Committee Summary for Senate Health and Human Services (04/16/2025)

Bill/Time	Type	Title	Sponsor
HB316 00:09:45.040 - 8:49:36 AM	Public Hearing	relative to reimbursement for ground ambulance services.	Hunt, John(R)[B+]2024
HB559 01:17:48.880 - 9:57:39 AM	Public Hearing	relative to staffing requirements in emergency medical transport vehicles.	Rhodes, Jennifer(R)[B]2024
HB548 01:36:26.800 - 10:16:17 AM	Public Hearing	relative to licensing requirements for health care facilities that operate on a membership-based business model.	McLean, Mark(R)[A-]2024
HB704 02:14:08.760 - 10:53:59 AM	Public Hearing	relative to caregiver respite and senior volunteer programs and making an appropriation therefor.	Wallner, Mary Jane(D)[CT]2024
HB704 02:41:18.720 - 11:21:09 AM	Executive Session	relative to caregiver respite and senior volunteer programs and making an appropriation therefor.	Wallner, Mary Jane(D)[CT]2024
HB704 1588s 02:42:45.920 - 11:22:36 AM	Executive Session	relative to caregiver respite and senior volunteer programs and making an appropriation therefor.	Wallner, Mary Jane(D)[CT]2024

HB316: Senator Avard, District 12 Information Only00:09:45.040 - 8:49:36 AM; Senator Avard introduced House Bill 316 on behalf of Representative Hunt. The bill aims to change the regulatory environment for ground ambulance services and commercial health insurance reimbursement by establishing a uniform default rate schedule, prohibiting balance billing by ground ambulance providers, providing for updates to the rate schedule, and establishing a commission on all payer model programs for these services.
HB316: Mark Pru, Hillsboro 15, Manchester Oppose00:10:56.240 - 8:50:47 AM; Mark Pru expressed opposition to HB316, arguing that the current proposed rates are insufficient for ambulance services to survive financially. He highlighted the increasing costs of equipment and the necessity of 24/7 service, suggesting that the bill should either increase the reimbursement rates or revert to the old billing system. He clarified his stance, stating he supports killing the bill.
HB316: Chris Dewis, Hollis, New Hampshire Ambulance Association Oppose00:13:28.160 - 8:53:19 AM; Chris Dewis, representing the New Hampshire Ambulance Association, opposed HB316, stating that the proposed reimbursement rate of 202% of Medicare does not meet the goal of ending balance billing without compromising ambulance service sustainability. He criticized the bill for protecting insurance companies at the expense of ambulance services and taxpayers, suggesting a rate of 325% of Medicare as a more sustainable solution.
HB316: Representative John Hunt, Cheshire - District 14 Support00:19:05.000 - 8:58:56 AM; Representative Hunt, although surprised the hearing was scheduled, supported HB316, explaining it as a solution developed by the House Commerce Committee in response to long-standing issues with ambulance service reimbursement. He emphasized the calculated approach to the bill's rate and its provisions to address non-transport scenarios, defending the rate as fair and necessary despite opposition.
HB316: Jerry Stringham, Representative from Lincoln Information Only00:23:07.480 - 9:02:58 AM; Representative Stringham provided background on his experience with medical fee schedules and his interest in ambulance services due to the high number of bankruptcies. He critiqued a study that suggested a reimbursement rate of 202% of Medicare and Medicaid rates, arguing that the methodology was flawed. He explained that the study removed costs covered by city and town taxes, which significantly skewed the results. He also mentioned issues with volunteer contributions and a 'fudge factor' in the study, suggesting that a higher rate like 325% would be more fair and could help eliminate balance billing. He responded to questions about the study's assumptions and suggested amendments to the bill.
HB316: Jack Wmack, former Cheshire County Commissioner, current Cheshire County Treasurer, EMT Oppose00:28:59.360 - 9:08:50 AM; Jack Wmack opposed HB316, citing the long history of inadequate ambulance reimbursement rates and the financial collapse of providers. He mentioned the impact on 30 communities and Cheshire County's involvement in EMS due to a private company's failure. He criticized the profit margins of insurance companies like Anthem and argued that the burden should not be shifted to taxpayers. He expressed concerns about the sustainability of EMS under the proposed legislation.
