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Lawmakers debate 'no‑surprises' ambulance billing; insurers and providers clash over reimbursement floor
Summary
Senate Bill 245, a 'no surprises' ambulance‑billing measure to ban balance billing and set reimbursement guardrails for out‑of‑network ground ambulance care, produced contested testimony from ambulance providers and insurers about costs and premium impacts.
Senate Bill 245, a measure to prohibit balance billing by ground ambulance providers and to set payment guardrails for out‑of‑network ambulance services, generated a lengthy committee hearing with opposing testimony from ambulance providers, fire chiefs, hospitals and insurers.
Sponsor Senator Suzanne Prentiss described the bill as a consumer‑protection measure aligned with federal discussions about ambulance billing. Under the bill’s draft text, emergency ambulance rides would be protected from balance billing; insurers would reimburse out‑of‑network ground ambulance providers either at locally‑approved municipal rates (where municipalities set rates via public process) or at a commercial rate floor tied to a percentage of Medicare. The sponsor also proposed a modest patient cost‑sharing cap for out‑of‑network ground ambulance transports.
Provider witnesses — including representatives of the New Hampshire Ambulance Association and long‑time paramedics — said existing commercial reimbursement is below the cost of operations and that many ambulance services rely on out‑of‑network balance billing to remain solvent. They said the state’s prior cost study (commissioned last year) shows reimbursement has not kept pace with operational costs, and urged statutory protection banning balance billing while ensuring a cost‑based reimbursement floor.
Insurers and PBMs (represented by Anthem, Centene/Ambetter, AHIP, and PCMA) cautioned against a legislated commercial rate floor without an evidence‑based methodology. Insurance department staff and carriers noted the state commissioned a cost study (using Medicare and provider survey data) that produced an estimate of the cost of ground ambulance services, and suggested the legislature base a payment approach on periodic, transparent cost analysis rather than setting a fixed high percentage. Industry witnesses warned that an open 325%‑of‑Medicare floor could shift costs to commercially insured members and raise premiums.
Committee members adopted a separate replace‑all study commission amendment (Senate Bill 130) and added insurer representation to that panel so payers would be part of the systemic review. The committee did not vote on the main SB 245 bill at the hearing; testimony will inform later deliberations on whether to adopt a reimbursement mechanism and what form it should take.
Ending: The committee continued deliberation on SB 245. It asked the Department of Insurance and stakeholders to coordinate on a factual baseline (cost study results, collected balance billing amounts) before taking final legislative action.
