Bill Text - HB343 (2021)

Relative to billing for ambulance services.


Revision: Jan. 9, 2021, 7:18 p.m.

HB 343  - AS INTRODUCED

 

 

2021 SESSION

21-0413

05/10

 

HOUSE BILL 343

 

AN ACT relative to billing for ambulance services.

 

SPONSORS: Rep. Weston, Graf. 8; Rep. Luneau, Merr. 10; Rep. Marsh, Carr. 8

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill prohibits balance billing for ambulance services under the managed care law and requires insurers to reimburse ambulance providers directly.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

21-0413

05/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT relative to billing for ambulance services.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  New Paragraph; Emergency Medical and Trauma Services; Definition of Private Safety Agency.  Amend RSA 153-A:2 by in serting 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; Definition of Public Safety Agency.  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 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-f the following new section:

420-J:8-g  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, with consideration of the actual, often higher costs of the service in rural communities.  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)  Carriers shall offer an ambulance service provider a commercially reasonable payment, including ambulance services provided through the 911 service.

6  Report.  The insurance commissioner shall make a report on or before July 1, 2022 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 January 1, 2022.

HB 343  - AS INTRODUCED

 

 

2021 SESSION

21-0413

05/10

 

HOUSE BILL 343

 

AN ACT relative to billing for ambulance services.

 

SPONSORS: Rep. Weston, Graf. 8; Rep. Luneau, Merr. 10; Rep. Marsh, Carr. 8

 

COMMITTEE: Commerce and Consumer Affairs

 

-----------------------------------------------------------------

 

ANALYSIS

 

This bill prohibits balance billing for ambulance services under the managed care law and requires insurers to reimburse ambulance providers directly.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

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.

21-0413

05/10

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty One

 

AN ACT relative to billing for ambulance services.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  New Paragraph; Emergency Medical and Trauma Services; Definition of Private Safety Agency.  Amend RSA 153-A:2 by in serting 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; Definition of Public Safety Agency.  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 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-f the following new section:

420-J:8-g  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, with consideration of the actual, often higher costs of the service in rural communities.  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)  Carriers shall offer an ambulance service provider a commercially reasonable payment, including ambulance services provided through the 911 service.

6  Report.  The insurance commissioner shall make a report on or before July 1, 2022 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 January 1, 2022.