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Merrimack council adopts ambulance billing rates under new state law
Summary
Following enactment of Senate Bill 245, the Merrimack Town Council voted unanimously to adopt the state-prescribed ambulance billing approach (325% of Medicare) and authorized the town manager to sign related documents; councilors heard data on call counts, payer mix and hardship protections.
The Merrimack Town Council voted unanimously Jan. 22 to adopt ambulance billing rates aligned with Senate Bill 245, the state law that sets payment rules for nonparticipating emergency ground ambulance services.
An agency official explaining the change said the law requires insurers to pay either a locally set rate agreed by contract or 325% of the Medicare rate for two years, and it eliminates balance billing for patients for amounts above insurer payments. The official said the town’s billing agency will still pursue deductibles and coinsurance, but not post-enforcement balance bills to patients once insurers pay the 325% level. “By going in this program, it’s 325% of Medicare rate,” the presenter said.
Council members reviewed local ambulance use and payer data presented at the meeting: the town billed for 1,843 ambulance trips in 2025; roughly 79% of runs involved Merrimack residents, about 94–95% of runs had some form of insurance coverage, and approximately 5.75% of runs were listed as uninsured. The presenter said shifting to the SB 245 framework would affect primarily commercial insurers and self-insured plans, and that the town has hardship-review procedures through the finance and welfare departments for patients who cannot pay.
Councilor Nancy (surname recorded in the minutes) made the motion to adopt the SB 245-related rate structure and authorize the town manager to sign necessary documents; the motion passed 7–0. The presenter told the council the town had already submitted the New Hampshire ground ambulance provider application that would be necessary to qualify for the statutory rate treatment.
The council did not change local hardship-review procedures and was told those options will remain available to residents. The town will implement the new rate structure and continue required cost reporting as dictated by the statute.
The action is effective under the town’s adopted implementation steps following the Jan. 22 vote; staff did not set a separate follow-up meeting date specifically for ambulance billing implementation at the time of the vote.
