New Hampshire Gov. Kelly Ayotte has signed legislation banning surprise ground ambulance billing and establishing reimbursement rates insurers must pay for services.
Beginning Jan. 1, 2026, ambulance providers — whether in-network or out-of-network — will be prohibited from billing patients more than their in-network cost-sharing amount for covered ground ambulance services.
From 2026 through 2027, participating and enrolling ground ambulance providers will be reimbursed at 325% of the current federal Medicare rate unless they and a health insurer agree to a different rate. Nonparticipating providers will be reimbursed at the higher of the insurer’s nonparticipating rate or the Medicare rate.
Starting in 2028, the state insurance commissioner will set a statewide, cost-based reimbursement schedule informed by an independent actuarial and accounting study. Rates will be adjusted annually for inflation beginning in 2029.
The legislation does not extend to air ambulance services.
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