The North Dakota Senate Human Services Committee convened on March 11, 2025, to discuss critical legislation aimed at reforming ambulance service reimbursement practices. The proposed House Bill 1322 seeks to address the financial challenges faced by ambulance services in the state, which have seen reimbursement rates stagnate at an increase of only 11% over recent years. This stagnation has placed a significant financial burden on property taxpayers, as ambulance services often rely on local funding to cover the gap between service delivery costs and reimbursement.

House Bill 1322 outlines three primary objectives: it prohibits ambulance services from charging patients more than their applicable co-pay, co-insurance, and deductible; it mandates that payments for services be made directly to ambulance providers; and it establishes a rate that healthcare insurers must pay to ensure access to these essential services. Currently, many ambulance services are forced to enter contracts with healthcare insurers to receive timely payments, as insurers often send payments directly to patients instead. This practice complicates the collection process for ambulance services and can lead to significant delays in payment.

The bill also addresses the lack of negotiation power ambulance services have with insurers, who typically offer take-it-or-leave-it contracts. The proposed direct payment provision aims to ensure that ambulance services are compensated for the care they provide, while also preventing balance billing, which could leave patients responsible for excessive charges.

The original proposal suggested a reimbursement rate of 400% of Medicare, which, while still below the actual cost of service delivery, would represent a significant improvement over the current reimbursement rate of approximately 250%. This increase is crucial for the sustainability of rural ambulance services in North Dakota and would alleviate some of the financial pressure on local taxpayers.

The committee expressed appreciation for the ongoing support from legislators for the emergency medical services (EMS) system and emphasized the importance of this bill in strengthening access to critical ambulance services across the state. The discussions highlighted the urgent need for reform in the reimbursement structure to ensure that ambulance services can continue to operate effectively and serve their communities.