Researcher: JO Page 1 3/13/24
OLR Bill Analysis
sSB 179
AN ACT CONCERNING RATES FOR AMBULANCE AND
PARAMEDIC SERVICES.
SUMMARY
Existing law generally requires certain health insurance policies to
cover medically necessary ambulance services. This bill expands this
coverage requirement by (1) requiring health carriers to provide this
coverage in line with the rate schedule that the Department of Public
Health (DPH) sets for these services and (2) extending this coverage
requirement to include paramedic intercept services.
By law, DPH must establish emergency medical services (EMS) rates
and adopt regulations on rate-setting methods. Corresponding to the
insurance changes, the bill eliminates provisions referring to required
regulations on the “maximum allowable rates” for EMS services, and
instead refers to the “rate schedule” set by DPH.
Additionally, the bill sets an annual (1) October 1 deadline for DPH
to issue the EMS rate schedule for ambulance and paramedic intercept
service agencies that accept the DPH-set rate and (2) November 1
deadline for DPH to issue rates for these agencies that apply for a rate
increase in excess of the inflationary increase and do not accept the rate
schedule. By law, these agencies have the option to either accept DPH’s
established rate with an inflationary increase or request a higher rate (in
which case, they must file detailed financial information).
EFFECTIVE DATE: July 1, 2024, except that the insurance provisions
are effective January 1, 2025.
INSURANCE COVERAGE
Under current law, certain health insurance policies must cover
medically necessary ambulance services. The bill requires coverage of 2024SB-00179-R000017-BA.DOCX
Researcher: JO Page 2 3/13/24
medically necessary conveyance and treatment and emergency medical
services by ambulance and paramedic intercept services, according to
DPH’s rate schedule. Similar to current law, the bill specifies that
carriers are not required to provide coverage exceeding DPH’s rate
schedule. (By law, “paramedic intercept services” are paramedic
treatment services provided by an entity that does not provide the
ground ambulance transport.)
The bill also requires that for paramedic intercept services, as under
existing law for ambulance services, (1) the policy must generally
provide for direct payment to the provider and (2) if the provider
submits a bill for direct payment, the bill must indicate that it is subject
to mandatory assignment.
As under current law, the bill applies to individual or group policies
delivered, issued, amended, renewed, or continued that cover (1) basic
hospital expenses; (2) basic medical-surgical expenses; (3) major medical
expenses; (4) accident-only coverage, (5) limited benefit coverage
(individual plans only); and (6) hospital or medical services, including
HMOs. (Because of the federal Employee Retirement Income Security
Act (ERISA), state insurance mandates do not apply to self-insured
benefit plans.)
COMMITTEE ACTION
Public Health Committee
Joint Favorable Substitute
Yea 35 Nay 2 (03/04/2024)