HB 725-FN - AS INTRODUCED
2025 SESSION
25-0695
05/06
HOUSE BILL725-FN
AN ACTrelative to ground ambulance services.
SPONSORS:Rep. Stringham, Graf. 3; Rep. Kuttab, Rock. 17; Rep. Proulx, Hills. 15; Sen. Prentiss, Dist 5
COMMITTEE:Commerce and Consumer Affairs
-----------------------------------------------------------------
ANALYSIS
This bill prohibits balance billing for ambulance services under the managed care law and establishes criteria for payment of ambulance services provided by nonparticipating ambulance service providers.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Explanation:Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
25-0695
05/06
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Five
AN ACTrelative to ground ambulance services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Managed Care Law; Ambulance Billing; Payment for Reasonable Value of Services; Prohibition on Balance Billing. Amend RSA 420-J by inserting after section 8-e the following new section:
420-J:8-f Ambulance Billing; Payment for Reasonable Value of Services, Prohibition on Balance Billing.
I. A health plan carrier shall provide payment to a nonparticipating ambulance service provider for ambulance service provided to a covered individual in an amount equal to the lesser of:
(a) The rate set or approved, by contract or ordinance, by the county or municipality in which the ambulance service originated;
(b) Three hundred twenty-five percent of the current published rate for ambulance service as established by the Centers for Medicare and Medicaid Services under Title XVIII of the federal Social Security Act, 42 U.S.C. section 1395 et seq., for the same ambulance service provided in the same geographic area; or
(c) The nonparticipating ambulance service provider's billed charges.
II.(a) If a health carrier makes payment to a nonparticipating ambulance service provider according to paragraph I for ambulance service provided to a covered individual:
(1) The payment shall be considered payment in full for the ambulance service provided, except for any copayment, coinsurance, deductible, and other cost sharing amounts that the health plan requires the covered individual to pay; and
(2) The nonparticipating ambulance service provider is prohibited from billing the covered individual for any additional amount for the ambulance service provided.
(b) The copayment, coinsurance, deductible, and other cost sharing amounts that a health plan requires a covered individual to pay in connection with ambulance service provided by a nonparticipating ambulance service provider shall not exceed the copayment, coinsurance, deductible, and other cost sharing amounts that the covered individual would be required to pay if the ambulance service had been provided to the covered individual by a participating ambulance service provider.
III.(a) A health carrier that receives a clean claim for ambulance service provided to a covered individual by a nonparticipating ambulance service provider:
(1) Shall remit payment for the ambulance service directly to the nonparticipating ambulance service provider not more than 30 days after receiving the clean claim; and
(2) Shall not send payment to the covered individual.
(b) If a claim that a health carrier receives for ambulance service provided to a covered individual by a nonparticipating ambulance service provider is not a clean claim, the health carrier, no more than 30 days after receiving the claim, shall:
(1) Remit payment for the ambulance service directly to the nonparticipating ambulance service provider; or
(2) Send to the nonparticipating ambulance service provider a written notice that:
(A) Acknowledges the date of the receipt of the claim; and
(B) Either:
(i) States that the health plan operator is declining to pay all or part of the claim and sets forth the specific reason or reasons for declining to pay the claim in full; or
(ii) states that additional information is needed to determine whether all or part of the claim is payable and specifically describes the additional information that is needed.
IV. In this section:
(a) A "clean claim" means a claim for payment for ambulance service:
(1) That is submitted to a health plan by an ambulance service provider; and
(2) About which there is no defect, impropriety, or particular circumstance requiring special treatment that may prevent or delay payment.
(b) "Nonparticipating ambulance service provider" means a ground or air ambulance service provider who is acting within the scope of practice of that provider's license or certification under applicable state law and who does not have a contractual relationship directly or indirectly with the health carrier.
2 Effective Date. This act shall take effect January 1, 2026.
LBA
25-0695
1/10/25
HB 725-FN- FISCAL NOTE
AS INTRODUCED
AN ACTrelative to ground ambulance services.
FISCAL IMPACT:
The Office of Legislative Budget Assistant is unable to complete a fiscal note for this bill as it is awaiting information from the Department of Health and Human Services. The Department was contacted on 12/31/24 for a fiscal note worksheet. When completed, the fiscal note will be forwarded to the House Clerk's Office.
AGENCIES CONTACTED:
Insurance Department and Department of Health and Human Services