Connecticut 2024 Regular Session

Connecticut Senate Bill SB00179 Compare Versions

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7		-	General Assembly ~~Substitute~~ Bill No. 179
	5	+	General Assembly Raised Bill No. 179
8	6		February Session, 2024
	7	+	LCO No. 1016
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	9	+
	10	+	Referred to Committee on PUBLIC HEALTH
	11	+
	12	+
	13	+	Introduced by:
	14	+	(PH)
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14	19		AN ACT CONCERNING RATES FOR AMBULANCE AND PARAMEDIC
15	20		SERVICES.
16	21		Be it enacted by the Senate and House of Representatives in General
17	22		Assembly convened:
18	23
19	24		Section 1. Subdivision (9) of section 19a-177 of the 2024 supplement 1
20	25		to the general statutes is repealed and the following is substituted in lieu 2
21	26		thereof (Effective July 1, 2024): 3
22	27		(9) (A) Establish rates for the conveyance and treatment of patients 4
23	28		by licensed ambulance services and invalid coaches and establish 5
24	29		emergency service rates for certified ambulance services and paramedic 6
25	30		intercept services, provided (i) the present rates established for such 7
26	31		services and vehicles shall remain in effect until such time as the 8
27	32		commissioner establishes a new rate schedule as provided in this 9
28	33		subdivision, and (ii) any rate increase not in excess of the Medical Care 10
29	34		Services Consumer Price Index, as published by the Bureau of Labor 11
30	35		Statistics of the United States Department of Labor, for the prior year, 12
31	36		filed in accordance with subparagraph (B)(iii) of this subdivision shall 13
32	37		be deemed approved by the commissioner. For purposes of this 14
33		-	subdivision, licensed ambulance services and paramedic intercept 15
	38	+	subdivision, licensed ambulance services and paramedic intercept 15 Raised Bill No. 179
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34	44		services shall not include emergency air transport services or mobile 16
35	45		integrated health care programs. 17
36		-	(B) Adopt regulations, in accordance with the provisions of chapter 18 Substitute Bill No. 179
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	46	+	(B) Adopt regulations, in accordance with the provisions of chapter 18
43	47		54, establishing methods for setting rates and conditions for charging 19
44	48		such rates. Such regulations shall include, but need not be limited to, 20
45	49		provisions requiring that: [on and after July 1, 2000:] (i) Requests for rate 21
46	50		increases [may] shall be filed no more frequently than once a year, 22
47	51		except, [that,] in any case where an agency's rate schedule [of maximum 23
48	52		allowable rates] falls below that of the Medicare allowable rates for that 24
49	53		agency, the commissioner shall immediately amend such schedule so 25
50	54		that the rates are at or above the Medicare allowable rates; (ii) only 26
51	55		licensed ambulance services, certified ambulance services and 27
52	56		paramedic intercept services that apply for a rate increase in excess of 28
53	57		the Medical Care Services Consumer Price Index, as published by the 29
54	58		Bureau of Labor Statistics of the United States Department of Labor, for 30
55	59		the prior year, and do not accept the [maximum allowable rates] rate 31
56	60		schedule contained in any voluntary state-wide rate schedule 32
57	61		established by the commissioner for the rate application year shall be 33
58	62		required to file detailed financial information with the commissioner, 34
59	63		provided any hearing that the commissioner may hold concerning such 35
60	64		application shall be conducted as a contested case in accordance with 36
61	65		chapter 54; (iii) licensed ambulance services, certified ambulance 37
62	66		services and paramedic intercept services that do not apply for a rate 38
63	67		increase in any year in excess of the Medical Care Services Consumer 39
64	68		Price Index, as published by the Bureau of Labor Statistics of the United 40
65	69		States Department of Labor, for the prior year, or that accept the 41
66	70		[maximum allowable rates] rate schedule contained in any voluntary 42
67	71		state-wide rate schedule established by the commissioner for the rate 43
68	72		application year shall, not later than the last business day in August of 44
69	73		such year, file with the commissioner a statement of emergency and 45
70	74		nonemergency call volume, and, in the case of a licensed ambulance 46
71	75		service, certified ambulance service or paramedic intercept service that 47
72	76		is not applying for a rate increase, a written declaration by such licensed 48
73		-	ambulance service, certified ambulance service or paramedic intercept 49
	77	+	ambulance service, certified ambulance service or paramedic intercept 49 Raised Bill No. 179
