SB 245-FN - AS AMENDED BY THE SENATE
03/13/2025 0775s
2025 SESSION
25-1109
05/08
SENATE BILL 245-FN
AN ACT prohibiting surprise ambulance billing and regulating ground ambulance reimbursement.
SPONSORS: Sen. Prentiss, Dist 5
COMMITTEE: Health and Human Services
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ANALYSIS
This bill prohibits health carriers and providers from balance billing for ambulance services and establishes parameters for reimbursement of ground ambulance services by participating and non-participating ambulance service providers.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/13/2025 0775s 25-1109
05/08
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACT prohibiting surprise ambulance billing and regulating ground ambulance reimbursement.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Managed Care Law; Ground Ambulance Reimbursement. Amend RSA 420-J by inserting after section 8-h the following new section:
420-J:8-i Ground Ambulance Reimbursement.
Each health carrier that issues or renews a health benefit plan shall provide reimbursement for ground emergency ambulance services, including responses to 9-1-1 calls or other unscheduled ground ambulance calls, in accordance with this section.
I. With respect to a claim for covered services rendered by a non-participating ground ambulance service provider, the health carrier shall directly reimburse the non-participating ground emergency ambulance service provider the rates set or approved, whether in contract, in ordinance, or otherwise, by a local governmental entity in the jurisdiction in which the non-participating ground emergency services originated. If the local government entity having jurisdiction where the ground emergency ambulance service originated does not have set or approved rates, the health carrier shall directly reimburse the non-participating ground emergency ambulance service provider a minimum of 325 percent of the current urban, rural or super rural Medicare rates based on the geographic area where the ground emergency ambulance service originated.
(a) The payment shall be considered payment in full for the ambulance service provided, except for any copayment, coinsurance, deductible, and other cost sharing amounts that the carrier requires the covered individual to pay; and
(b) The non-participating ambulance service provider is prohibited from billing the covered individual for any additional amount for the ambulance service provided except for any copayment, coinsurance, deductible, and other cost sharing amounts that the carrier requires the covered individual to pay.
II. An health carrier shall not require a non-participating ground emergency ambulance service provider to obtain prior authorization before transporting an enrollee in an emergency or otherwise unscheduled manner to a hospital, between hospitals or from a hospital to a nursing home, hospice care facility or other health care facility.
III. If the non-participating ground emergency ambulance service is requested in accordance with the local governmental entity dispatch protocols, by a medical clinician or first responder, the service is deemed medically necessary.
IV. This section shall not apply to air ambulance services.
V. A health carrier shall reimburse a non-participating ground emergency ambulance provider in accordance with RSA 420-J:8-a, the prompt payment requirements.
VI. A health carrier shall clearly indicate on all payment explanations of benefits whether the claim relates to an insurance plan subject to the jurisdiction of the commissioner.
VII. A health carrier that issues or renews any individual policy, plan, or contract of accident or health insurance that constitutes health coverage and that provides benefits for medically necessary ambulance services shall reimburse the non-participating ground emergency ambulance service provider directly.
VIII. Nothing in this section shall preclude an health carrier from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for ground emergency ambulance services; provided that until such time as a contract is entered the health carrier shall reimburse the non-participating ground emergency ambulance service provider at the rates and methods set forth in this section.
2 Effective Date. This act shall take effect January 1, 2026.
25-1109
5/9/25
SB 245-FN- FISCAL NOTE
AS AMENDED BY THE SENATE (AMENDMENT #2025-0775s)
AN ACT prohibiting surprise ambulance billing and regulating ground ambulance reimbursement.
FISCAL IMPACT: This bill does not provide funding, nor does it authorize new positions.
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Estimated State Impact | ||||||
| FY 2025 | FY 2026 | FY 2027 | FY 2028 | ||
Revenue | $0 | Indeterminable Increase | Indeterminable Increase | Indeterminable Increase | ||
Revenue Fund(s) | Insurance Premium Tax - General Fund | |||||
Expenditures* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
Appropriations* | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None | |||||
*Expenditure = Cost of bill *Appropriation = Authorized funding to cover cost of bill | ||||||
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Estimated Political Subdivision Impact | ||||||
| FY 2025 | FY 2026 | FY 2027 | FY 2028 | ||
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:
The Insurance Department indicates this bill would amend the managed care laws in RSA 420-J to require managed care health insurance plans to cover emergency ground ambulance services. Health carriers would be required to pay, directly, nonparticipating ambulance service providers either the rate set by the local government entity in which the ambulance service originated or in the absence of a local government rate, 325% of the current urban, rural, or super-rural Medicare rate. The bill would also prohibit balance billing to the covered individual for emergency ground ambulance services.
