Senate hearing exposes deep divides over HB 316 ambulance reimbursement plan

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.