Final hearing fails to close rift over ambulance rate charges legislation

A final public hearing this week failed to close the wide gap between Senate and House leaders over how much ambulance service companies should be paid for emergency and non-scheduled transfers of patients with commercial health insurance coverage.

State Sen. Sue Prentiss, D-Lebanon, a paramedic and executive director of the American Trauma Society, made a last pitch for her bill (SB 245) that would set that charge at 325% of the federal Medicare rate.

“This has become the nationally recognized rate; six states have it,” Prentiss told the House Commerce and Small Business Committee, adding that West Virginia recently adopted a 400%.

Congress outlawed balanced billing which is the practice of a health care provider going after an individual insured for extra payment on charges an insurance company declined to cover. These also were called “surprise medical bills.”

“I don’t think people should be nervous when an ambulance shows up at the door that they are going to be financially bankrupt by the experience,” said Rep. Jerry Stringham, D-Woodstock, and a medical strategy consultant who said he could defend a 365% rate.

The only medical service allowed by Congress to continue balanced billing was ambulance service because there was no national standard rate for the service.

Prentiss served on a 15-person committee that traveled across the country to see how states were dealing with it.

House Commerce Chairman John Hunt, R-Rindge, said Prentiss’s bill wouldn’t end the practice since balanced billing would still be allowed for non-emergency and scheduled transports by ambulance.

In March, the House voted, 250-85, to approve Hunt’s competing bill (HB 316) that would set the ambulance rate at 202% of the federal Medicare rate.

The Senate endorsed Prentiss's bill with a higher rate by a voice vote.

Ambulance companies staged protest caravan

When Hunt’s bill came before a Senate committee last month, ambulance service company owners staged a caravan outside the Legislative Office Building in protest. Several EMS executives and fire chiefs predicted some companies would go out of business if they had to survive on the rate allowed in Hunt’s bill.

In response, Hunt said the Senate rate would make commercial insurance customers “suckers” who were asked to pay excessive rates because 80% of all ambulance transports come under Medicare or Medicaid that pay much lower rates.

Studies confirm Medicare pays about 46% of the actual cost to transport by ambulance, Medicaid about 42%.

Paula Rogers, a lobbyist with the American Association of Health Insurance Plans, said it’s difficult to come up with a “new” solution to a problem that has plagued the industry for 15 years.

From 1999-2003, Rogers served as the state’s insurance commissioner.

“We have heard this lament from the (ambulance) providers,” said Rogers, adding that her clients don’t like leaving this to rate-setting.

“Where is it going to ever be sorted out?”

Sen. David Rochefort, R-Littleton, is chairman of Senate Health Care and authored a separate, Senate-passed bill (SB 130) to name a 12-person commission to study delivery models for EMS and report back to lawmakers with recommendations by Nov. 1.

But on Wednesday, Hunt’s committee voted, 10-8, along party lines to recommend killing the bill, all Republicans wanting to kill it, all House Democrats wanting to pass it.

Whatever happens in the coming weeks, the issue will stay before House lawmakers.

Hunt convinced his committee to retain until next year a fourth bill (HB 725) from Stringham that would have set the same 325% rate as Prentiss has proposed.

What’s Next: The House Commerce and Small Business Committee in the coming week or so is expected to recommend the House reject Prentiss’ bill.

Prospects: Odds are heavily in favor that this issue will remain a stalemate. If that occurs, private talks between insurers and ambulance company supporters will continue this summer and fall with Stringham’s bill as a placeholder should an agreement be reached.

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