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Council grapples with state ambulance-billing law that could raise local fees; final decision deferred
Summary
After explanation of Senate Bill 245 (effective Jan. 1) that requires carrier reimbursements tied to Medicare rates, councilors debated whether to set local ambulance charges at 325% or 100% of Medicare rates; concerns about uninsured residents and collection led the council to request more data and defer a final local decision.
Town staff and councilors discussed the local effects of Senate Bill 245 at the Jan. 8 meeting, focusing on what rate the town should adopt for nonparticipating ground ambulance service reimbursement once the state’s new law is implemented.
Staff explained that SB245 requires health carriers to reimburse nonparticipating ambulance providers either the rate set by the local jurisdiction or, if no local rate exists, a minimum of 325% of current Medicare rates (geography-adjusted). The town’s current practice had been "Medicare plus 50%"; under the new law the town faces a practical choice presented in the meeting: adopt a local rate (and have carriers reimburse that rate if the town establishes it) or rely on the law’s fallback reimbursement at 325% of Medicare. Staff said the BLS Medicare base example would equate roughly to $1,527 if the 325% option is chosen for that class of call; another local community had higher rates reported in the meeting.
Councilors voiced concern about how higher nominal ambulance charges could affect uninsured residents or those with large deductibles. Finance staff noted the town’s collection rate is about 70% for ambulance billing and that the town offers payment plans and an abatement process through the welfare department; staff also said truly indigent cases often are written off following welfare review. Several councilors suggested the town explore policy options to reduce financial burden for uninsured and low-income residents, such as clearer abatement criteria or targeted relief.
Because councilors requested specific data—especially the number and share of calls involving uninsured patients, the town’s historical write-offs and collections, and the mechanics of setting a local approved rate—the council did not adopt a final rate at the meeting. The manager said he had enrolled the town in the state process (a required administrative step) but that enrollment did not obligate the town to accept a particular reimbursement approach; he will return with additional data for council consideration.
No final vote on setting a local ambulance rate was taken; the council asked staff to return with detailed collection and uninsured/indigent statistics and options for relief policy.
