Alabama 2025 Regular Session

Alabama House Bill HB478 Compare Versions

Only one version of the bill is available at this time.

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1	1	HB478INTRODUCED
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3	3	HB478
4	4	JPI5SYN-1
5	5	By Representative Oliver
6	6	RFD: Insurance
7	7	First Read: 20-Mar-25
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12	12	5 JPI5SYN-1 03/20/2025 JC (L)lg 2025-1301
13	13	Page 1
14	14	First Read: 20-Mar-25
15	15	SYNOPSIS:
16	16	This bill would regulate the provision of
17	17	emergency ambulance services in the state for a period
18	18	of approximately four years, by imposing requirements
19	19	on reimbursement by health insurers for ambulance
20	20	providers that depend on whether the provider is
21	21	in-network or out-of-network.
22	22	Currently, a provider that is not in a health
23	23	care insurer's network may bill an insured individual
24	24	for the balance of its retail charge for ground
25	25	ambulance service after it has received payment from
26	26	the insurer. This bill would prohibit this practice and
27	27	limit the charge to an enrollee to no more than the
28	28	in-network cost-sharing amount under the insurance
29	29	contract.
30	30	This bill would require health insurers to
31	31	reimburse an ambulance service within 30 days of
32	32	receiving the claim.
33	33	During the first two years that the requirements
34	34	of this bill would be in effect, the Alabama Department
35	35	of Public Health would be required to study its impact
36	36	on the responsiveness and availability of ambulance
37	37	services, especially in rural areas of the state.
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65	65	28 HB478 INTRODUCED
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67	67	A BILL
68	68	TO BE ENTITLED
69	69	AN ACT
70	70	Relating to health insurance; to set requirements on
71	71	reimbursement rates for ambulance services covered by health
72	72	insurance plans; to prohibit balance billing of insureds who
73	73	receive emergency transportation; to regulate cost-sharing for
74	74	insureds and to require reimbursement within a defined period;
75	75	to require the Alabama Department of Public Health to conduct
76	76	a study on the effects of this act on ambulance services in
77	77	the state; and to provide for the repeal of this act.
78	78	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
79	79	Section 1. For the purposes of this act, the following
80	80	words have the following meanings:
81	81	(1) CLEAN CLAIM. A reimbursement claim for covered
82	82	services which is submitted to a health care insurer and which
83	83	contains substantially all of the data and information
84	84	necessary for accurate adjudication, without the need for
85	85	additional information from the emergency medical provider
86	86	service or a third party.
87	87	(2) COST-SHARING AMOUNT. The enrollee's deductible,
88	88	coinsurance, copayment, or other amount due under a health
89	89	care benefit plan for covered services.
90	90	(3) COVERED SERVICES or COVERED SERVICE. Those services
91	91	provided by an emergency medical service provider which are
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121	121	provided by an emergency medical service provider which are
122	122	covered by an enrollee's health care benefit plan, including
123	123	emergency ground transport.
124	124	(4) EMERGENCY MEDICAL SERVICE PROVIDER. Any public or
125	125	private organization that is licensed to provide emergency
126	126	medical services as defined in Section 22-18-1, Code of
127	127	Alabama 1975, including emergency ground transport.
128	128	(5) ENROLLEE. An individual who resides in the State of
129	129	Alabama who is covered by a health care benefit plan.
130	130	(6) HEALTH CARE BENEFIT PLAN. Any individual or group
131	131	plan, policy, or contract issued, delivered, or renewed in
132	132	this state by a health care insurer to provide, deliver,
133	133	arrange for, pay for, or reimburse health care services,
134	134	including those provided by an emergency medical service
135	135	provider, except for payments for health care made under
136	136	automobile or homeowners insurance plans, accident-only plans,
137	137	specified disease plans, long-term care plans, supplemental
138	138	hospital or fixed indemnity plans, dental and vision plans, or
139	139	Medicaid.
140	140	(7) HEALTH CARE INSURER. Any entity that issues or
141	141	administers a health care benefit plan, including a health
142	142	care insurer, a nonprofit health care services plan
143	143	incorporated under Chapter 20, Title 10A, Code of Alabama
144	144	1975, or a health maintenance organization established under
145	145	Chapter 21A, Title 27, Code of Alabama 1975.
146	146	(8) IN-NETWORK. When an emergency medical service
147	147	provider is in a contract with the health care insurer to
148	148	provide covered services in the health care insurer's provider
149	149	network.
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179	179	network.
180	180	(9) OUT-OF-NETWORK. When an emergency medical service
181	181	provider does not have a contract with a health care insurer
