Guidance on Implementation of SB 245 (Chapter 262 of the 2025 laws of the New Hampshire General Court)

The State of New Hampshire Insurance Department 21 South Fruit Street, Suite 14 Concord, NH 03301 David J. Bettencourt Keith E. Nyhan Commissioner Deputy Commissioner BULLETIN Docket #INS 25-073-AB TO: FROM: DATE: RE: All New Hampshire Licensed Health Carriers and Providers of Ground Ambulance Services Commissioner David J. Bettencourt November 21, 2025 laws of the New Hampshire General Court) I. Introduction: SB 245 represents the Legislature’s response to a marketplace that, for years, failed to align incentives for carriers, ambulance providers, and—most importantly, the insured patients who rely upon them during medical emergencies. Most providers remained out of network, reimbursement varied widely, and patients, despite maintaining insurance, were occasionally exposed to balance billing. The statute adopts a framework that does not displace competition but restores it. Ground ambulance providers are encouraged, not compelled, to enter carrier networks by pairing protections for consumers with the opportunity for providers to secure predictable, economically viable reimbursement. In exchange for a prohibition on balance billing and participation in a standardized contracting process, providers gain access to reimbursement rates initially set at 3.25 times the Medicare rate and, thereafter, to a cost-based schedule developed by an independent expert. This Bulletin addresses the implementation of those reimbursement provisions during the two-year interim period while the statewide cost study is undertaken. A dedicated webpage has been added to the Department’s website to provide ongoing updates and resources for carriers and providers. II. The Temporary Two-Year Rate Schedule: From January 1, 2026, through December 31, 2027, ground ambulance providers may receive reimbursement at 3.25 times the applicable Medicare rate only if they take the steps necessary to enter into the Standard Contract with each carrier. This is a conditional right—not automatic—and SB 245 ties eligibility directly to a Guidance on Implementation of SB 245 (Chapter 262 of the 2025 Telephone 603-271-2261 • Fax 603-271-1406 • TDD Access: Relay NH 1-800-735-2964 insurance.nh.gov provider’s willingness to participate in the network environment envisioned by the Legislature. a. Qualifying Contingencies A ground ambulance provider qualifies for the 3.25× Medicare reimbursement rate with respect to a carrier by: 1.) Submitting the Standard Contract Application Form and diligently pursuing the contracting process (status as an “enrolling” provider), or 2.) Executing the Standard Contract with the carrier. The Standard Contract Application Form is available online and, once submitted electronically, is automatically transmitted to both the Department and the selected carriers. Providers wishing to access enhanced reimbursement as early as January 1, 2026, are strongly advised to complete and submit the form on or before December 31, 2025. b. Disqualifying Contingencies A provider may lose eligibility for the 3.25× reimbursement rate if: 1.) The provider fails to pursue the contracting process in good faith for 60 days (e.g., failing to respond, provide documents, or sign materials). 2.) The provider fails to cooperate with the cost study— including cost data submission, validation, or audits. 3.) A Standard Contract is terminated for good cause by the carrier or by the provider for any reason. In such circumstances, reimbursement reverts to the carrier’s non-participating rate or the Medicare rate, whichever is higher. When the provider is found to not be pursuing a contract in good faith, the provider cannot re-submit the Standard Contract Application Form for 180 days. However, the provider can gain access to the contracted rate as soon as the contract is fully executed. These provisions are intended not to penalize, but to ensure that providers receiving enhanced reimbursement are those contributing to the cost-based system that will govern the market going forward. III. Providers Already Under a Pre-Existing Contract: The Standard Contract established under SB 245 does not displace valid existing negotiated contracts. Providers currently in network may continue under those arrangements. Page 2 of 5 However, many providers, facing increasing operational and workforce pressures, may find that the Standard Contract provides a more predictable and sustainable reimbursement framework once the interim rate and later the cost-based schedule take effect. Whether to transition rests with each provider; SB 245 leaves space for market choice, not mandated uniformity. IV. Reporting Requirements: The temporary reimbursement framework relies on accurate reporting from both carriers and providers. Carriers must report to the Department: • All fully executed Standard Contracts • All fully executed negotiated contracts • Any instance in which a provider has failed to actively engage in contracting for 60 days Providers should report to the Department: • Submission of the web based Standard Contract Application Form • Any carrier’s failure to finalize contracting within 45 days following receipt of all required materials All reporting shall be submitted to: ambulancecontracting@ins.nh.gov. V. Reimbursement Eligibility Registry: To ensure uniformity and transparency, the Department will maintain a public Registry tracking: • Each provider’s contract status with every carrier • The reimbursement rate that applies to each relationship • The dates that establish rate eligibility Carriers must consult the Registry when processing claims. If a billed amount is lower than the applicable Registry rate, reimbursement should be made at the billed amount. VI. Due Process: A provider’s eligibility for 3.25× Medicare reimbursement may not be changed based solely on a report from a carrier or the independent expert. The Department will: 1. Notify the affected provider of the allegation, Page 3 of 5 2. Provide an opportunity to respond, and 3. Decide eligibility only after reviewing both sides Any determination is appealable under RSA 400-A:17. The system created by SB 245 thus balances efficiency with fairness and predictability—values essential to maintaining confidence in the regulatory process. VII. “Any Willing Provider” Rule: Carriers must offer the Standard Contract to any qualified ground ambulance provider willing to meet its terms. Carriers may propose alternative terms, and providers may negotiate alternatives. However, in all circumstances, the option to contract under the Standard Contract must remain available. A contract that varies from the standard terms is considered a negotiated contract. This approach preserves market freedom while ensuring that providers seeking network participation cannot be excluded. VIII. Applicability of SB 245: SB 245 applies to fully insured commercial coverage regulated by the Department. It does not apply to: • Medicare • Medicare Advantage • Medicaid / CHIP • TRICARE • Out-of-state commercial policies • Self-funded employer plans However, carriers may choose to apply the Standard Contract to their self-funded business as well. If they do, providers treating self-funded beneficiaries under that contract will receive the same protections and reimbursement structure. IX. Medicare Temporary Add-On Payments: Recent temporary Medicare add-on payments have been extended until January 31, 2026. If the add-on program is not in effect, carriers are not required to reimburse add-on amounts when calculating SB 245 reimbursements. Carriers should continue monitoring federal action and be prepared to implement the add-on adjustments—potentially retroactively—should Congress reinstate them. X. Frequently Asked Questions: Page 4 of 5 The Department will maintain a regularly updated list of FAQs regarding SB 245 on its website and encourages carriers and providers to consult that resource as questions arise. XI. Contact: Questions regarding this Bulletin should be directed to Brenda Golden Hallisey, Health Law and Policy Legal Counsel, at Brenda.M.GoldenHallisey@ins.nh.gov. Concluding Note SB 245 does not seek to command the marketplace, but to repair its incentives. When ambulance providers are compensated predictably and fairly, participation rises; when participation rises, balance billing disappears; and when balance billing disappears, patients—who reasonably expect their insurance to protect them—are no longer placed in financial jeopardy because of the timing or location of a medical emergency. The Department’s responsibility is to ensure that the statute operates as written by promoting consumer protection, financial stability for emergency medical providers, and a marketplace grounded in competition, transparency, and lawful process. Page 5 of 5