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74	83		service that no change in its currently approved [maximum allowable 50
75	84		rates] rate schedule will occur for the rate application year; and (iv) 51
76	85		detailed financial and operational information filed by licensed 52
77		-	ambulance services, certified ambulance services and paramedic 53 Substitute Bill No. 179
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	86	+	ambulance services, certified ambulance services and paramedic 53
84	87		intercept services to support a request for a rate increase in excess of the 54
85	88		Medical Care Services Consumer Price Index, as published by the 55
86	89		Bureau of Labor Statistics of the United States Department of Labor, for 56
87	90		the prior year, shall cover the time period pertaining to the most recently 57
88	91		completed fiscal year and the rate application year of the licensed 58
89	92		ambulance service, certified ambulance service or paramedic intercept 59
90	93		service. Not later than November first, annually, the commissioner shall 60
91	94		issue the licensed ambulance service, certified ambulance service and 61
92	95		paramedic intercept service rate schedule for each such agency that 62
93	96		applies for a rate increase pursuant to clause (ii) of this subparagraph. 63
94	97		Not later than October first, annually, the commissioner shall issue the 64
95		-	rate schedule for each such agency that accepts the ambulance service 65
96		-	or paramedic intercept service rate schedule pursuant to clause (iii) of 66
97		-	this subparagraph. 67
98		-	(C) Establish rates for licensed ambulance services, certified 68
99		-	ambulance services or paramedic intercept services for the following 69
100		-	services and conditions: (i) "Advanced life support assessment" and 70
101		-	"specialty care transports", which terms have the meanings provided in 71
102		-	42 CFR 414.605; and (ii) mileage, which may include mileage for an 72
103		-	ambulance transport when the point of origin and final destination for 73
104		-	a transport is within the boundaries of the same municipality. The rates 74
105		-	established by the commissioner for each such service or condition shall 75
106		-	be equal to (I) the ambulance service's base rate plus its established 76
107		-	advanced life support/paramedic surcharge when advanced life 77
108		-	support assessment services are performed; (II) two hundred twenty-78
109		-	five per cent of the ambulance service's established base rate for 79
110		-	specialty care transports; and (III) "loaded mileage", as the term is 80
111		-	defined in 42 CFR 414.605, multiplied by the ambulance service's 81
112		-	established rate for mileage. Such rates shall remain in effect until such 82
113		-	time as the commissioner establishes a new rate schedule as provided 83
114		-	in this subdivision. 84
115		-	(D) Establish rates for the treatment and release of patients by a 85
116		-	licensed or certified emergency medical services organization or a 86 Substitute Bill No. 179
	98	+	rate schedule for each such agency that accepts the ambulance rate 65
	99	+	schedule pursuant to clause (iii) of this subparagraph. 66
	100	+	(C) Establish rates for licensed ambulance services, certified 67
	101	+	ambulance services or paramedic intercept services for the following 68
	102	+	services and conditions: (i) "Advanced life support assessment" and 69
	103	+	"specialty care transports", which terms have the meanings provided in 70
	104	+	42 CFR 414.605; and (ii) mileage, which may include mileage for an 71
	105	+	ambulance transport when the point of origin and final destination for 72
	106	+	a transport is within the boundaries of the same municipality. The rates 73
	107	+	established by the commissioner for each such service or condition shall 74
	108	+	be equal to (I) the ambulance service's base rate plus its established 75
	109	+	advanced life support/paramedic surcharge when advanced life 76
	110	+	support assessment services are performed; (II) two hundred twenty-77
	111	+	five per cent of the ambulance service's established base rate for 78
	112	+	specialty care transports; and (III) "loaded mileage", as the term is 79
	113	+	defined in 42 CFR 414.605, multiplied by the ambulance service's 80
	114	+	established rate for mileage. Such rates shall remain in effect until such 81
	115	+	time as the commissioner establishes a new rate schedule as provided 82
	116	+	in this subdivision. 83 Raised Bill No. 179
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123		-	provider who does not transport such patients to an emergency 87
124		-	department and who is operating within the scope of such 88
125		-	organization's or provider's practice and following protocols approved 89
