Committee hires PWW Advisory Group to study ambulance delinquent billing after two proposals
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Summary
The Emergency Response Services Committee voted to hire PWW Advisory Group to study the feasibility of a delinquent-billing reimbursement grant for ambulance providers and to analyze revenues, expenses, delinquent accounts and potential grant frameworks.
The Emergency Response Services Committee voted Oct. 26 to hire a national consulting team, PWW Advisory Group, to study the feasibility of a state grant program to reimburse ambulance providers for unpaid bills and delinquent accounts.
Representative Carlton Heinert moved to award the contract; Representative Holly seconded the motion. The committee conducted a roll call; the motion passed with recorded yes votes from committee members present.
The study follows language in 2025 legislation that directed the Legislative Council to examine whether a delinquent-billing reimbursement grant system would be feasible and desirable for ambulance service providers. The committee earlier received two competing proposals: a local team led by John Reinhart (NDW) and a national consulting group (PWW Advisory Group) partnered with EMS Management & Consultants (EMSMC). The committee selected PWW based on experience in comparable multi-state work and an ability to benchmark North Dakota against national trends.
PWW told the committee it will gather financial and operational data from ambulance providers and analyze revenue and expense patterns, delinquent accounts, cafeteria of charges, and the potential design of a reimbursement grant. PWW proposed taking a mixed approach: (1) collect existing CMS cost-report and billing data where available; (2) offer a simple Excel workbook for providers that do not have ready data; (3) produce an aggregate statewide analysis and provide agency-level feedback for participating providers.
Representative Heinert, who moved to hire PWW, said the study is intended to give lawmakers a data-driven basis for policy choices before proposing funding changes. The committee has available interim funds already approved by legislative leadership for consultant work and earlier session appropriations earmarked $20,000 to the Legislative Council for the broader study; the committee discussed confirming those funds and proceeding to work with the consultant.
The consultant—s scope includes: revenue and expense comparisons, delinquent billing totals, accounts sent to collections, volunteer/employee counts and staffing trends, and an assessment of how existing state grants and reimbursements interact with a potential new program. Committee members said they want the consultant to present cost estimates and options that can be considered by the full Legislature if policy changes are proposed.
Why it matters: Many rural ambulance providers report high levels of unpaid or underpaid emergency transport bills; the study will quantify the problem and propose options for a reimbursement program if warranted.
What—s next: PWW and EMSMC expect to begin outreach and data collection once the Legislative Council issues a notice to proceed. Committee members asked staff to confirm interim funding and set a timetable for initial deliverables, and the consultant proposed a condensed work plan to deliver an interim report suitable for legislative review.
