[{"_1":2,"_112":-5,"_113":-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",[32,76,88,100],{"_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",6600724,"mediaKeyId","3024259-bd70136f96dbd99e42b46b730cd438cd","parentId",3024259,"title","Senate hearing exposes deep divides over HB 316 ambulance reimbursement plan","audioSeconds",3958,"startMs",585000,"endMs",4543000,"viewUrl","/Search/View?dp=1&key=3024259-bd70136f96dbd99e42b46b730cd438cd&start=585&end=4543","thumbnailUrl","https://assets.pipeline.soar.com/3024259-bd70136f96dbd99e42b46b730cd438cd/thumbnail_585000.jpg","articleUrl","/articles/6600724/New-Hampshire/Senate-hearing-exposes-deep-divides-over-HB-316-ambulance-reimbursement-plan","mediaUrl","https://secure.pipeline.soar.com/6600724-8e3bbe73f969aa2790ed53f5c37cddea/orig.mp4?Expires=1771170893&Signature=X0emLT52zFM7okGA6A8-GllxU80v8jtZ334THweOKFU661K3edR93LYY6~xopM7XTCHLkFKyvOvnyupTBc975LAPg-q7PkagndMtB6pirQrj84M517bVF17o7Vz450p0GSw9B1QJ4DLw13PooUVfFmdpynDGeHS5QDzPKUTwdOywwlUjg-rSDx2dTCMRvSHzP8qHuJAV3G6yAmLBftAEc9UU1O0xRqtSbjXWPcW224ZNqiOojEFOUgBHD7xcyxqI5JBl-OnuEAoQIWdNXQJ~KSEK5tcMfir8OeOAEO~Thw86Y5-Pap35HIalk2I2HCyUr36qVaQ5YuH9X5YcusnQCg__&Key-Pair-Id=KUT5TJCACFTXG","author","New Hampshire Legislature","date","2025-04-16T16:59:54.777Z","article","House Bill 316, which proposes a uniform commercial insurance reimbursement schedule and a prohibition on balance billing for ground ambulance services, drew heavy opposition from ambulance providers, municipal officials and local chiefs at an April 16 hearing of the New Hampshire Senate Health and Human Services Committee.

The bill's sponsor in the House, Representative John Hunt (absent at the hearing), asked the Insurance Department's work product and the House Commerce Committee's solution be considered in the Senate. Senator Jeb Avard (R-District 12) introduced the bill for Representative Hunt, summarizing its main elements as a default rate schedule, a prohibition on provider balance bills and a two-year review mechanism.

Why it matters: EMS officials and local elected leaders said the proposed default commercial rate'set at 202 percent of Medicare in the department's study'would not cover operating costs and could force more providers out of business, shifting costs to towns and counties that already subsidize local ambulance services.

Providers and local officials gave multiple examples of financial strain. Chris (last name not provided), executive board member of the New Hampshire Ambulance Association and a paramedic, said Medicare pays about 46 percent of cost and Medicaid roughly 42 percent, and objected to the 202 percent figure as insufficient. He urged a commercial reimbursement floor closer to 325 percent of Medicare and asked for a short independent cost study and a pilot clause.

Multiple municipal officials and county representatives, including Jack Wozmack (Cheshire County treasurer and EMT) and Justin Van Etten (board chair, Stuart's Ambulance), said dozens of providers have failed or run on skeleton crews in recent years. They said the shortfall in reimbursement has forced some counties to step in and provide EMS service directly. Officials argued that the insurer-backed study relied on assumptions (including doubling Medicaid or paying for \"treat-no-transport\" at high rates) that lowered the calculated commercial rate.

Representatives with firefighting and EMS leadership organizations also opposed HB 316 as written. Michael Sitar, chief of the Tilton-Northfield Fire District and a representative of the New Hampshire Association of Fire Chiefs, said the PCG study omitted replacement costs and excluded some high-cost providers from its sample; NH Association of Fire Chiefs supports eliminating balance billing but only with sustainable reimbursement.

Insurers and the New Hampshire Insurance Department urged a more measured approach. Sabrina Dunlap, senior director of government relations for Anthem, told the committee she did not sponsor the department study and said insurers generally oppose government rate setting but viewed the study as a \"measured approach\" relative to other proposals. DJ Bettencourt, commissioner of the New Hampshire Insurance Department, said the department convened stakeholders, commissioned an actuarial study under a statutory mandate, and supports a ban on balance billing alongside work to identify a sustainable rate. Jason Aziz, the department's director of health economics, defended the study methodology and said implausible outlier reports were censored using accepted statistical methods.

