This RSA section is an unofficial mirror, is not legal advice, and may be incomplete, outdated, or incorrectly processed.
RSA 420-J:26 · Requiring an Independent Study by an Accounting and Actuarial Expert of Ground Ambulance Costs in the State and the Establishment of a Cost-Based Reimbursement Schedule for Participating Ground Ambulance Service Providers
420-J:26 Requiring an Independent Study by an Accounting and Actuarial Expert of Ground Ambulance Costs in the State and the Establishment of a Cost-Based Reimbursement Schedule for Participating Ground Ambulance Service Providers. –
Copy linkBeginning on the effective date of this section, the commissioner shall oversee the process provided for in this section of contracting with an independent accounting and actuarial expert to conduct a study of the costs incurred by ground ambulance providers related to the provision of ground ambulance services in the state. Costs shall include the cost of pre-hospital care and the cost of sustaining a reasonable operating margin in support of the expectation that ground ambulance providers in the state maintain readiness to meet demand for services. Cost estimates shall be based on the assumption that services shall be provided in a reasonably cost-effective manner.
Copy linkThe commissioner of the department of safety shall collaborate with the commissioner in collecting cost surveys from ground ambulance providers in the state. These surveys may either be designed by the accounting and actuarial expert or may be adopted by the expert from the medicare ground ambulance data collection system cost reports. The commissioner of the department of safety shall have authority to enforce this reporting requirement upon ground ambulance providers under the general supervision and specific enforcement authority conferred by RSA 153-A and shall work with the commissioner to set a deadline for ground ambulance providers to submit their cost reports that is sufficient to facilitate the completion of the study and report provided for in this section in a timely manner.
Copy linkThe independent accounting and actuarial expert shall submit all cost data submitted by ground ambulance providers to rigorous data validation and auditing procedures and shall verify that the ground ambulance provider has used proper cost allocation methods, including when fire and ambulance services are provided by the same entity. The commissioner of the department of safety shall have authority under the general supervision and specific enforcement authority conferred by RSA 153-A to enforce compliance by ground ambulance providers with data validation and auditing of cost reports. The commissioner of the department of safety shall work with the commissioner to set a deadline for ground ambulance providers to comply with data validation and auditing requirements that is sufficient to facilitate the completion of the study and report provided for in this section in a timely manner.
Copy linkIf a ground ambulance provider fails to cooperate with cost data submission requirements or with requirements to facilitate data validation or cost report auditing requirements, then that provider shall lose access to the temporary rate schedule established for enrolling and participating ground ambulance providers in RSA 420-J:21, and health carriers shall be required to reimburse such providers at their nonparticipating rate or at the Medicare rate that is current as of the date of service, whichever is higher. During the period of the cost study, the commissioner shall maintain a list that shall be made available to health carriers doing business in the state that includes all ground ambulance providers who have been determined by the commissioner to have failed to cooperate with cost data submission requirements or with requirements to facilitate data validation or cost report auditing requirements.
Copy linkIf an analytical sample of audited cost reports is utilized by the independent expert that is obtained from a subset of ground ambulance providers in the state, then the most appropriate statistical methods shall be used to ensure that the analytical sample is appropriately normalized and adequately representative of the general population of ground ambulance providers doing business in the state.
Copy linkBased on the information provided through the cost reports, the independent accounting and actuarial expert shall be directed to summarize the cost information collected and to derive a statewide cost-based rate schedule appropriate for health carriers to use in reimbursing participating ground ambulance providers. The schedule may vary based on geographic region. Reimbursement under the schedule shall be designed to cover the costs attributable to the provision of covered services assuming that all public and commercial ground ambulance payers in the state are paying at the same rate. The independent accounting and actuarial expert shall produce a final report by June 30, 2027, which shall include the expert's recommended cost-based reimbursement schedule for participating ground ambulance providers and which shall detail the methodology used to calculate ground ambulance costs in the state and such other supplemental information as shall be directed by the commissioner. The commissioner shall assist the independent expert as necessary to complete the study, the rate schedule, and the report in a timely manner.
Copy linkPrior to the completion of its work on June 30, 2027, the independent accounting and actuarial expert shall also advise the commission on improving the ground ambulance services financing and delivery system established in RSA 153-A:38 on the feasibility and advisability of applying for a waiver under Section 1115A of the Social Security Act to enter into an all-payer model agreement for ground ambulance services in the state to implement a uniform, cost-based reimbursement schedule for ground ambulance services that includes Medicare, Medicaid, and all commercial payers and that builds upon the mandatory participating rate schedule and the cost study conducted under this section.
