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N.H. bill bans surprise ambulance bills, sets new payment standard for EMS providers

New Hampshire is the first New England state to ban surprise ambulance bills, with a new rate starting Jan. 1 to protect patients and support EMS

By Kevin Landrigan
The New Hampshire Union Leader

NASHUA, N.H. 鈥 New Hampshire became the first state in New England to outlaw surprise billing for ambulance ground transport costs, Gov. Kelly Ayotte鈥檚 signature capping a three-year campaign to rescue financially strapped ambulance services, especially in rural areas.

Chris Stawasz, Northeast regional director for American Medical Response, credited Ayotte with forcing warning parties to forge this compromise (SB 245).

| MORE: From data to action: How EMS leaders are closing the equity gap

Starting next Jan. 1, it will set a new, two-year commercial insurance rate for all carriers while creating an actuarial study to come up with a permanent price-setting level.

鈥淭his new law takes the uncertainty out of ambulance bills for consumers and Emergency Medical Service (EMS) agencies in a fair way. New Hampshire EMS providers can now focus on what they do best 鈥 providing pre-hospital health care 鈥 knowing there will be financial predictability and hopefully additional stability,鈥 Stawasz said.

Ayotte noted federal law banned surprise billing for many medical services, but left ambulance care to the free market and states to regulate.

鈥淚magine if you or a loved one and needed an ambulance. This bill is going to make sure that if you have an ambulance come to your house, there is not going to be a surprise that leaves you at wit鈥檚 end on how you are going to pay for it.鈥

Sen. Suzanne Prentiss, D- Lebanon , a paramedic and head of the American Trauma Society, admitted anxiety last spring that 2025 was again going to bring stalemate to this pet cause of hers.

鈥淚 really had an emotional moment thinking back to how uncertain this looked until together we found the path forward,鈥 Prentiss said.

Sen. Tim McGough, R- Merrimack and a former AMR staffer, said work on this issue goes back even longer.

鈥淚 remember this topic coming up during my first term in House back in 1996,鈥 McGough recalled.

The compromise will require that providers be paid at least 3.25 times the Medicare rate.

Providers must seek in-network status

As a condition of that new rate, all providers must start the process to become in network with commercial insurers, something industry leaders argued has led to these higher charges.

鈥淔or too long, our communities have struggled with the uncertainty of underfunded emergency care,鈥 said Berlin Fire Chief James Watkins, president of the New Hampshire Association of Fire Chiefs.

鈥淲ith this legislation, we finally have a framework that recognizes the true cost of providing lifesaving services and protects patients from unexpected financial hardship. It鈥檚 a win for public safety and a win for the people we serve.鈥

Last April, the Berlin Fire Department had to take over emergency services after the abrupt end to a contract with Berlin EMS, a relationship that dated back to 1985.

Ayotte said the conditional Medicare rate will reflect the differing financial challenges for a rural versus an urban emergency services agency.

House Commerce Committee Chairman John Hunt, R- R-Rindge, had championed a competing bill (HB 316) to set the rate at 202% of the Medicare rate.

Hunt originally said the higher rate would make taxpayers 鈥渟uckers,鈥 but agreed to the deal while predicting the actuarial study would yield a lower number.

Stawasz said in the 17 states that have banned balanced billing, not one has had a study that reduced the permanent rate.

In 2023, the Insurance Department enlisted a six-month study that recommended a lower rate closer to the one in Hunt鈥檚 bill.

Stawasz said that study was rushed and used 鈥減re-pandemic鈥 data that was no longer valid, given inflation costs that came after the end of the pandemic.

Ayotte vowed to ensure the study produces a fair, permanent rate outcome.

鈥淚 look forward to making sure that this bill is enforced properly and that it is implemented well,鈥 Ayotte said.

Citing a conflict, Insurance Commissioner D.J. Bettencourt could not attend this bill signing ceremony at AMR鈥檚 Nashua headquarters on Thursday.

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