By Michael Graham
New Hampshire Journal
CONCORD, N.H.— Granite State lawmakers have reached a compromise on how to set rates for ambulance services, bringing an end to “balance billing,” resolving — at least temporarily — one of the most contentious issues in the State House this session.
Balance billing, sometimes referred to as “surprise billing,” is when someone who used an ambulance service receives a bill they didn’t expect for the balance between their insurance coverage and the amount charged by the ambulance company.
The state House and Senate have been at odds for months over setting a rate for these services.
The House bill, sponsored by Rep. John Hunt (R- Rindge ), proposed a rate of around 202 percent of Medicare’s rate, and it was based on the findings of a consulting group released earlier this year.
The Senate bill set the rate at 325 percent of Medicare and was backed by the ambulance companies.
Under the compromise announced during Wednesday’s hearing of the House Commerce and Consumer Affairs Committee, ambulance companies will operate under a temporary rate structure for the next two years. It’s a tiered system with an in-network rate of 325 percent of Medicare and an out-of-network rate of 100 percent.
During those two years, a second cost study will be done, using the data from the new rates, to determine a more permanent rate structure for ambulance services.
New Hampshire Insurance Commissioner D.J. Bettencourt, who’s been in the middle of the rate debate from the beginning, called the compromise good news for people who need ambulance services and aren’t on Medicare or Medicaid.
“The big win for the consumer is no more balance billing,” Bettencourt said. But he also noted good news for legislators as well.
“You all don’t have to hear about that every year anymore.”
One month ago, a caravan of ambulances slowly circled the State House to protest the House bill. Chris Stawasz, regional director for American Medical Response, said it would “put our entire EMS at significant risk.”
On Wednesday, Stawasz praised the outcome.
“We deeply appreciate the amount of work that has gone into this issue and, in particular, we want to recognize and thank Gov. Ayotte’s office, Rep. Hunt, and Sen. Sue Prentiss for their ongoing support of our industry and the challenges we face,” Stawasz said. “Our system has been in financial crisis for some time, and this bill will be a lifeline to many of my colleagues, especially those in rural areas of New Hampshire who are struggling the most.”
However, many House members say this two-year Band-Aid won’t stick, and the ambulance companies will need to find a way to lower rates while still being able to provide services. Bettencourt made a similar point before the committee on Wednesday.
“What this two-year stopgap compromise provides for is the opportunity for EMS providers to look at their business models and figure out where they can find efficiencies, how they can innovate to bring down their costs,” Bettencourt said. “Because once this second cost study is done and over with, that’s the rate that’s going to be in place moving forward.”
The job of the state, Bettencourt said, is to “look at how we cover the cost of those services, not how to help the providers get into the black. They’re going to have to figure out how they right-size their business model to make themselves sustainable.”
Still, the fact that a deal was reached resolves a lot of tension at the State House and gives the ambulance companies what they need to move forward.
“This is a truly New Hampshire solution, which balances the needs of emergency crews to recoup true costs for patient care with the need to protect access and affordability,” said Derick Aumann, president of the New Hampshire Ambulance Association. “I am confident this will resolve the ongoing challenge of balanced billing facing New Hampshire families.”
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