NASHUA, NH – In a ceremony hosted by American Medical Response (AMR) in Nashua, Governor Kelly Ayotte on Thursday signed Senate Bill 245 into law. This law makes New Hampshire the first in New England to ban ground ambulance billing, a practice that leaves patients liable for unexpected out-of-pocket billing for ambulance services.
The law establishes reimbursement rates for emergency medical service providers and fire departments in New Hampshire, which will take effect in January 2026. The New Hampshire Association of Fire Chiefs, the New Hampshire Ambulance Association, and AMR all advocated for this to ensure predictable reimbursement statewide.
“It prohibits once and for all the unfair and financially damaging practice of surprise ambulance billing, and provides a predictable framework of reimbursement for all New Hampshire’s ambulance providers, with enhanced rates for rural providers whose costs are so much lower than urban areas, ” said Chris Stawasz, Northeast Regional Director of Government Affairs for American Medical Response.
“This legislation addresses a long-standing issue faced by ambulance users. By eliminating unexpected ambulance charges, we are protecting the patients and families from financial shock during some of their most vulnerable moments. At the same time, the legislation recognizes the operational needs of both private and municipal services, providing us with a guaranteed minimum payment for the essential services they deliver. This balanced approach is the result of years of collaboration,” said Chief Mike Sitar, Tilton-Northfield Fire & EMS.
Said Ayotte, “Can you imagine if you or a loved one needed an ambulance because you were having a health situation that threatened your life? This bill is going to make sure that when you have that ambulance come to your house or your mother or your father or your loved one, that there’s not a surprise bill that comes afterwards.”
Key provisions of the law:
- Patients will only be held responsible for standard copayments, coinsurance, or deductible amounts.
- All NH ambulance providers will be paid at least 3.25 times the Medicare rate for the next two years to ensure fair reimbursement while keeping costs predictable.
- As a condition of the new reimbursement rate, all ambulance providers are expected to start the process of becoming in-network with commercial insurers.
- Patients are fully protected from balance billing if insurers and ambulance providers disagree on payment.
The new legislation also sets up a process for the ongoing evaluation of reimbursement policies to help maintain the strength and sustainability of New Hampshire’s EMS system. “I think it also shows you that in New Hampshire, we can come together to get things done in a common-sense way, and this is a win for patients. It is a win for those who are behind us who do the very hard work every single day, our EMS officials, our firefighters, our emergency responders, and it’s a win for the providers because having that stability in rates and making sure those services are there, “ Ayotte said. “I just want to congratulate everyone involved. This is such an important bill. I’m honored to be here to sign it today.”
