[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6380092,"mediaKeyId","2133276-ae007c5098e2b3537a52f01a527df9e5","parentId",2133276,"title","Critical-access hospitals seek exemption from ambulance-district mandate","audioSeconds",3229,"startMs",4675000,"endMs",7904000,"viewUrl","/Search/View?dp=1&key=2133276-ae007c5098e2b3537a52f01a527df9e5&start=4675&end=7904","thumbnailUrl","https://assets.pipeline.soar.com/2133276-ae007c5098e2b3537a52f01a527df9e5/thumbnail_4675000.jpg","articleUrl","/articles/6380092/North-Dakota/Critical-access-hospitals-seek-exemption-from-ambulance-district-mandate","mediaUrl","https://secure.pipeline.soar.com/6380092-5fed5088833e9279db34d1dcc8c65ba5/orig.mp4?Expires=1771193047&Signature=kDSUT2ALbVdF5sZGZFtE0hkm9oOedtuWRB~aqbhZ-8KEa3EhQ4a07j8w3tL1oDs6feojTRDAJeE00pNeRU9el9EGIToqUxarDUXNwc4dmlTLYYMGOihBfyuxW~9rv8wA0LWgz-nxz1R6ChiI5rqNMeJ9P-TyFqjorDAnHjrbG2OG~Py-eXtXVeOpykgeioiJ4Y4IypMy-HFZX6723p2sdmhP~nHLZDDSmjJpLWBD8ijeUlMDEuCWm8EDID1nT4dr8Ro-1iHSlWo0gFXYqj9xeivq2ONGZp5n9Dno7qSx~mvI49q~L~8okjkJuRPtfBzXfkQbHG2fIXjNOQ335d2CzQ__&Key-Pair-Id=KUT5TJCACFTXG","author","House Human Services, ND","date","2025-01-20T00:00:00Z","article","House Bill 1339 would exempt critical-access hospitals that own and operate ambulance services from a statutory requirement to form rural ambulance service districts. Representative Gretchen Dobrevich (District 11) introduced the bill at a House Human Services Committee hearing, saying the exemption would avoid duplicative oversight and possible loss of funding for small hospital-run services.

\"This area of code currently exempts ambulance services owned by a county, a city, under joint ownership, a tribal nation, the federal government, and cities with population of 6,500 or more,\" Dobrevich said. She told members that nine of North Dakota's 36 critical-access hospitals currently operate ambulance services and that the bill would give those hospitals the choice to forego district formation.

Pete Antonson, a long-time Northwood community leader, testified that his hospital's ambulance service is tightly integrated with facility operations — sharing staff, vehicles, billing and community programs — and that forcing a separate taxing district would create another board, duplicate oversight and risk unintended financial consequences. \"Our clinic manager currently is on the ambulance squad and will leave during the day when there's a run,\" Antonson said, describing staff sharing and billing integration.

Wayne Reed, CEO of Langdon Prairie Health, said his hospital already reports to boards, receives county mill levies and provides cross-jurisdictional coverage; he argued a mandate would add complexity and could harm rural hospitals. \"Anything that we do in America to make what we do in rural health care more difficult is something I want to avoid at all cost,\" Reed said.

Supporters of the 2023 law that required district formation previously argued districts provide a stable local funding mechanism and shared governance for ambulance services. Adam Parker of the North Dakota EMS Association told the committee the 1365 legislation aimed to make ambulance service funding and governance more consistent across rural areas and that districts can consolidate reporting requirements across multiple counties. Parker said many ambulance services already receive some tax support and that the district structure is intended to ensure sustainable local backing.

