Revision: Jan. 16, 2019, 3:47 p.m.
HB 685-FN - AS INTRODUCED
2019 SESSION
19-0531
01/05
HOUSE BILL 685-FN
SPONSORS: Rep. Luneau, Merr. 10; Rep. Morrison, Rock. 9
COMMITTEE: Commerce and Consumer Affairs
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ANALYSIS
This bill clarifies ambulance billing under the law governing emergency and medical trauma services.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0531
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Paragraph; Emergency Medical and Trauma Services; Definitions. Amend RSA 153-A:2 by inserting after paragraph XVI-a the following new paragraph:
XVI-b. "Private safety agency" means a private entity which provides emergency police, fire, ambulance, or medical services.
2 New Paragraph; Emergency Medical and Trauma Services; Definitions. Amend RSA 153-A:2 by inserting after paragraph XVIII the following new paragraph:
XVIII-a. "Public safety agency" means a functional division of a public agency which provides firefighting, law enforcement, ambulance, medical, rescue or other emergency services.
3 New Section; Emergency Medical and Trauma Services; Ambulance Billing; Payment for Reasonable Value of Services; Prohibition of Balance Billing. Amend RSA 153-A by inserting after section 20-a the following new section:
153-A:20-b Ambulance Billing; Payment for Reasonable Value of Services, Prohibition of Balance Billing.
I. When a commercially insured patient is covered by a managed care plan, as defined under RSA 420-J:3, XXV, a private safety agency or public safety agency shall not balance bill the patient for fees or amounts other than copayments, deductibles, or coinsurance, if the service is covered under the patient’s health insurance plan.
II. Pursuant to paragraph I, fees for ambulance services submitted to an insurance carrier for payment shall be limited to a commercially reasonable value, based on payments for similar services from New Hampshire insurance carriers to New Hampshire ambulance providers.
III. In the event of a dispute between a provider and an insurance carrier relative to the reasonable value of a service under this section, the insurance commissioner shall have exclusive jurisdiction under RSA 420-J:8-f to determine if the fee is commercially reasonable. The provider and the insurance carrier shall each make best efforts to resolve any dispute prior to applying to the insurance commissioner for resolution, which shall include presenting to the other party evidence supporting its contention that the fee level it is proposing is commercially reasonable. The department of insurance may require the parties to engage in mediation prior to rendering a decision.
4 New Section; Managed Care Law; Reasonable Value of Ambulance Services. Amend RSA 420-J by inserting after section 8-e the following new section:
420-J:8-f Reasonable Value of Ambulance Services. In the event of a dispute between a health care provider and an insurance carrier relative to the reasonable value of a service under RSA 415:27, the commissioner shall have exclusive jurisdiction to determine if the fee is commercially reasonable. Either the provider or the insurance carrier may petition for a hearing under RSA 400-A:17. The petition shall include the appealing party’s evidence and methodology for asserting that the fee is reasonable, and shall detail the efforts made by the parties to resolve the dispute prior to petitioning the commissioner for review.
5 New Subparagraph; Managed Care Law; Rulemaking. Amend RSA 420-J:7, II by inserting after subparagraph (e) the following new subparagraph:
(f) Standards for addressing network access to ambulance services, including that carriers shall offer an ambulance service provider a commercially reasonable payment to include in-network access to ambulance services in each of the 2 zip codes with the largest population in every New Hampshire County. The carrier shall also offer a commercially reasonable payment to include in-network access to ambulance services provided through the 911 service for the same zip codes.
6 Report. The insurance commissioner shall make a report on or before July 1, 2020 detailing the impact of RSA 153-A:20-b as inserted by section 3 of this act and RSA 420-J:8-f as inserted by section 4 of the act on health insurance premium rates to the chairpersons of the house and senate committees having jurisdiction over insurance issues.
7 Reimbursement for Ambulance Service Providers; Individual. Amend RSA 415:6-q to read as follows:
415:6-q Reimbursement for Ambulance Service Providers. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance that constitutes health coverage under RSA 420-G:2, IX, and that provides benefits for medically necessary ambulance services shall reimburse the ambulance service provider directly [or by a check payable to the insured and the ambulance service provider] subject to the terms and conditions of the policy, plan, or contract. Nothing in this section shall preclude an insurer from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for emergency medical services.
8 Reimbursement for Ambulance Service Providers; Group. Amend RSA 415:18-v to read as follows:
415:18-v Reimbursement for Ambulance Service Providers. Each insurer that issues or renews any policy of group or blanket accident or health insurance that constitutes health coverage under RSA 420-G:2, IX, and that provides benefits for medically necessary ambulance services shall reimburse the ambulance service provider directly [or by a check payable to the insured and the ambulance service provider] subject to the terms and conditions of the policy, plan, or contract. Nothing in this section shall preclude an insurer from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for emergency medical services.
9 Effective Date. This act shall take effect July 1, 2019.
19-0531
1/16/19
HB 685-FN- FISCAL NOTE
AS INTRODUCED
FISCAL IMPACT: [ X ] State [ ] County [ X ] Local [ ] None
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STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ ] Other | |||
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LOCAL: |
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Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill clarifies ambulance billing under the law governing emergency and medical trauma services. The Insurance Department indicates this bill prohibits balance billing for ambulance services. The bill limits reimbursement for ambulance services to a commercially reasonable value. Ambulance providers and insurers are to make best efforts to resolve disputes regarding reimbursement rates before petitioning the Insurance Commissioner to determine whether the rate is commercially reasonable. The Department states limiting rates to "commercially reasonable" may impact claim costs, which may impact insurance premiums and premium tax revenue. The bill may also impact municipal revenues as the bill also applies to public safety agencies. The Department is not able to estimate the potential number of conflicts it may have to resolve to ascertain whether it could handle the administrative responsibilities with existing resources.
The Department of Health and Human Services indicates the potential fiscal impact to the Department of the legislation's prohibition for balance billing and requirement for commercially reasonable fees for ambulance services is indeterminable at this time.
The Department of Safety indicates this bill may impact local revenue for communities with a public ambulance service.
AGENCIES CONTACTED:
Departments of Insurance, Safety and Health and Human Services