Emergency Response Committee hires consultant to study ambulance delinquent billing; award passes on roll call
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Summary
The Legislative Emergency Response Services Committee voted to award a consulting contract to PWW Advisory Group to study delinquent ambulance billing and the feasibility of a state reimbursement grant system after receiving testimony about insurance limits and provider financial strain.
The Emergency Response Services Committee voted Wednesday to hire a national consulting team to study unpaid ambulance billing across North Dakota and to recommend whether the state should create a delinquent-billing reimbursement grant for ambulance providers.
The committee approved awarding the work to PWW Advisory Group after hearing competing proposals and listening to testimony from providers, the Insurance Department and other stakeholders. Representative Jim Heinert moved to award the contract to PWW; Representative Holly seconded. The award passed on a roll-call vote.
Why it matters: committee members said they want reliable data that will show how much unpaid billing local ambulance services carry, how unpaid runs affect operations, and whether a state-funded reimbursement program would be a cost-effective way to keep rural services open. State law (House Bill 1322, 2025) already directed a legislative study of the issue and included a $20,000 appropriation to the Legislative Council; the committee authorized a contract with a consultant to carry out the detailed data work.
What the committee heard: small ambulance operators and local officials told the committee unpaid bills and low reimbursement from some payers are a major financial pressure. John Reinhart, representing ambulance providers, told the committee he and local services want “actionable data” and recommended a listening tour and simple data collection tools so providers can submit their financials. Deputy Insurance Commissioner John Arnold said insurance regulation covers many disputes for covered patients — “for those covered services, we do have prompt payment laws in place” — but he cautioned that many plans and large-employer “self-funded” arrangements are regulated at the federal level and fall outside the state insurance regulator’s authority.
What the contract covers: the consultant will collect revenue and expense data from services, quantify delinquent and uncollectable accounts, analyze patterns by payer (including Medicare/Medicaid, private, and uninsured), and draft recommendation(s) for whether and how a state grant program might reimburse uncompensated ambulance runs. The consultant will also identify administrative approaches and a cost estimate for implementing any reimbursement program.
Next steps: the committee directed Legislative Council staff to complete contracting with the selected vendor and to proceed with the consultant timetable. The consultant will survey providers and produce a written report for the committee with policy options for legislation or grant design.
Votes at a glance: The motion to award the contract to PWW Advisory Group was made by Representative Jim Heinert and seconded by Representative Holly. The committee then took a roll call; the motion carried. (Committee clerks recorded the roll-call yes votes.)
What remains open: Committee members said they expect the consultant to return concrete cost estimates, which the panel will use when it considers whether to recommend a state-funded reimbursement program. Several members said they wanted the next meeting scheduled to review a detailed consultant scope and to give absent committee members a chance to weigh in on priorities.
