Ambulance providers push for statutory rate floor, warning rural services face collapse

Ambulance services, fire chiefs and municipal leaders told the House Commerce and Consumer Affairs Committee that prohibiting out‑of‑network balance billing will leave a fiscal hole for ground ambulance providers unless the Legislature establishes a replacement revenue mechanism.

Several witnesses supported House Bill 7 25, sponsored by Rep. Jerry Stringham, which would extend the prohibition on balance billing to ground ambulance transports and establish a non‑contract payment standard — the bill’s sponsors proposed a 325% of Medicare benchmark for non‑contract ambulance claims. Proponents said that number would stabilize provider revenues and keep services running, particularly in rural areas, and would protect patients from surprise bills.

Rep. Stringham, a consultant on health reimbursement, told the committee the ambulance business model has “broken down,” and said the proposed statutory floor would bridge the gap providers face if balance billing is banned. He referenced a state cost study and told members the approach would be neutral for taxpayers at the statewide level and would not rely on general fund appropriations.

Representatives of ambulance associations and county EMS described local operational distress: Michael Sitar of the New Hampshire Association of Fire Chiefs and Justin Van Etten of Stewart’s Ambulance said some ambulance providers are operating at a loss, relying heavily on municipal contracts and donations, and warned that closures would lengthen response times. Chris Daywas and Derek Auman of the New Hampshire Ambulance Association said existing studies did not quantify how much ground ambulance providers currently recover from balance billing and that a 325% Medicare floor was their preferred compromise to avoid destabilizing community services.

Several municipal witnesses, including Cheshire County officials, described rapid start‑up experiences and large operational bills. Cheshire EMS leaders said Medicare and some insurers pay only a small fraction of billed charges under current arrangements; one example submitted to the committee showed an ambulance billed amount where the insurer’s payment was a fraction of the charge, leaving providers to pursue balance billing that often goes unpaid.

Insurers and trade groups expressed concern. Paula Rogers of America’s Health Insurance Plans and Sabrina Dunlap of Anthem said the proposed 325% floor could raise premiums and risk shifting costs to fully regulated markets and to subsidized individual market consumers; Anthem warned a set floor could reduce carriers’ incentives to contract and could discourage providers from joining networks. Centene’s representative said many individual‑market members are subsidy‑sensitive and an across‑the‑board 325% could have unintended affordability impacts.

Insurers and some committee members urged further study and negotiation: several testified that the problem is complex because some payers are regulated by the state and others are self‑insured ERISA plans beyond state rate‑setting reach; there was concern that capping or setting rates for New Hampshire carriers could cross‑subsidize out‑of‑state policyholders and shift costs to New Hampshire property taxpayers who support municipal contracts.

Committee members said the competing bills and the insurance department’s technical report will be discussed in subcommittee and that further stakeholder work is needed to quantify the amount recovered by balance billing, model premium impacts, and design protections for rural providers.

No formal action was taken; the committee closed the public hearing and scheduled subcommittee work on competing proposals.