Representative Dobrevich and hospital witnesses proposed the exemption as an option, not a mandate, and said hospitals would be willing to sign memoranda of agreement to ensure backup coverage for neighboring volunteer services. The committee heard multiple local examples and closed the hearing without taking a final vote.","mediaType","Video","parentTitle","House Human Services Jan 20, 2025","oneSentenceSummary","Representative Gretchen Dobrevich and several rural hospital leaders told the committee that hospitals that operate ambulance services should be exempt from a new mandatory ambulance-district requirement, citing administrative duplication and potential funding impacts.","taxTitle","Human Services, House of Representatives, Legislative, North Dakota","taxId",28893,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6380098,"Committee hears bill to allow ambulance-license transfers, close substation model for part-time posts",1756,2918000,4674000,"/Search/View?dp=1&key=2133276-ae007c5098e2b3537a52f01a527df9e5&start=2918&end=4674","https://assets.pipeline.soar.com/2133276-ae007c5098e2b3537a52f01a527df9e5/thumbnail_2918000.jpg","/articles/6380098/North-Dakota/Committee-hears-bill-to-allow-ambulance-license-transfers-close-substation-model-for-part-time-posts","https://secure.pipeline.soar.com/6380098-4a9f9828a46b3d27cff6db7f36598b1e/orig.mp4?Expires=1771193047&Signature=IExvnEVS4aNFsYDhWkmEJc8bmpaq-tQqFSUl4pveSQxrubG42hVRX7lI4GhuvUiDQdLZ1LLV6gUDTxPRu1h2XqRgcOha09TA2Upd0nyRdjafHEa~CgOYcUpp4Am4b11Q1Sn82UHgG1nWeOYPWpV60Mvt-7s~gSqzcVkc08llUiQxwwDgpjEA0Eanf0AOelrh3hTWFHOmM26s8RI2y9H2i2QtMjP32uHoaRtV4OrKyVgNBAhbCmKaLOlsgtn9yG~XkgbbMk3~hhgSystASYc4FKYSr9dz0gDsIdPVTDL3yXiIcZCDjh7Vi2x8~mgOnT0V3rlIOLGBfh2FRsp-7JYDSQ__&Key-Pair-Id=KUT5TJCACFTXG","The House Human Services Committee opened a hearing on House Bill 1394, which would make two primary changes to ambulance licensing: permit ambulance-license transfers subject to approval by the Department of Health and Human Services, and prevent creation of new \"substations\" — part-time ambulance postings that the bill's proponents say have not reliably provided coverage.

Representative Pat Heinert (District 32) introduced the bill, saying it \"allows for ambulance licensing to be transferred subject to approval of the State Department of Health and Human Services\" and \"closes the door on substation licensure.\" He said the changes are intended to improve system reliability when services consolidate or change ownership.

Adam Parker of the North Dakota EMS Association testified in support and circulated an amendment intended to clarify existing statute language about stations, substations and assigned service areas. \"Substations are generally former ambulances that no longer provide full time coverage,\" Parker said, and he told the committee that part-time substations sometimes fail to respond reliably, producing long response times for residents in those assigned areas.

Parker and other supporters asked that existing substations be allowed to continue under the amendment while new substations be blocked going forward. \"We would allow existing substations to continue,\" Parker said, adding the department could address problems through rulemaking and that some substations function adequately while others do not.

Chris Price, director of the state's EMS unit at the Department of Health and Human Services, said the department supports the bill and would treat license transfers the same as new applications, noting the department's statutory needs-assessment and multi-year budget review for licensing. \"There is quite a process,\" Price said, \"we just don't want to hand out licenses like trading cards.\"

Opponents raised concerns that the bill as originally worded could force established multi-station services to close additional stations or alter local operations. Corey Johnson, assistant fire chief for the Williston Fire Department, said Williston operates a headquarters and two additional stations that the department has treated as a single licensed service and that mandatory substation relicensing or sunset rules could require closure of stations. Johnson said the amended language circulated by supporters would meet the Williston department's needs.

Committee members asked how fees and licensing reviews work and whether transfers would prompt reallocation of service areas. Price said transfers would be assessed by the department using the same application, needs assessment and budget-review process as any new service. Supporters said the bill is intended to help transitions when a nonprofit sells an ambulance operation or when a rural district is created to assume an operation.

