NH Commerce and Consumer Affairs subcommittee votes to ITL HB 185 after debate over ambulance reimbursement

The Commerce and Consumer Affairs subcommittee voted unanimously to recommend Inexpedient to Legislate (ITL) on House Bill 185 after an extended discussion about how health insurers should reimburse ambulance providers and whether to ban balance billing.

The vote came after members and stakeholders described three different proposals for addressing ambulance reimbursement. Sponsors and witnesses contrasted HB 185, which a sponsor described as requiring insurers to pay the ambulance company’s billed amount; a proposal that would require insurers to reimburse at 325% of Medicare rates and bar balance billing; and HB 316, which would direct the Insurance Department to use a consultant and published cost data to calculate a default reimbursement schedule (PCG’s analysis produced a recommended level the department described as roughly 204% of Medicare for the current analysis).

Why it matters: ambulance reimbursement affects municipal budgets, provider finances and patient exposure to “balance bills.” Subcommittee members repeatedly framed the choice as shifting costs between property taxpayers, insurers (and thus premiums) and patients. Several municipal and provider witnesses said existing in‑network contracts are rare outside urban areas; some providers said network payments are too low to sustain operations.

Members and witnesses

Michelle Heaton, director of life and health at the New Hampshire Insurance Department, told the panel that emergency services are treated as an essential benefit and “It would be covered under. It's part of our benchmark plan, so it's gonna be covered.” Heaton said the department used federal CMS GATS cost data as the basis for a consultant (PCG) analysis and offered to host further Q&A on the study.

Michael Sitar, chief of the Tilton‑Northfield Fire District, described local rate setting and the gap between billed charges and what providers collect: “I don't set the rates. The board of fire commissioners ... set the rates,” Sitar said, explaining his district’s internal method for allocating costs and why billed charges can differ from the PCG cost study.

Representative Gibbs, a lead sponsor of the motion to ITL HB 185, summarized the policy tradeoffs: the state cannot change federal Medicare/Medicaid reimbursement, nor directly set municipal property taxes, so the committee can act only on the insured market. Gibbs said testimony from providers indicated a reimbursement level of 325% of Medicare would give many providers “a fighting chance of not going out of business.”

Key differences among the three bills discussed

- HB 185 (sponsor discussed in the hearing): described by proponents as a measure that would require insurers to pay the provider’s billed charge in the absence of a contract. Opponents and staff noted the bill contains a clause saying the section would not apply to policies that exclude ambulance coverage; Insurance Department staff told the panel they were not aware of any major medical plan that currently excludes ambulance service. The subcommittee voted to ITL HB 185.

- The 325% proposal (referred to during the meeting as HB 725 in discussion): sets reimbursement at 325% of Medicare published rates for noncontracted ambulance transports and includes a prohibition on balance billing to patients if insurers pay at that level. Supporters argued the higher floor would reduce municipal subsidy and end balance billing; critics called the 325% figure arbitrary and said it could increase premiums.

- HB 316 (sponsor-presented, study-driven approach): directs the Insurance Department to rely on CMS/GATS data and a consultant (PCG) to calculate a uniform default reimbursement schedule, with separate urban/rural/super‑rural rates. PCG’s analysis cited in the meeting produced a calculated level described by staff as about 204% of Medicare for the current data set; committee members discussed updating the analysis every two years and holding a department Q&A to walk through methodology.

Numbers and financial context clarified at the hearing

- The 325% number was described repeatedly as a legislatively set reimbursement floor in one bill; PCG’s cost analysis produced a markedly lower calculated floor (staff cited ~204% of Medicare for the current dataset).

- Participants disputed how much balance billing is collected: witnesses gave ranges during the hearing, and one presenter said “60 to 80% gets paid” while others said a much smaller share of balance bills is actually collected.

Committee action and next steps

Representative Gibbs moved that the subcommittee recommend ITL on HB 185. The motion passed unanimously on a voice vote recorded as seven ayes. Committee members discussed advancing either the PCG study approach (HB 316) or a statutory percentage (the 325% proposal) instead of HB 185; several members asked the Insurance Department and PCG to make their detailed analysis available and offered to hold a follow‑up technical Q&A session for members and stakeholders.

Ending: The subcommittee closed the session after adopting the ITL recommendation on HB 185. Members said they expect further work on reimbursement methodology — either a legislated percentage or a data‑driven default schedule — in later committee action. A department staffer said the cost study and its urban/rural breakdowns are available and that PCG can be asked to present the methodology at a later meeting.