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to the general statutes is repealed and the following is substituted in lieu 2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