182	182	to provide covered services in the health care insurer's
183	183	provider network.
184	184	Section 2. (a) Every health care insurer shall provide
185	185	an option for the emergency medical service provider to be
186	186	in-network.
187	187	(b) Negotiated or contracted in-network rates shall not
188	188	decrease after October 1, 2025.
189	189	(c) Negotiated or contracted in-network rates shall be
190	190	and remain a percentage of the current published rate for
191	191	ambulance services as established by the Centers for Medicare
192	192	and Medicaid Services under Title XVIII of the Social Security
193	193	Act for the same service provided in the same geographic area.
194	194	Section 3. (a) The minimum reimbursement rate for
195	195	covered services under any health care benefit plan issued by
196	196	a health insurer to an out-of-network emergency medical
197	197	service provider shall be 185 percent of the current published
198	198	rate for ambulance services as established by the Centers for
199	199	Medicare and Medicaid Services under Title XVIII of the Social
200	200	Security Act for the same service provided in the same
201	201	geographic area.
202	202	(b) The cost-sharing amounts shall not exceed the
203	203	in-network cost-sharing amounts for the covered health care
204	204	services received by an enrollee when the services are
205	205	provided by an out-of-network emergency ambulance service
206	206	provider.
207	207	Section 4. The reimbursement rate to an emergency
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237	237	Section 4. The reimbursement rate to an emergency
238	238	medical service provider for covered services under any health
239	239	care benefit plan issued by a health care insurer shall be the
240	240	greater of the following:
241	241	(1) The negotiated or contract rate for being
242	242	in-network as provided in Section 2.
243	243	(2) The minimum reimbursement rate for covered services
244	244	for an out-of-network emergency medical service provider as
245	245	provided in Section 3.
246	246	Section 5. (a) Payment made in accordance with Section
247	247	4 shall be considered payment in full for the covered services
248	248	provided, except for any cost-sharing amount, noncovered
249	249	service, or service considered not medically necessary
250	250	required to be paid by an enrollee.
251	251	(b) An emergency medical service provider is prohibited
252	252	from balance billing an enrollee for any additional amounts
253	253	for paid covered services.
254	254	Section 6. A health care insurer shall not require any
255	255	prior authorization for services provided by an emergency
256	256	medical services provider or follow the same practices
257	257	established by the Centers for Medicare and Medicaid Services
258	258	under Section 1834 of Title XVIII of the Social Security Act.
259	259	Section 7. (a)(1) Within 30 days after receipt of a
260	260	clean claim for reimbursement, a health care insurer shall
261	261	remit payment to the emergency medical service provider and
262	262	shall not send payment to an enrollee.
263	263	(2) A health care insurer shall remit payment with a
264	264	specific remark code to indicate that the claim has been paid
265	265	under the provisions of this act.
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295	295	under the provisions of this act.
296	296	(b)(1) If a claim for reimbursement submitted by an
297	297	emergency medical service provider to a health care insurer is
298	298	not a clean claim, within 30 days, the health care insurer
299	299	shall send the provider a written notice acknowledging the
300	300	date of receipt of the claim, accompanied with one of the
301	301	following applicable statements:
302	302	a. The insurer is declining to pay all or a part of the
303	303	claim and the specific reason or reasons for the denial.
304	304	b. Additional information is necessary to determine if
305	305	the claim is payable and the specific additional information
306	306	that is required.
307	307	(2) On any claim denial, the emergency medical service
308	308	provider may bill the enrollee for all billed charges.
309	309	Section 8. (a) The Alabama Department of Public Health
310	310	shall conduct a comprehensive study to determine the
311	311	effectiveness of reimbursement payments paid in accordance
312	312	with this act and determine whether: (i) the average response
313	313	time for ambulance services in Alabama has decreased; and (ii)
314	314	the number of ambulances in Alabama, especially in rural
315	315	areas, has increased.
316	316	(b) All costs and expenses of the study shall be paid
317	317	by a nonprofit health care services plan incorporated under
318	318	Chapter 20, Title 10A, Code of Alabama 1975.
319	319	(c) The results of this study shall be provided to Blue
320	320	Cross Blue Shield of Alabama and the Alabama Association of
321	321	Ambulance Services no later than January 1, 2028.
322	322	Section 9. This act is repealed on June 1, 2029.
323	323	Section 10. This act shall become effective on October
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353	353	Section 10. This act shall become effective on October
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