NH| The New Hampshire Insurance Department Bulletin 25-073-AB addresses the implementation of SB 245, establishing interim reimbursement provisions for ground ambulance providers and health carriers from January 1, 2026, through December 31, 2027. The aim is to align incentives, prohibit balance billing, and introduce a conditional reimbursement rate based on network participation.
Key Issues:
- Ground ambulance providers can receive 3.25 times the Medicare rate only by actively pursuing or executing the Standard Contract with each carrier; failure to engage or cooperate results in loss of eligibility and reversion to lower rates.
- The bulletin identifies both qualifying (timely application and contracting) and disqualifying (failure to engage, cost study non-compliance, contract termination) contingencies for enhanced reimbursement, with built-in good faith requirements and resubmission waiting periods.
- Providers with pre-existing network contracts may keep those arrangements or choose to transition to the new Standard Contract for possibly more stable reimbursement, offering market choice instead of mandated uniformity.
- Detailed reporting requirements are established for both carriers and providers, including public registry maintenance to track contract status and reimbursement rates, which carriers must consult when processing claims.
- The rule applies to fully insured commercial health plans, with clear exclusion for Medicare, Medicaid, TRICARE, and most self-funded plans, though carriers may optionally extend the Standard Contract to self-funded business.