Several witnesses described policy tradeoffs. Advocate and provider witnesses said raising commercial reimbursement to about 325 percent of Medicare would stabilize provider finances while minimally affecting premiums; insurers warned that mandatory rate-setting is \"anathema\" to managed-care models and would undercut networks and contracting.

Committee outcome and next steps: The April 16 hearing was informational; the committee took no final vote on HB 316 during the hearing. Committee members and the department indicated they intend further stakeholder conversations focused on the reimbursement rate and suggested possible compromise approaches or additional study before a final legislative decision.

Sources and evidence: Testimony and exchanges cited the Insurance Department's PCG cost study, providers' experience with Medicare and Medicaid shortfalls, and examples of local providers running deficits or ceasing operations in recent years.

The hearing closed after extended testimony and questions. The committee will consider the bill in subsequent business sessions and work sessions.

","mediaType","Video","parentTitle","Senate Health and Human Services (04/16/2025)","oneSentenceSummary","House Bill 316, which proposes a uniform commercial insurance reimbursement schedule and a prohibition on balance billing for ground ambulance services, drew heavy opposition from ambulance providers, municipal officials and local chiefs at an April 16 hearing of the New Hampshire Senate Health and Human Services Committee.","taxTitle","Judiciary, Senate , Committees\t, Legislative, New Hampshire","taxId",29511,"location","New Hampshire","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},6600714,"Lawmakers hear competing views on HB 548 to allow membership-based (direct-pay) health facilities",2329,5615000,7944000,"/Search/View?dp=1&key=3024259-bd70136f96dbd99e42b46b730cd438cd&start=5615&end=7944","https://assets.pipeline.soar.com/3024259-bd70136f96dbd99e42b46b730cd438cd/thumbnail_5615000.jpg","/articles/6600714/New-Hampshire/Lawmakers-hear-competing-views-on-HB-548-to-allow-membership-based-direct-pay-health-facilities","https://secure.pipeline.soar.com/6600714-a4bd6d5f0e0b2302d1302c6a6e1bac98/orig.mp4?Expires=1771170893&Signature=OuNfC5kTBVf~CIueZ1JwgMDJ~R~lnEwOXYIToc2KwOlWMaFGUNgpGZ0Ff9ds16773W6rTh5mcr-dPdOb2lgTF83UtXpEvVzpUgL6kAdU-Rvx5696oQgXXJNJ8oM~0upZ4bZBGCMLb2nZjMothJEpBzsvO-HVK5XvZ5muwcTrhk393K6l-8EomPDPuoAu9LvlI0I8gQjqsZYbbsG-3yXNBm4k52CgMV5IFSisW9LC1CPS2SzdSVbjVV~zNU~PPPiCLixYynbaKvlLdG2JCaST2ubTZ96rwbHLUdBfGslv17CGNGagbdjit5PfNx-Ew0d7Rj33h1LTlTXCIC9ZAOkaxw__&Key-Pair-Id=KUT5TJCACFTXG","House Bill 548 would permit licensed health care facilities to operate under a membership-based, direct-pay business model that accepts direct payment from patients rather than participating in third-party payer networks. The bill drew sharply divided testimony at an April 16 hearing of the New Hampshire Senate Health and Human Services Committee.

Why it matters: Proponents say the law would expand pricing transparency and give self-pay or uninsured patients a lower-cost alternative for elective and routine services. Opponents said the bill risks creating two classes of patients, would undermine hospitals and nursing homes that rely on a mix of payer sources to cross-subsidize care, and could reduce access for Medicaid recipients.

Supporters' case: Representative (prime sponsor) argued the measure is a narrow, market-based expansion of the direct primary care model already authorized in state law and would only apply to facilities that exclusively accept direct payment. Greg Moore of Americans for Prosperity and supporters said the approach has had limited uptake where tried (citing a long-running example in Oklahoma) and would not likely destabilize critical access hospitals; proponents also emphasized price transparency benefits for self-insured or uninsured patients.