HB316: Justin Vanetten, Board Chair of Stewart's Ambulance Oppose00:32:26.399 - 9:12:17 AM; Justin Vanetten, representing Stewart's Ambulance, opposed HB316 and supported Senator Apprentice's bill. He highlighted the opposition from public safety leaders, healthcare providers, and retired senators. He criticized the study's assumptions, including the unrealistic expectation of Medicaid reimbursement doubling and the inclusion of 'treat no transport' billing. He mentioned the failure of similar rates in Maine and urged amendments to the bill to reflect more sustainable rates.
HB316: Sarah Burke Cohen, New Hampshire Municipal Association Oppose00:36:23.040 - 9:16:14 AM; Sarah Burke Cohen, representing the New Hampshire Municipal Association, opposed HB316, stating that the proposed reimbursement rate would not be adequate for ground ambulance services to survive. She supported previous testimonies regarding the technical issues with the rate and did not elaborate further.
HB316: Michael Satar, Chief of the Tilton Northfield Fire District, representing the New Hampshire Association of Fire Chiefs Oppose00:37:16.880 - 9:17:07 AM; Michael Satar, representing the New Hampshire Association of Fire Chiefs, opposed HB316, stating it was based on a flawed study with unrealistic assumptions about Medicare and Medicaid rate increases, the implementation of 'treat no transport' billing, and the exclusion of certain costs. He supported the elimination of balance billing but emphasized the need for adequate reimbursement rates to prevent further financial strain on EMS services. He mentioned the potential of SB245 as a better option.
HB316: Paula Rogers, America's Health Insurance Plans (AHIP) Information Only00:43:28.880 - 9:23:19 AM; Paula Rogers, representing America's Health Insurance Plans, discussed the general opposition of insurance companies to rate setting. She mentioned her long history of discussing ambulance issues and the broader national context of the problem. She acknowledged the inevitability of some action this session around Medicare percentage rates and supported the concept of a commission to comprehensively address EMS service delivery. She suggested that the pressure was on to increase the proposed 202% rate but did not commit to a specific number.
HB316: Sabrina Dunlap, Anthem Information Only00:50:46.559 - 9:30:37 AM; Sabrina Dunlap, Senior Director of Government Relations for Anthem, discussed the complexities surrounding ambulance services in New Hampshire, highlighting the challenges due to its dual nature as both a municipal and healthcare service. She noted the logistical difficulties for EMS providers in emergency situations and the practical challenges in collecting insurance information. Dunlap also mentioned the cost study conducted the previous year, clarifying that it was not initiated by insurance companies but mandated by legislation. She expressed a neutral stance on the bill, not supporting rate setting but indicating a preference for HB316 over SB245 as a more measured approach. She discussed the impact of both bills on managed care networks, suggesting they could eliminate the concept of networks, which are crucial for ensuring provider qualifications and contractual relationships.
HB316: DJ Benton Court, New Hampshire Insurance Department Information Only00:55:33.559 - 9:35:24 AM; DJ Benton Court, Commissioner of the New Hampshire Insurance Department, accompanied by Michelle Heaton, Director of Life and Health, provided insights into the department's involvement in the ambulance billing issue. He discussed the actuarial cost study mandated by a previous legislative session, acknowledging some exceptions to the study's findings but defending its overall foundation. He emphasized the department's stance against balance billing and the need to support EMS providers. Benton Court also mentioned plans to convene stakeholders to focus on resolving the rate issue, suggesting a potential compromise between House and Senate positions.
HB316: Michelle Heaton, New Hampshire Insurance Department Information Only01:01:43.680 - 9:41:34 AM; Michelle Heaton, Director of Life and Health at the New Hampshire Insurance Department, provided details on the data collection process for the cost study. She explained that the study used existing data from CMS's GATS report and a quick survey for those who did not submit to GATS, due to the limited timeframe. Heaton noted that some data submissions were incomplete or contained errors, leading to exclusions based on statistical principles to ensure accuracy. She emphasized the study's reliance on sound data from New Hampshire EMS units and the importance of continued analysis of the rates.
HB316: Chris Lemlin, McGregor EMS, New Hampshire Ambulance Association Support01:11:20.000 - 9:51:11 AM; Chris Lemlin, Executive Director of McGregor EMS and a member of the New Hampshire Ambulance Association's executive board, supported ending balance billing but expressed concerns about the bill's impact on ambulance services. He shared personal experiences with patient billing issues and the challenges of negotiating with insurance companies. Lemlin highlighted the potential negative effects on rural communities and the treat-no-transport policy, suggesting it might deter patients from seeking necessary care. He emphasized the need for a policy that supports EMS statewide.