The Department assumes that a county or municipality that sets a rate would not set a rate less than 325% of Medicare as this is the lowest amount that could be collected for the services. The minimum rate of 325% of Medicare is a substantial increase from the current rates at which health carriers are reimbursing providers for these services. The increase in costs will exert upward pressure on future years’ premiums, as carriers design their plans to consider reimbursement to providers and the covered person’s cost sharing liability. The Department’s analysis assumes the cost increase will be result in increased premiums. An increase in premiums will result in a correspondent increase in premium tax revenue.
To the extent local and county governments purchase health insurance, they may see increased premiums. Localities and counties that provide ambulance services will also be impacted in that they would have the ability to set rates for ambulance services without restrictions which could potentially increase their revenues. The extent of the impact will vary by specific locality.
To estimate the fiscal impact of the new rates, the Department examined the PY2024 NH Comprehensive Healthcare Information System (NH CHIS), which contains adjudicated claims for fully insured commercial members. Total amounts paid for the applicable ground ambulance procedure codes [A0426, A0427, A0428, A0429, A0432, A0433, A0434] were compared to total revenue potential using 2025 Medicare rates * 3.25 (i.e.: 325% of Medicare). The Department applied the procedure-specific ground ambulance claim frequencies by their respective urban, rural, and super-rural NH proportions to derive an aggregate 2025 Medicare rate at 325% value (this value was: $33,890,817). The observed PY2024 total paid amount ($10,025,546) was subtracted from this projection to derive the difference between what commercial payers paid for the selected services and what the payments would be at 325% of Medicare. The result was an increase of $23,865,271.
To estimate the impact on commercial health insurance premiums, the Department divided the increase by the number of fully insured commercial members as of April 2024. The table below provide per member per year (PMPY) and per member per month (PMPM) premium impact. These costs are provided assuming that the enhanced advance premium tax credits (APTCs) are intact (267,000 commercial fully insureds), and assuming the enhanced APTCs are repealed (252,000 commercial fully insureds):
Rates at 325% of Medicare - Marginal Aggregate cost of $23,865,271 | |||
With Enhanced APTCs | Without Enhanced APTCs | ||
PMPY | PMPM | PMPY | PMPY |
$89.38 | $7.45 | $94.70 | $7.89 |
The Department of Health and Human Services states this bill will have no impact on their Department as it does not apply to the Medicaid Managed Care Organizations.
AGENCIES CONTACTED:
Insurance Department and Department of Health and Human Services
| Date | Amendment |
|---|---|
| March 6, 2025 | 2025-0775s |
| Date | Body | Type |
|---|---|---|
| Feb. 12, 2025 | Senate | Hearing |
| March 13, 2025 | Senate | Floor Vote |
| May 13, 2025 | House | Hearing |
| May 27, 2025 | House | Exec Session |
May 21, 2025: Executive Session: 05/27/2025 01:15 pm LOB 302-304
May 21, 2025: Subcommittee Work Session: 05/27/2025 10:00 am LOB 302-304
May 20, 2025: Subcommittee Work Session: 05/21/2025 11:30 am LOB 302-304
May 7, 2025: ==CANCELLED== Subcommittee Work Session: 05/20/2025 11:00 am LOB 302-304
April 30, 2025: ==CANCELLED== Subcommittee Work Session: 05/07/2025 10:00 am LOB 302-304
April 30, 2025: Public Hearing: 05/13/2025 01:15 pm LOB 302-304
March 28, 2025: Introduced (in recess of) 03/27/2025 and referred to Commerce and Consumer Affairs HJ 11 P. 113
March 13, 2025: Ought to Pass with Amendment #2025-0775s, MA, VV; OT3rdg; 03/13/2025; SJ 7
March 13, 2025: Committee Amendment # 2025-0775s, AA, VV; 03/13/2025; SJ 7
March 7, 2025: Committee Report: Ought to Pass with Amendment # 2025-0775s, 03/13/2025; Vote 5-0; CC; SC 12
Feb. 5, 2025: Hearing: 02/12/2025, Room 101, LOB, 10:15 am; SC 9
Jan. 23, 2025: Introduced 01/09/2025 and Referred to Health and Human Services; SJ 3