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.

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.