Senate consideration. The roll call to withdraw was recorded by committee staff (withdrawal approved as recorded in transcript).

Why it matters Supporters said the bill could spur innovation and offer more options to consumers; opponents warned it could destabilize existing facilities, shift profitable procedures away from safety‑net providers, and create regulatory and patient‑safety concerns. The committee’s action preserved the sponsor’s right to pursue the bill while removing it from the budget vehicle so the Senate policy committees can vet the policy more fully.

Ending Representative McLean thanked the committee; members asked the sponsor and stakeholders to continue engagement as the bill proceeds through policy committee channels.