The committee took testimony from EMS association representatives, the department and local respondents and closed the hearing without taking final action.","House Bill 1394 would allow transfer of ambulance licenses with DHHS approval and limit creation of 'substations' — part-time posted ambulances — after testimony showed substations sometimes failed to provide reliable coverage.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6380102,"Committee hears bill to bar ambulance balance billing, set insurer payments at up to 400% of Medicare",2666,232000,2898000,"/Search/View?dp=1&key=2133276-ae007c5098e2b3537a52f01a527df9e5&start=232&end=2898","https://assets.pipeline.soar.com/2133276-ae007c5098e2b3537a52f01a527df9e5/thumbnail_232000.jpg","/articles/6380102/North-Dakota/Committee-hears-bill-to-bar-ambulance-balance-billing-set-insurer-payments-at-up-to-400-of-Medicare","https://secure.pipeline.soar.com/6380102-a4198aee5236dbd4e9d4cb33c76b6046/orig.mp4?Expires=1771193047&Signature=Y-YutnmApx8PxGCkCsfmgG9wg0pyH5cIIZVIHLfLOdWkSyk0I2Qz2kEHMNOy3UqhZd2qu056F-TWYteApj54PhjgXH5ZzqZEqJAhcytNgRMYIXLcUPokWDsCGkrlU1w-sP6PUu3i7XoiJj5w0ttBM6Lmhm66narNm6V5YHFjehYgmckh2Pw7g55gEuw~lMzHjULrRWpZ~8LZjGyuHvpWdqcdKuZqn3DX84xBQXXbAzNUs2B3V0QCBco2hr6rC3by8wfMrM9GsQt51IDiWmOKJMLkEe4yHu~LzQUHCOuVIqVq4imVR0Dcnas3KUeVUmWlZzaLEAt2CX8GK-evMtNrGA__&Key-Pair-Id=KUT5TJCACFTXG","The House Human Services Committee opened a hearing on House Bill 1322, a proposal to change how insurers pay ground ambulance providers and to prohibit balance billing of patients.

Proponents said the bill would protect rural ambulance services that are losing money on many calls and prevent patients from receiving surprise bills. \"This bill is...another cog in the wheel of trying to shore up our rural EMS, making sure it's viable in the future,\" said Representative Robin Wise (District 14), who introduced the measure.

The bill would (1) prohibit ambulance providers from collecting amounts from patients beyond applicable copayments, coinsurance and deductibles; (2) require insurers to pay ambulance providers directly in many instances; and (3) set a payment benchmark the bill's proponents described as up to 400% of Medicare for ground ambulance reimbursement.

Adam Parker, testifying for the North Dakota EMS Association, said state-collected data show the cost of delivering ambulance services rose about 66% over six years while reimbursement rose about 11%, leaving local taxpayers to make up the difference. \"There are 116 licensed ambulance services,\" Parker said, and many rural services subsidize operations through property taxes and state grants. He told the committee that about 30% of calls result in no transport and are typically not reimbursed, and that average costs per response reported by state and federal data (about $2,110 to $2,457) are substantially higher than typical Medicare payments.

Parker told lawmakers the 400%-of-Medicare figure would move many reimbursements closer to cost, illustrating that a Medicare base rate he cited (about $435.90 for a BLS emergent call and $8.76 per mile, using last year's figures) would translate to a much larger payment when multiplied by 400% and when rural/remote modifiers apply. He said other states have adopted similar approaches and that a direct-pay requirement helps small services with cash flow.

Hospital and ambulance supporters backed the bill. Tim Blassel, president of the North Dakota Hospital Association, said funding and workforce are the two recurring issues he hears from members and that increased reimbursement aligns payment with the cost of providing service.

Insurers and some health plans expressed concerns. Megan Ruby of Blue Cross Blue Shield of North Dakota said the bill as drafted could \"negate all of those contracts\" and disincentivize providers from joining insurer networks, because a statutorily set reimbursement could remove the advantage of being in-network. She warned parts of the bill could be preempted by federal law for self-funded (ERISA) plans and urged amendments to limit the law's application to out-of-network providers or to exclude air ambulances.

Dylan Wheeler of Sanford Health Plan said his company strongly supports the bill's prohibition on balance billing for ground ambulances but questioned a fixed 400%-of-Medicare statutory rate. Wheeler said visibility of plan rates and local contracting should be used to set fair payments, and he cautioned that a high statutory rate might remove incentives to contract and raise costs for members.

Committee members asked about unreimbursed calls, the drivers of rising costs (largely staffing and declining volunteerism), the difference between BLS and ALS codes, and how other states have approached rates. Supporters and opponents said they were willing to work on amendments.

The hearing record included data points and policy trade-offs rather than a committee vote. Testimony for and against the bill was extensive, and insurers requested targeted amendments to preserve in-network contracting and avoid federal preemption issues. The committee closed the hearing without taking final action.

Ending: The committee moved next to other bills on its agenda; no final vote on House Bill 1322 was recorded during the hearing.","A House Human Services hearing on House Bill 1322 featured supporters saying the measure would protect patients and shore up rural ambulance services, while insurers warned the bill could disrupt provider networks and raise premiums.","actionData","errors"]

Article not found

Critical-access hospitals seek exemption from ambulance-district mandate

Committee hears bill to allow ambulance-license transfers, close substation model for part-time posts

Committee hears bill to bar ambulance balance billing, set insurer payments at up to 400% of Medicare