126		-	by the sponsor hospital. The rates established pursuant to this 90
127		-	subparagraph shall not apply to the treatment provided to patients 91
128		-	through mobile integrated health care programs; 92
129		-	Sec. 2. Section 38a-498 of the general statutes is repealed and the 93
130		-	following is substituted in lieu thereof (Effective January 1, 2025): 94
131		-	(a) Each individual health insurance policy providing coverage of the 95
132		-	type specified in subdivisions (1), (2), (4), (6), (10), (11) and (12) of section 96
133		-	38a-469 delivered, issued for delivery, renewed, amended or continued 97
134		-	in this state shall provide coverage for medically necessary conveyance 98
135		-	and treatment and emergency medical services by licensed and certified 99
136		-	ambulance services and paramedic intercept services for persons 100
137		-	covered by the policy pursuant to the rate schedule issued by the 101
138		-	Commissioner of Public Health pursuant to subdivision (9) of section 102
139		-	19a-177, as amended by this act. The hospital policy shall be primary if 103
140		-	a person is covered under more than one policy. The policy shall, as a 104
141		-	minimum requirement, cover such services whenever any person 105
142		-	covered by the contract is transported when medically necessary by 106
143		-	ambulance to a hospital. Such benefits shall be subject to any policy 107
144		-	provision which applies to other services covered by such policies. 108
145		-	Notwithstanding any other provision of this section, such policies shall 109
146		-	not be required to provide benefits in excess of the [maximum 110
147		-	allowable] rate schedule established by the Department of Public Health 111
148		-	in accordance with section 19a-177, as amended by this act. 112
149		-	(b) (1) Each such individual health insurance policy shall provide that 113
150		-	any payment by such company, corporation or center for emergency 114
151		-	ambulance services or paramedic intercept services under coverage 115
152		-	required by this section shall be paid directly to the ambulance or 116
153		-	paramedic intercept service provider rendering such service if such 117
154		-	provider has complied with the provisions of this subsection and has 118
155		-	not received payment for such service from any other source. 119 Substitute Bill No. 179
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162		-	(2) Any ambulance or paramedic intercept service provider 120
163		-	submitting a bill for direct payment pursuant to this section shall stamp 121
164		-	the following statement on the face of each bill: "NOTICE: This bill 122
165		-	subject to mandatory assignment pursuant to Connecticut general 123
166		-	statutes". 124
167		-	(3) This subsection shall not apply to any transaction between an 125
168		-	ambulance or paramedic intercept service provider and an insurance 126
169		-	company, hospital service corporation, medical service corporation, 127
170		-	health care center or other entity if the parties have entered into a 128
171		-	contract providing for direct payment. 129
172		-	Sec. 3. Section 38a-525 of the general statutes is repealed and the 130
173		-	following is substituted in lieu thereof (Effective January 1, 2025): 131
174		-	(a) Each group health insurance policy providing coverage of the type 132
175		-	specified in subdivisions (1), (2), (4), (6), (11) and (12) of section 38a-469 133
176		-	delivered, issued for delivery, renewed, amended or continued in this 134
177		-	state shall provide coverage for medically necessary conveyance and 135
178		-	treatment and emergency medical services by licensed and certified 136
179		-	ambulance services and paramedic intercept services for persons 137
180		-	covered by the policy pursuant to the rate schedule issued by the 138
181		-	Commissioner of Public Health pursuant to subdivision (9) of section 139
182		-	19a-177, as amended by this act. The hospital policy shall be primary if 140
183		-	a person is covered under more than one policy. The policy shall, as a 141
184		-	minimum requirement, cover such services whenever any person 142
185		-	covered by the contract is transported when medically necessary by 143
186		-	ambulance to a hospital. Such benefits shall be subject to any policy 144
187		-	provision which applies to other services covered by such policies. 145
188		-	Notwithstanding any other provision of this section, such policies shall 146
189		-	not be required to provide benefits in excess of the [maximum 147
190		-	allowable] rate schedule established by the Department of Public Health 148
191		-	in accordance with section 19a-177, as amended by this act. 149
192		-	(b) (1) Each such group health insurance policy shall provide that any 150
193		-	payment by such company, corporation or center for emergency 151 Substitute Bill No. 179