Opponents' case: County and hospital representatives warned of unintended fiscal consequences. Jerry Kinnirk (opposing testimony) and David Ross (Hillsborough County Nursing Home, New Hampshire Association of Counties) said Medicaid reimbursements already fall short of costs, and nursing homes and hospitals rely on private-pay and rehabilitation revenue to subsidize care for Medicaid patients. Ben Bradley of the New Hampshire Hospital Association and Catholic Charities' Bob Dunn said the bill would bifurcate patient protections and patient rights, omitting key protections for patients who later become Medicaid-eligible. Bradley noted the bill's proposed separate patient bill of rights lacks protections in current law that prevent involuntary discharge when a patient becomes eligible for Medicaid; he called that omission a serious policy gap.

Sponsor amendments and narrow scope: The sponsor provided amended language in the House to exclude nursing homes and added clarifying language requested by counties; the sponsor said the version included in the budget reflected her amended language. Sponsors said they would accept targeted clarifications to the legislation to address county concerns.

Committee outcome: The committee took testimony from numerous stakeholders and did not vote on the bill at the hearing. Sponsors and opponents asked for further technical work and suggested the bill might be revised to add explicit patient-rights protections and to ensure the moratorium on nursing home bed growth remains intact.

","House Bill 548, which would permit licensed health care facilities to operate on a membership-based, direct-pay model, prompted sharply divided testimony at a Senate Health and Human Services Committee hearing on April 16.",{"_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},6600719,"Senate hears proposals to allow two-person ambulance response when staffing shortfalls persist",2809,2797000,5606000,"/Search/View?dp=1&key=3024259-bd70136f96dbd99e42b46b730cd438cd&start=2797&end=5606","https://assets.pipeline.soar.com/3024259-bd70136f96dbd99e42b46b730cd438cd/thumbnail_2797000.jpg","/articles/6600719/New-Hampshire/Senate-hears-proposals-to-allow-two-person-ambulance-response-when-staffing-shortfalls-persist","https://secure.pipeline.soar.com/6600719-bbe8892651345b019738aa3adb28d721/orig.mp4?Expires=1771170894&Signature=Iv6Wpoe-cGc8jxqR02dSeDzu~0F-G8wUjDBJ7tY3gcU5S5~gZWUvMHbywXYedBUvl61nYBIbDNfVz30nb-sWgnDdDHkfJq7wwS61WNq-jgEi6EOuUN2USLMVlayk1IJXB6ZWvCluqKAcJ-Wse8DM1BeEt93oUL1uz5PbwWTotcqKKgEw-gn3XD-3ED1BAcJjTtb~BxWw1H4BzxSYScNKPgW9paSuaxDmEtLd0Iflmb0s1J4ZmOCMFAjtSWtI0T9z606dfywfIYrGUUGrSdjE~ef2a2WDr3XOTAq5duhX94zkcHq12b65-VBMJpXwQXCwJ-PKwGRMHpWze-P-33xLhQ__&Key-Pair-Id=KUT5TJCACFTXG","Representative Jennifer Rhodes and Representative Mark Pru introduced House Bill 559 before the Senate Health and Human Services Committee on April 16, seeking to make permanent an emergency staffing rule used during the COVID-19 pandemic that allowed an ambulance to respond staffed by one licensed EMS provider and one trained firefighter.

Why it matters: Several small-town chiefs and volunteer-based departments told the committee that persistent workforce shortages make it difficult to staff two licensed EMS personnel for every ambulance shift. Proponents said the bill would be an exception to the norm used only when necessary and would preserve timely response in rural and volunteer-reliant communities.

Proponents' testimony: The bill's prime sponsor, Representative Jennifer Rhodes (Cheshire County District 17), said the measure mirrors an earlier emergency order and is intended as a narrowly used option, not the new standard. She described local experiences in which departments could get an ambulance to a scene by sending one EMS provider and a firefighter for equipment and patient handling. Representatives and town chiefs said this approach was used infrequently during the pandemic but was lifesaving in isolated incidents.

Senator questions focused on safety and operational safeguards. Senator Susan Prentiss (questioning from her EMS background) noted state data showing the COVID-era waiver was used in fewer than 1 percent of transports in 2020'21 and pressed sponsors on training and safety expectations for the non-licensed team member. Representatives and chiefs said the driver/firefighter would be a trained member of the department, not a random volunteer; sponsors said they would accept clarifying amendments to require the second person be a member of the department and receive training.

Opposition and concerns: The hearing record did not show organized opposition in the same volume as the ambulance reimbursement hearing; a few committee members pressed sponsors on whether rulemaking options or licensing waivers might address infrequent staffing emergencies without making a statutory change.

