SB 407-FN - AS INTRODUCED
2024 SESSION
24-3036
05/10
SENATE BILL 407-FN
AN ACT relative to direct pay for ambulance services.
SPONSORS: Sen. Prentiss, Dist 5; Sen. Fenton, Dist 10; Sen. Watters, Dist 4; Sen. Altschiller, Dist 24; Sen. Perkins Kwoka, Dist 21; Sen. Soucy, Dist 18; Sen. Rosenwald, Dist 13; Sen. Whitley, Dist 15; Sen. Gannon, Dist 23; Sen. Innis, Dist 7; Sen. Birdsell, Dist 19; Sen. Carson, Dist 14; Sen. Chandley, Dist 11; Sen. D'Allesandro, Dist 20; Rep. Goley, Hills. 21; Rep. S. Pearson, Rock. 13; Rep. Stringham, Graf. 3; Rep. Wolf, Merr. 7
COMMITTEE: Health and Human Services
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ANALYSIS
This bill requires insurers to directly reimburse ambulance service providers at the usual and customary rate for such services or at the rate negotiated by the insurer and ambulance service provider.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
24-3036
05/10
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Twenty Four
AN ACT relative to direct pay for ambulance services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Accident and Health Insurance; Individual Policies; Reimbursement for Ambulance Service Providers. Amend RSA 415:6-q to read as follows:
415:6-q Reimbursement for Ambulance Service Providers.
I. Each insurer that issues or renews any individual policy, plan, or contract of accident or health insurance that constitutes health coverage under RSA 420-G:2, IX, and that provides benefits for medically necessary ambulance services shall reimburse the ambulance service provider directly [or by a check payable to the insured and the ambulance service provider subject to the terms and conditions of the policy, plan, or contract]. An insurer shall provide reimbursement for ambulance services at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, subject to review by the insurance department in the event of a dispute regarding whether the rate is reasonable. The provisions of this section shall not apply to policies that do not include coverage for ambulance services.
II. Nothing in this section shall preclude an insurer from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for emergency medical services.
2 Accident and Health Insurance; Group Policies; Reimbursement for Ambulance Service Providers. Amend RSA 415:18-v to read as follows:
415:18-v Reimbursement for Ambulance Service Providers.
I. Each insurer that issues or renews any policy of group or blanket accident or health insurance that constitutes health coverage under RSA 420-G:2, IX, and that provides benefits for medically necessary ambulance services shall reimburse the ambulance service provider directly [or by a check payable to the insured and the ambulance service provider subject to the terms and conditions of the policy, plan, or contract]. An insurer shall provide reimbursement for ambulance services at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, subject to review by the insurance department in the event of a dispute regarding whether the rate is reasonable. The provisions of this section shall not apply to policies that do not include coverage for ambulance services.
II. Nothing in this section shall preclude an insurer from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for emergency medical services.
3 Effective Date. This act shall take effect 60 days after its passage.
24-3036
11/30/23
SB 407-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to direct pay for ambulance services.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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Estimated State Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable | ||
Revenue Fund(s) | General Fund Insurance Premium Tax Revenue | |||||
Expenditures | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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Appropriations | $0 | $0 | $0 | $0 | ||
Funding Source(s) | None
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• Does this bill provide sufficient funding to cover estimated expenditures? [X] N/A • Does this bill authorize new positions to implement this bill? [X] No | ||||||
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Estimated Political Subdivision Impact - Increase / (Decrease) | ||||||
| FY 2024 | FY 2025 | FY 2026 | FY 2027 | ||
County Revenue | $0 | $0 | $0 | $0 | ||
County Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
Local Revenue | $0 | $0 | $0 | $0 | ||
Local Expenditures | $0 | Indeterminable | Indeterminable | Indeterminable | ||
METHODOLOGY:
This bill requires insurers to directly reimburse ambulance service providers at the usual and customary rate for such services or at the rate negotiated by the insurer and ambulance service provider.
The Insurance Department indicates this bill would amend RSA 415:6-q (individual) and RSA 415:18-v (group) insurance laws by altering language regarding the payment of ambulance service providers. This bill removes language permitting reimbursement via check issued to the insured and provider, and mandates payment directly to the ambulance service provider. In addition, the new language directs insurers to reimburse ambulance providers at specific negotiated rates. In the absence of a negotiated rate, the insurer will be required to pay at the usual charge rate subject to review by the Insurance Department. Any increase in monthly premiums would depend on the rates negotiated between the insurer and the ambulance provider. If negotiated rates are higher than what the insurer is currently paying, it may result in an increase in premiums resulting in additional premium tax revenue. To the extent premiums increase county and local expenditures for health insurance may also increase. The Department anticipates existing staff could absorb any work related to reviewing rate disputes between ambulance providers and insurers. Overall, the fiscal impact is indeterminable.
AGENCIES CONTACTED:
Department of Insurance