Copy linkThe cost study required under this section shall be funded in an amount up to $400,000 out of funds as provided in RSA 400-A:15, IV. Source. 2025, 262:1, eff. July 31, 2025.
Copy linkSource note
Source. 2025, 262:1, eff. July 31, 2025.
Source history
- 2025, 262:1, eff. July 31, 2025
Related materials
Bill relationships
-
2026 HB1268
reference · effective 2027-01-01
pharmacy or pharmacist to reverse and rebill the claim in question. (3) All claims adjudications, appeals, and utilization review processes shall comply with the requirements of RSA 420-J and rules promulgated thereunder. (b) For every drug for which the health carrier or pharmacy benefit manager establishes a maximum allowable cost to determine the drug product reimbursement, the health carrier or p
-
2026 HB1323
amend · effective 2027-01-01
shall consider the factors set forth in RSA 461-A:6. 10 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required. I. A health carrier shall not require prior authorization for
-
2026 HB1323-FN
amend · effective 2027-01-01
shall consider the factors set forth in RSA 461-A:6. 10 New Section; Managed Care Law; Prior Authorization for Physical Therapy and Occupational Therapy; When Required. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-f Prior Authorization for Physical Therapy and Occupational Therapy; When Required. I. A health carrier shall not require prior authorization for
-
2026 HB1463
reference
nduct a detailed analysis and report, in consultation with practicing community physicians in every New Hampshire county and health system, to assess compliance with RSA 420-E and RSA 420-J and make recommendations for appropriate penalties for insurers and insurance carriers not in compliance with such chapters of law. The department shall report its findings to the speaker of the house of representative
-
2026 HB1463-FN
reference
nduct a detailed analysis and report, in consultation with practicing community physicians in every New Hampshire county and health system, to assess compliance with RSA 420-E and RSA 420-J and make recommendations for appropriate penalties for insurers and insurance carriers not in compliance with such chapters of law. The department shall report its findings to the speaker of the house of representative
-
2026 HB1638
amend
ep therapy protocols when medically necessary. Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Subdivision; Step Therapy. Amend RSA 420-J by inserting after section 26 the following new subdivision: Step Therapy 420-J:27 Definitions. As used in this subdivision: I. "Advanced, metastatic cancer" means a cancer that has spread from the primary or orig
-
2026 HB1638-FN
amend
ep therapy protocols when medically necessary. Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Subdivision; Step Therapy. Amend RSA 420-J by inserting after section 26 the following new subdivision: Step Therapy 420-J:27 Definitions. As used in this subdivision: I. "Advanced, metastatic cancer" means a cancer that has spread from the primary or orig
-
2026 HB1744
amend
Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Section; Managed Care Law; Mental Health Coverage Reporting and Oversight. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-e Mental Health Coverage Reporting and Oversight. I. Each health insurance carrier offering health benefit plans in this state shall submit an annual r
-
2026 HB1744-FN
amend
Be it Enacted by the Senate and House of Representatives in General Court convened: 1 New Section; Managed Care Law; Mental Health Coverage Reporting and Oversight. Amend RSA 420-J by inserting after section 6-e the following new section: 420-J:6-e Mental Health Coverage Reporting and Oversight. I. Each health insurance carrier offering health benefit plans in this state shall submit an annual r
-
2026 HB241
amend · effective 2027-01-01
sed standards used in deciding which therapies should be available. 2 New Section; Managed Care Law; Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. Amend RSA 420-J by inserting after section 7-e the following new section: 420-J:7-f Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. I. Health carriers shall develop, in a
-
2026 HB241-FN
amend · effective 2027-01-01
ich therapies should be available. 2 New Section; Managed Care Law; Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. Amend RSA 420-J by inserting after section 7-e the following new section: 420-J:7-f Development of a Comprehensive Program of Pain Management Services for the Management of Chronic Pain. I. Health carriers shall develop, in accorda
-
2026 HB705
amend · effective 2026-03-16
transparency. Be it Enacted by the Senate and House of Representatives in General Court convened: 5:1 New Subdivision; Managed Care Law; Transparency in Coverage. Amend RSA 420-J by inserting after section 26 the following new subdivision: Transparency in Coverage 420-J:27 Definitions. In this subdivision: I. “Billed charge” means the total charges for an item or service billed to a healt