Committee outcome: The hearing closed without a committee vote; sponsors and committee members discussed the possibility of statutory amendments to require department membership and training for the non-licensed responder and explore commissioner-level waiver options as alternatives.

","A House bill (HB 559) to codify emergency-era staffing flexibility for ground ambulances drew support from small-town officials and fire chiefs seeking a legal option to send one licensed EMS provider and one trained firefighter when staffing shortages prevent two licensed EMS providers from responding.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6600709,"Committee suspends action and re-refers bill seeking standardized healthcare price files after insurer, industry concerns",1698,8029000,9727000,"/Search/View?dp=1&key=3024259-bd70136f96dbd99e42b46b730cd438cd&start=8029&end=9727","https://assets.pipeline.soar.com/3024259-bd70136f96dbd99e42b46b730cd438cd/thumbnail_8029000.jpg","/articles/6600709/New-Hampshire/Committee-suspends-action-and-re-refers-bill-seeking-standardized-healthcare-price-files-after-insurer-industry-concerns","https://secure.pipeline.soar.com/6600709-74212d333352910c1f8641e891c2940d/orig.mp4?Expires=1771170894&Signature=RqquQj5UiazYoEwHdZHwAmaY8pL8i7~mChFXxQ73eePsUMX-rJIwtpH387xrepwvG8R6K1VTeja7-4jYCHSwFS4sVcH7gciewwdp-3cyqpopQKK57k6P2zVB6nFDVo4bR~vD0SQYdF0~Kx-xNkExrpnZ6KIJEXaY3~tJUUFx8YU8N9OWrk7uoOVW8YhNKjI5SND74mGx4zXayydOshdB55GqvUz~sQ0wM5oY3gqi9ZsLtM6Uq6Q4srQ4Mk4W9q1X8jJwdIcAvKToxQC2c6py643iV38n111XxrMkMvYH1HDja7uZoakpWmp1gWnzBRABtR-CRgxpSFt0RK0VsT-Txg__&Key-Pair-Id=KUT5TJCACFTXG","House Bill 705, introduced to require standardized, machine-readable price-and-coverage files from health plans to improve health care cost transparency, was discussed at length in a Senate Health and Human Services hearing on April 16. The committee later voted to re-refer the bill for further work after insurers and the insurance department raised timing and technical concerns.

What the bill would do: HB 705 would require insurers to submit three machine-readable files: (1) allowed amounts for in-network professional and facility services by provider; (2) maximum out-of-network payment schedules; and (3) prescription-drug pricing information including insurer-paid amounts and average negotiated prices after rebates. The bill seeks a standardized format so files from multiple plans can be compiled into market-wide comparisons and to make files publicly available for private-sector tools.

Why it matters: The New Hampshire Insurance Department said the state's existing New Hampshire Health Cost site lists only a limited set of services (roughly a few hundred) because the department must rely on claims data; standardized insurer files would significantly expand the actionable pricing data available to consumers and the department.

Insurer concerns and timing: Carriers and trade groups, including AHIP and Cigna representatives, said the federal government is revising its own transparency rules following an executive order and a 90-day review; they cautioned that imposing state-specific statutory formats before federal guidance could impose substantial technical costs, duplication and uncertainty. Anthem and other insurers said the files are expensive to produce, require new computing capabilities, and currently exist in multiple inconsistent formats. Several witnesses recommended waiting for finalized federal rules and seeking collaborative, standardized formats.

Committee action: After discussion the committee voted to re-refer HB 705 for further consideration (executive session), giving committee staff and stakeholders additional time to align state requirements with expected federal guidance. The Insurance Department said it could continue stakeholder work and that a delayed schedule would be acceptable.

","House Bill 705 would require standardized, machine-readable cost-and-coverage files from health plans to improve statewide price transparency and feed the state's New Hampshire Health Cost website. Insurance department officials supported standardization; carriers urged waiting for federal guidance and complained about high implementation costs.","actionData","errors"]

Article not found

Senate hearing exposes deep divides over HB 316 ambulance reimbursement plan

Lawmakers hear competing views on HB 548 to allow membership-based (direct-pay) health facilities

Senate hears proposals to allow two-person ambulance response when staffing shortfalls persist

Committee suspends action and re-refers bill seeking standardized healthcare price files after insurer, industry concerns