Revision: April 18, 2024, 10:42 a.m.
SB 407-FN - AS AMENDED BY THE SENATE
03/21/2024 0999s
04/11/2024 1422s
2024 SESSION
24-3036
05/10
SENATE BILL 407-FN
AN ACT relative to direct pay for ambulance services.
SPONSORS: Sen. Prentiss, Dist 5; Sen. Fenton, Dist 10; Sen. Watters, Dist 4; Sen. Altschiller, Dist 24; Sen. Perkins Kwoka, Dist 21; Sen. Soucy, Dist 18; Sen. Rosenwald, Dist 13; Sen. Whitley, Dist 15; Sen. Gannon, Dist 23; Sen. Innis, Dist 7; Sen. Birdsell, Dist 19; Sen. Carson, Dist 14; Sen. Chandley, Dist 11; Sen. D'Allesandro, Dist 20; Rep. Goley, Hills. 21; Rep. S. Pearson, Rock. 13; Rep. Stringham, Graf. 3; Rep. Wolf, Merr. 7
COMMITTEE: Health and Human Services
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AMENDED ANALYSIS
This bill regulates insurance reimbursement for ambulance 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/21/2024 0999s
04/11/2024 1422s 24-3036
05/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to direct pay for ambulance services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Accident and Health Insurance; Individual Policies; Reimbursement for Ambulance Service Providers. Amend RSA 415:6-q to read as follows:
415:6-q Reimbursement for Ambulance Service Providers.
I. 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]. An insurer shall provide reimbursement for ambulance services at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the rates set by the local government or contracted entity subject to a public process prior to adoption or readoption, or at the rate of 325 percent of the published rate for ambulance services established under the Medicare law for the same ambulance service provided in the same geographic area, or according to the participating ambulance provider's billed charges, whichever is the lesser amount. All current rates set by local government and the entities shall remain in place unless a change is proposed. This section shall apply to unscheduled emergency calls and emergency interfacility transfers. This section shall not apply to policies that do not include coverage for ambulance services.
II. 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.
III. In the event of a dispute between a health care provider and an insurance carrier relative to this process, RSA 420-J:8-e shall apply.
2 Accident and Health Insurance; Group Policies; Reimbursement for Ambulance Service Providers. Amend RSA 415:18-v to read as follows:
415:18-v Reimbursement for Ambulance Service Providers.
I. 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]. An insurer shall provide reimbursement for ambulance services at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the rates set by the local government or contracted entity subject to a public process prior to adoption or readoption, or at the rate of 325 percent of the published rate for ambulance services established under the Medicare law for the same ambulance service provided in the same geographic area, or according to the participating ambulance provider's billed charges, whichever is the lesser amount. All current rates set by local government and the entities shall remain in place unless a change is proposed. This section shall apply to unscheduled emergency calls and emergency interfacility transfers. This section shall not apply to policies that do not include coverage for ambulance services.
II. 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.
III. In the event of a dispute between a health care provider and an insurance carrier relative to this process, RSA 420-J:8-e shall apply.
3 Effective Date. This act shall take effect 60 days after its passage.
24-3036
Amended 4/18/24
SB 407-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2024-1422s)
AN ACT relative to direct pay for ambulance services.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable | ||
Revenue Fund(s) | General Fund Insurance Premium Tax Revenue | |||||
Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
Funding Source(s) | None
| |||||
Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• Does this bill provide sufficient funding to cover estimated expenditures? [X] N/A • Does this bill authorize new positions to implement this bill? [X] No | ||||||
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Estimated Political Subdivision Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
County Revenue | $0 | $0 | $0 | $0 | ||
County Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
Local Revenue | $0 | $0 | $0 | $0 | ||
Local Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
METHODOLOGY:
This bill regulates insurance reimbursement for ambulance services. The Insurance Department indicates this bill would amend RSA 415:6-q (individual) and RSA 415:18-v (group) insurance laws by requiring insurers to reimburse ambulance service providers at negotiated rates. In the absence of negotiated rates (e.g., ambulance provider is out-of-network), the bill would require insurers to pay ambulance providers at rates set by local (municipal or county) government, or their contracted entity providing such services, subject to a public approval process, or at a rate set at 325% of the Medicare reference rate. The Department notes the current Medicare reference rate is stratified by three levels of rurality status: urban, rural, and super rural. The requirement would apply to unscheduled emergency calls and emergency inter-facility transfers. The Department estimated increased total claims cost for emergency ground ambulance services of at least $11.8 million or $4.41 per member per month (PMPM) if the local rate were set at billed rates for 2022. The Department assumes providers would migrate to the 325% of Medicare rate, rather than to negotiate a lower rate if this bill were to become law.
To arrive at the estimated fiscal impact on claims of $11.8 million, the Department analyzed claims data from plan year 2022, for two candidate emergency ground ambulance service base rates representing an overwhelming majority of the emergency transport claims in PY2022 (CPT codes: A0427 ALS-emergency; A0429 BLS-Emergency), plus average mileage charges based on reference values from the 2018 NHID Ground Ambulance Report—which uses 2017 medical claims data. The Department compared the result of this analysis to a rate at 325% of the Medicare rate (considering rural status) and applied the difference to the 6,782 paid claims for A0427 and 3,187 paid claims for A0429.
AGENCIES CONTACTED:
Insurance Department