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200		-	ambulance services under coverage required by this section shall be 152
201		-	paid directly to the ambulance or paramedic intercept service provider 153
202		-	rendering such service if such provider has complied with the 154
203		-	provisions of this subsection and has not received payment for such 155
204		-	service from any other source. 156
205		-	(2) Any ambulance or paramedic intercept service provider 157
206		-	submitting a bill for direct payment pursuant to this section shall stamp 158
207		-	the following statement on the face of each bill: "NOTICE: This bill 159
208		-	subject to mandatory assignment pursuant to Connecticut general 160
209		-	statutes". 161
210		-	(3) This subsection shall not apply to any transaction between an 162
211		-	ambulance or paramedic intercept service provider and an insurance 163
212		-	company, hospital service corporation, medical service corporation, 164
213		-	health care center or other entity if the parties have entered into a 165
214		-	contract providing for direct payment.166
	122	+	(D) Establish rates for the treatment and release of patients by a 84
	123	+	licensed or certified emergency medical services organization or a 85
	124	+	provider who does not transport such patients to an emergency 86
	125	+	department and who is operating within the scope of such 87
	126	+	organization's or provider's practice and following protocols approved 88
	127	+	by the sponsor hospital. The rates established pursuant to this 89
	128	+	subparagraph shall not apply to the treatment provided to patients 90
	129	+	through mobile integrated health care programs; 91
	130	+	Sec. 2. (NEW) (Effective January 1, 2025) Each individual health 92
	131	+	insurance policy providing coverage of the type specified in 93
	132	+	subdivisions (1), (2), (4), (11) and (12) of section 38a-469 of the general 94
	133	+	statutes that is delivered, issued for delivery or renewed, amended or 95
	134	+	continued in this state on or after January 1, 2025, shall provide coverage 96
	135	+	for (1) the conveyance and treatment of a patient by a licensed 97
	136	+	ambulance service or invalid coach, (2) emergency services provided by 98
	137	+	a certified ambulance services, and (3) paramedic intercept services 99
	138	+	pursuant to the rate schedule issued by the Commissioner of Public 100
	139	+	Health to each such agency of such services pursuant to subdivision (9) 101
	140	+	of section 19a-177 of the general statutes, as amended by this act. 102
	141	+	Sec. 3. (NEW) (Effective January 1, 2025) Each group health insurance 103
	142	+	policy providing coverage of the type specified in subdivisions (1), (2), 104
	143	+	(4), (11) and (12) of section 38a-469 of the general statutes that is 105
	144	+	delivered, issued for delivery or renewed, amended or continued in this 106
	145	+	state on or after January 1, 2025, shall provide coverage for (1) the 107
	146	+	conveyance and treatment of a patient by a licensed ambulance service 108
	147	+	or invalid coach, (2) emergency services provided by a certified 109
	148	+	ambulance services, and (3) paramedic intercept services pursuant to 110
	149	+	the rate schedule issued by the Commissioner of Public Health to each 111
	150	+	such agency of such services pursuant to subdivision (9) of section 19a-112
	151	+	177 of the general statutes, as amended by this act. 113
215	152		This act shall take effect as follows and shall amend the following
216	153		sections:
217	154
218		-	Section 1 July 1, 2024 19a-177(9)
219		-	Sec. 2 January 1, 2025 38a-498
220		-	Sec. 3 January 1, 2025 38a-525
	155	+	Section 1 July 1, 2024 19a-177(9) Raised Bill No. 179
221	156
222		-	Statement of Legislative Commissioners:
223		-	In Section 2(b)(3), "ambulance provider or paramedic intercept service
224		-	provider" was changed to "ambulance or paramedic intercept service
225		-	provider", for consistency with Section 2(b)(1) and (b)(2) and Section
226		-	3(b).
227	157
228		-	PH Joint Favorable Subst.
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	160	+
	161	+	Sec. 2 January 1, 2025 New section
	162	+	Sec. 3 January 1, 2025 New section
	163	+
	164	+	Statement of Purpose:
	165	+	To change the maximum allowable rate for the conveyance and
	166	+	treatment of patients by licensed ambulance services and invalid
	167	+	coaches and emergency services rates for certified ambulance services
	168	+	and paramedic intercept services to a rate schedule accepted by
	169	+	providers and require insurance coverage for such services pursuant to
	170	+	such rate schedule.
	171	+	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
	172	+	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
	173	+	underlined.]
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