HB559: Jennifer Rhodess, Representative from Chester County District 17 (Winchester, Richmond, Swanzey, Troy, Fitzwilliam) Support01:17:48.880 - 9:57:39 AM; Jennifer Rhodess introduced HB559, which aims to make permanent a temporary staffing rule from the COVID-19 period allowing ambulances to operate with one EMT and one driver. She explained that the rule was initially implemented by an emergency order and has been beneficial for her local ambulance service. Rhodess argued that the staffing issue persists post-COVID, justifying the need for the bill.
HB559: Mark Pru, Representative from Hillsborough 15 (Manchester Ward 8) Support01:17:48.880 - 9:57:39 AM; Mark Pru, a fire chief and co-sponsor, supported HB559, stating that the bill would help address ongoing staffing shortages in emergency medical transport. He described the difficulties in staffing ambulances post-COVID and the necessity of having the option to send an ambulance with one EMT and a firefighter to emergencies. Pru emphasized the bill's role in potentially saving lives by allowing faster response times and addressed concerns about safety and the use of mutual aid.
HB548: Representative (name not specified) Support01:36:26.800 - 10:16:17 AM; The representative introduced HB548, which expands the primary care direct pay model to healthcare facilities, allowing them to opt out of the all-payer requirement if they exclusively receive direct payments from patients. The bill aims to enhance pricing transparency, choice, and competition in healthcare. The representative cited the Surgery Center of Oklahoma as a successful example of this model and addressed concerns about cherry-picking patients and the impact on critical access hospitals, arguing that the model's uptake would be modest and not significantly threaten existing facilities. He also mentioned an amendment to clarify that the bill does not apply to nursing homes, following concerns raised during the public hearing.
HB548: Jerry Kerk, Mount Washington Oppose01:49:12.119 - 10:29:03 AM; Jerry Kerk testified against HB548, focusing on section 4 which deals with intermediate care facilities, rehab facilities, and hospitals. He argued that Medicaid reimbursement rates are lower than the actual costs of care, and allowing facilities to only accept cash or members would disrupt healthcare, which is not a luxury good but a basic need. He emphasized that in rural areas like Mount Washington, there are limited options for care, and allowing for-profit facilities to cherry-pick healthier patients would shift the burden to other facilities, potentially leading to their closure and leaving less wealthy individuals without options.
HB548: Greg Moore, Americans for Prosperity Support01:53:00.639 - 10:32:51 AM; Greg Moore supported HB548, providing a historical context of the certificate of need process and its impact on healthcare costs. He highlighted that the bill would allow for a direct pay model, which could save patients money by eliminating third-party payment structures. He noted the limited scope of people this would apply to, mainly those not covered by traditional insurance, but argued it could significantly benefit them and not adversely affect existing resources.
HB548: David Ross, Hillsboro County Nursing Home, New Hampshire Association of Counties Oppose01:56:29.679 - 10:36:20 AM; David Ross, representing Hillsboro County Nursing Home and the New Hampshire Association of Counties, opposed the bill as written but could support it with the amendment submitted by the sponsor. He expressed concerns about increased costs to counties due to a higher Medicaid population in nursing facilities and the potential dilution of self-paying patients, which would impact county taxpayers and the operation of facilities. He urged the committee to oppose the bill as written and consider the sponsor's amendment.
HB548: Ben Bradley, New Hampshire Hospital Association Oppose01:58:05.760 - 10:37:56 AM; Ben Bradley, representing the New Hampshire Hospital Association, opposed HB548, arguing that it would bifurcate the healthcare system into two classes of patients and set up a regulatory framework that treats facilities differently based on payment models. He highlighted concerns about patient safety, quality requirements, and potential discrimination against patients based on their ability to pay. He also pointed out issues with the bill establishing a separate patient bill of rights, which could lead to confusion and potentially deny patients care based on their payment source or insurance plan.
HB548: Bob Dunn, Catholic Charities New Hampshire Oppose02:05:07.760 - 10:44:58 AM; Bob Dunn, representing Catholic Charities New Hampshire, opposed HB548 due to its potential unintended consequences on nursing homes. He explained that nursing home funding relies on a three-legged stool of Medicaid, rehabilitation care, and private pay. The bill would compromise the latter two legs, which are critical for making up the Medicaid shortfall. He used an analogy of two gas stations to illustrate how the bill could disadvantage nursing homes, urging opposition to protect these vital services.
