Prohibiting surprise ambulance billing and regulating ground ambulance reimbursement.
Summary
SB 245 would prohibit surprise billing for ground ambulance services by barring health carriers and ambulance providers from balance billing covered individuals for emergency or other unscheduled ground ambulance transports, except for normal copayments, coinsurance, deductibles, and other required cost-sharing. It applies to non-participating ground ambulance providers and requires health carriers to reimburse them directly for covered services.
The bill sets a reimbursement floor tied either to local government-approved ambulance rates or, if no local rate exists, to at least 325% of the applicable Medicare ground ambulance rate based on the service area. It also deems certain dispatch-requested ambulance services medically necessary, prohibits prior authorization for emergency or unscheduled transports, requires prompt payment, and excludes air ambulance services. The bill takes effect January 1, 2026.
Impact
SB 245 would amend New Hampshire’s managed care law, RSA 420-J, by adding a new section governing ground ambulance reimbursement. It would change how health carriers pay non-participating ambulance providers, establish direct reimbursement rules, and limit what providers may bill patients. The bill would also affect insurance plan administration by requiring clearer explanation-of-benefits disclosures and by applying to individual and other health coverage that includes medically necessary ambulance benefits. According to the fiscal note, the measure could increase insurance premiums and, indirectly, premium tax revenue, while local and county governments may face higher insurance costs and potentially higher ambulance reimbursement obligations where they purchase coverage or operate ambulance services.
Sentiment
The overall sentiment appears supportive of consumer protection and ambulance provider reimbursement, with the bill framed as a response to surprise ambulance billing and inadequate payment for emergency ground transport. The fiscal note and agency comments suggest the policy is viewed as likely to raise reimbursement levels and reduce patient exposure to unexpected bills. At the same time, the discussion reflects concern that higher mandated payments may increase commercial insurance premiums and shift costs across the insurance market.
Contention
The main point of contention is the reimbursement standard: insurers and purchasers may object to the requirement to pay either local government-set rates or at least 325% of Medicare, which the fiscal note says could materially increase premiums. Another likely issue is the bill’s patient-protection approach versus carrier cost control, including the prohibition on prior authorization and the direct-payment mandate. Local governments and ambulance providers may support the bill for improving payment adequacy, while insurers and some employers or public purchasers may be concerned about cost growth. The bill also distinguishes ground ambulance from air ambulance services, leaving air transport outside its scope.
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