This is a production of Citizen in a Republic, which covers New Hampshire legislative politics.

Explainer: HB 185-FN – Reimbursement Rates for Ambulance Service Providers

Overview: House Bill 185-FN (HB 185-FN) is a proposed legislative act introduced during the 2025 New Hampshire legislative session. The primary objective of this bill is to reform how ambulance service providers are reimbursed by health insurers. By amending existing laws, HB 185-FN seeks to ensure that ambulance providers receive fair compensation for their services, either through direct billing amounts or mutually agreed-upon rates.

Key Provisions of HB 185-FN:

1. Direct Reimbursement Mandate:

   • Individual Insurance Policies (RSA 415:6-q):

     • Insurers must reimburse ambulance service providers directly for medically necessary ambulance services.
     • Reimbursement can be either the amount billed by the provider or a rate negotiated between the insurer and the provider.
     • If no negotiated rate exists, insurers are required to pay the billed amount, subject to review by the New Hampshire Insurance Department if there’s a dispute over the reasonableness of the charge.
     • This requirement applies only to policies that include ambulance service coverage.

   • Group Insurance Policies (RSA 415:18-v):

     • Similar to individual policies, group or blanket accident and health insurance policies must directly reimburse ambulance providers.
     • Reimbursement is based on negotiated rates or the billed amount if no agreement is reached.
     • Dispute resolution follows the same protocol as individual policies, involving the Insurance Department.

2. Negotiation and Dispute Resolution:

   • Insurers and ambulance providers are encouraged to negotiate reimbursement rates.
   • In cases where negotiation fails, insurers must pay the billed amount unless contested by the Insurance Department.
   • The bill anticipates the need for a dispute resolution mechanism but does not provide specific funding or resources for this process.

3. Exemptions:

   • Policies that do not cover ambulance services are exempt from these requirements.

4. Effective Date:

   • The provisions of HB 185-FN take effect 60 days after the bill’s passage.

Context with Existing Laws:

• RSA 415:6-q and RSA 415:18-v:

  • These sections currently govern reimbursement for ambulance services under individual and group insurance policies, respectively.
  • HB 185-FN amends these sections to enforce direct reimbursement based on billed or negotiated rates, removing any previous conditions that may have allowed indirect reimbursement methods.

• RSA 420-G:2 (Definitions):

  • Provides definitions relevant to health insurance, including terms like “health coverage,” “eligible dependents,” and “health carrier,” which are pertinent to understanding the scope of HB 185-FN.

Fiscal Impact:

• State Budget:

  • The bill does not allocate new funding or create new positions within the state government.
  • Projected Costs:
    • An estimated increase in claims costs for emergency ground ambulance services by approximately $11.8 million annually if reimbursement is set at billed rates.
    • Non-emergency transport costs are also expected to rise, though to a lesser extent.

• Insurance Department:

  • May require additional resources to handle disputes over reimbursement rates.
  • The analysis suggests the potential need for hiring an additional administrative law judge, costing an estimated $118,000 in FY 2026, increasing to $152,000 by FY 2028.

• Health Insurance Premiums:

  • Insurers might pass increased reimbursement costs to consumers through higher premiums.
  • Increased premiums could also affect local and county governments that provide health insurance to their employees, potentially leading to higher insurance premium tax revenues for the state.

Impact on Stakeholders:

1. Ambulance Service Providers:

   • Positive Impact: Guaranteed reimbursement rates may enhance financial stability and ensure providers are adequately compensated for their services.
   • Potential Challenges: Providers may need to engage more actively in rate negotiations with insurers.

2. Health Insurers:

   • Challenges: Increased reimbursement rates could lead to higher operational costs.
   • Potential Response: Insurers may seek to negotiate lower rates or adjust other aspects of their coverage to offset costs, possibly impacting policyholder premiums.

3. Consumers (Policyholders):

   • Potential Increase in Premiums: Higher costs for insurers may translate to increased health insurance premiums for individuals and groups.
   • Benefit: Assurance that ambulance services are fairly reimbursed, potentially leading to better service availability and quality.

4. Insurance Department:

   • Increased Workload: Handling disputes over reimbursement rates could strain existing resources unless additional support is provided.
   • Role Expansion: May need to develop new procedures or frameworks for effective dispute resolution.

Conclusion: HB 185-FN aims to streamline and ensure fair reimbursement for ambulance service providers by mandating direct payments from insurers based on either billed amounts or negotiated rates. While this initiative supports ambulance providers and could improve service quality, it also poses financial challenges for insurers and may lead to higher premiums for consumers. Additionally, the Insurance Department may need to expand its capacity to manage potential disputes effectively. Stakeholders should weigh the benefits of fair compensation against the potential economic impacts when considering the passage of this bill.