HB548: Aubrey Freriedman, Bridgewater Support02:08:48.000 - 10:48:39 AM; Aubrey Freriedman supported HB548, arguing that it would mainly affect wealthy individuals who can afford membership-type healthcare and should have the option to pay for their own care without subsidizing others. He shared positive experiences of friends with direct pay medical offices, citing quicker access to care and better personal attention. He also emphasized the importance of healthcare cost transparency, suggesting that even if only a few facilities adopted this model, it could help bring down overall healthcare costs.
HB704: Prime Sponsor Support02:14:08.760 - 10:53:59 AM; The prime sponsor introduced House Bill 704, which aims to increase healthcare pricing transparency. The bill requires the disclosure of specific pricing information for covered items and services, contingent upon a federal presidential executive order. The sponsor highlighted the importance of a standardized format for data from different health plans to enable effective compilation and comparison of marketwide cost data. The bill includes provisions for machine-readable files that detail in-network and out-of-network costs, as well as prescription drug pricing. The implementation is set to begin six months after the finalization of federal guidance, which would allow for additional state rule-making.
HB704: DJ Bettin, Court Support02:21:04.800 - 11:00:55 AM; DJ Bettin from the Insurance Department supported the bill, emphasizing its role in their long-term effort to enhance transparency in healthcare costs. The legislation aims to ensure the authority to collect necessary data to improve the New Hampshire Health Cost website, focusing on practical and tangible data utility for consumers and policymakers.
HB704: Jason Azis, Director of Health Economics, Insurance Department Support02:22:15.520 - 11:02:06 AM; Jason Azis explained the utility of the bill for the New Hampshire Health Cost website, which currently uses claims data for a limited number of services. The proposed transparency and coverage data in a standardized format would allow for a comprehensive model, significantly enhancing the website's utility for citizens.
HB704: Cam Leine, Orin Reno representing Sigma Oppose02:28:56.680 - 11:08:47 AM; Cam Leine opposed the bill, arguing that it's premature given the ongoing federal review of healthcare transparency requirements. He noted that the bill's requirements might not align with future federal guidance, suggesting a re-referral to allow time for federal developments.
HB704: Paula Rogers, AHIP America's Health Insurance Plans Oppose02:33:19.600 - 11:13:10 AM; Paula Rogers opposed the bill, citing the complexities and costs associated with current federal transparency directives. She expressed concerns about the alignment between federal and state data requirements and suggested re-referral until federal guidance is clearer.
HB704: Sabrina Dunlap, Senior Director of Government Relations, Anthem Oppose02:36:31.040 - 11:16:22 AM; Sabrina Dunlap opposed the bill, highlighting the high costs and complexities of implementing transparency requirements, especially considering the ongoing federal review. She questioned the necessity and cost-effectiveness of state-level mandates, suggesting a re-referral to assess federal outcomes.
HB704: Peter Bracken, Harvard Pilgrim Healthcare Oppose02:39:20.000 - 11:19:11 AM; Peter Bracken opposed the bill, emphasizing the costs incurred by carriers to comply with federal transparency mandates. He supported a re-referral, citing the uncertainty surrounding future federal guidance and the potential for duplication of efforts.
HB704: Committee Vote02:41:18.720 - 11:21:09 AM; The committee decided to re-refer House Bill 704, following discussions and testimonies that highlighted the need for clarity on federal guidance before proceeding with state legislation.
HB704 1588s: Committee Vote02:42:45.920 - 11:22:36 AM; The committee discussed and voted on HB704. An amendment, 1588s, was proposed to clarify that community living facilities must comply with state and local zoning ordinances. The amendment was discussed and passed with no opposition. Subsequently, a motion to pass HB704 as amended was made and passed unanimously with a 5-0 vote. The committee also discussed the possibility of a floor amendment if further adjustments were needed. The session concluded with a motion to move out of the executive session, which was also passed unanimously.

Rochefort, David(Chairman)(R)	Avard, Kevin(V Chairman)(R)[C+]2024	Birdsell, Regina(R)[C+]2024
Prentiss, Suzanne(D)[F]2024	Long, Pat(D)