04/03/2025
MOST RECENT LEGISLATIVE UPDATE:
Despite total opposition from NH’s EMS providers, fire chiefs and municipal association members and over 600 petition signers, the NH House passed House Bill 316. The bill mandates the end of ‘balance billing’ for all NH ground ambulance providers without ensuring sustainable reimbursement rates for those providers. NH Ambulance providers will no longer be able to ‘balance bill’ when commercial insurance carriers pay less than the cost of the actual service provided. The bill now heads to the NH Senate for their review.
Here’s a breakdown of the key concerns:
1. The Impact of Ending Balance Billing
- Balance billing occurs when a ground ambulance provider bills a patient for the costs not ‘covered’ by their insurance. All parties want it to end.
- HB.316 mandates eliminating this practice, meaning ambulance providers can no longer charge patients directly for uncovered costs or below cost reimbursement.
- Without a neutral funding mechanism, this new mandate will leave ground ambulance providers with more reimbursement shortfalls, especially when insurers set low rates to increase their profits and maximize shareholder returns.
2. The Financial Void
- The NHAA maintains that HB.316 protects insurers but doesn’t provide sustainable ground ambulance reimbursement rates. It is a pro-insurance bill.
- If commercial insurance companies pay only at Medicare or only slightly above Medicare rates, this will create significant added financial strain for all NH ground ambulance providers leading to higher property taxes - all to keep for profit commercial insurance rates low.
- Ambulance providers already struggle with below cost Medicaid and Medicare reimbursements – which currently reimburse at less than half of actual costs – and are at severe risk of being reduced even further.
3. Serious Risks to Ambulance Services
- The NHAA warns that added inadequate funding could lead to More financial instability, forcing more NH ground ambulance services to close or reduce operations; Increased property taxes, as municipalities will need to increase subsidies of emergency medical services (EMS) to compensate for the additional lost revenue; longer response times and reduced ambulance availability, impacting patient care, wait times and emergency response efficiency.
4. What the NH Senate Could Do
- The NHAA is advocating for an amendment that sets the minimum commercial insurance reimbursement rate in line with the 325% of Medicare benchmark seen in successful legislation in currently more than a dozen other states. This 325% rate recognizes the cost sharing inequity challenges facing ambulance providers and is proven to provide neutral reimbursement levels after ending balance billing. It also allows ambulance providers to eliminate balance billing while preserving affordable insurance premium rates for consumers.
The NHAA urges the NH Senate leadership to amend the required minimum reimbursement amount of this bill.
