This bill amends the managed care law to prohibit balance billing for ambulance services and establishes payment criteria for nonparticipating ambulance service providers. Specifically, it mandates that health plan carriers pay these providers an amount equal to the lesser of either the rate set by local authorities, 325% of the Medicare rate for similar services, or the provider's billed charges. Additionally, once payment is made, it is considered full payment, barring any copayments or deductibles that the covered individual must pay. The bill also stipulates that health carriers must remit payment directly to the ambulance service provider within 30 days of receiving a clean claim and prohibits them from sending payment to the covered individual.

The bill introduces new legal language by adding a section (420-J:8-f) to RSA 420-J, which outlines the payment structure and prohibits balance billing. It defines terms such as "clean claim" and "nonparticipating ambulance service provider" to clarify the scope of the law. The effective date for this act is set for January 1, 2026. The fiscal impact of the bill is indeterminable, but it is expected to increase costs for health carriers, which may lead to higher premiums for consumers. Local and county governments that provide ambulance services may also experience financial implications due to the new reimbursement rates.