LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
200 W. Washington St., Suite 301
Indianapolis, IN 46204
(317) 233-0696
iga.in.gov
FISCAL IMPACT STATEMENT
LS 6920 NOTE PREPARED: Feb 1, 2024
BILL NUMBER: HB 1385 BILL AMENDED:
SUBJECT: Payment for Ambulance Services.
FIRST AUTHOR: Rep. Barrett BILL STATUS: As Passed House
FIRST SPONSOR: Sen. Johnson T
FUNDS AFFECTED:XGENERAL IMPACT: State & Local
XDEDICATED
FEDERAL
Summary of Legislation: The bill requires a health plan operator to provide payment to a nonparticipating
ambulance service provider for ambulance service provided to a covered individual:
(1) at a rate not to exceed the rates set or approved, by contract or ordinance, by the county or
municipality in which the ambulance service originated; or
(2) if there are no rates set or approved by the county or municipality in which the ambulance service
originated:
(A) at the rate of 500% of the published rate for ambulance services established under the
Medicare law for the same ambulance service provided in the same geographic area; or
(B) according to the nonparticipating ambulance provider's billed charges; whichever is less.
It provides that if a health plan makes payment to a nonparticipating ambulance service provider in
compliance with these requirements:
(1) the payment shall be considered payment in full, except for any copayment, coinsurance,
deductible, and other cost sharing amounts that the health plan requires the covered individual to
pay; and
(2) the nonparticipating ambulance service provider is prohibited from billing the covered individual
for any additional amount.
The bill provides that the copayment, coinsurance, deductible, and other cost sharing amounts that a covered
individual is required to pay in connection with ambulance service provided by a nonparticipating ambulance
service provider shall not exceed the copayment, coinsurance, deductible, and other cost sharing amounts
that the covered individual would be required to pay if the ambulance service had been provided by a
participating ambulance service provider.
HB 1385 1 It requires a health plan operator that receives a clean claim from a nonparticipating ambulance service
provider to remit payment to the nonparticipating ambulance service provider not more than 30 days after
receiving the clean claim.
The bill also provides that if a claim received by a health plan operator for ambulance service provided by
a nonparticipating ambulance service provider is not a clean claim, the health plan operator, not more than
30 days after receiving the claim, shall:
(1) remit payment; or
(2) send a written notice that:
(A) acknowledges the date of receipt of the claim; and
(B) either explains why the heath plan operator is declining to pay the claim or states that
additional information is needed for a determination whether to pay the claim.
It repeals the requirement that a health plan operator negotiate rates and terms with any ambulance service
provider willing to become a participating provider and the requirement that the Department of Insurance
(DOI), not later than May 1, 2024, submit a report concerning these negotiations.
Effective Date: July 1, 2024.
Explanation of State Expenditures: (Revised) State Employee Health Plan (SEHP): The bill requires the
SEHP to reimburse a nonparticipating ambulance service provider for ambulance services at the rate set or
approved by the county or municipality in which the ambulance service originated. If there is no rate set or
approved by the county or municipality of origin, the SEHP will pay the lesser amount of either 500% of
current Medicare rates or the amount billed by the nonparticipating ambulance provider. The resulting
increase in SEHP expenditures is indeterminate and will depend on the prevalence of ambulance services
provided by nonparticipating providers and the applicable rate. Any potential increases in plan premiums as
a result of these changes may be mitigated with adjustments to other benefits or to employee compensation
packages, or through the division of premium costs between the state and state employee.
The bill will decrease workload for the Department of Insurance (DOI) by repealing the need for the DOI
to submit a report detailing negotiation rates and terms between health plan operators and ambulance service
providers. [The DOI is funded with a dedicated agency fund.]
(Revised) Additional Information - The ambulance service rate provisions in this bill will only impact the
SEHP once the individual receiving services has met their deductible. These provisions only apply to
nonparticipating ambulance service providers that hold an Indiana certificate under IC 16-31-3. The State
Personnel Department reviewed nonparticipating ambulance claims and found that about 58% of the claims
reviewed originated in states outside of Indiana. However, this does not preclude the ambulance service
providers from being certified in Indiana. In all claims reviewed the amount billed was less than 500% of the
Medicare rate. Any increase in the number of services provided by nonparticipating ambulance service
providers would likely increase costs to the SEHP.
Explanation of State Revenues: (Revised) The ambulance service rate provision in the bill may result in
an increase in health care premiums. If overall premiums collected in the state increase, revenue to the state
General Fund could increase from either corporate Adjusted Gross Income Tax or Insurance Premium Tax
collections.
Explanation of Local Expenditures: (Revised) The bill impacts local units of government that offer health
HB 1385 2 insurance coverage for employees. An increase in the cost of premiums may be mitigated with adjustments
to other benefits or employee compensation packages, or through the division of premium costs between a
local unit and its employees.
Local units that provide emergency medical services (EMS) may have increased workload under the bill’s
requirements.
(Revised) Additional Information: The bill requires the health plan operators to reimburse a nonparticipating
ambulance service provider for ambulance services provided to a covered individual at a rate not to exceed
the rates set or approved, by contract or ordinance, by the county or municipality in which the ambulance
service originated. If there are no rates set or approved by the county or municipality of origin, the health
plan operators will pay the lesser amount of either 500% of current Medicare rates or the amount billed by
the nonparticipating ambulance provider.
According to CMS in CY 2023, the Medicare base rate for ambulance services was about $265.54, with
mileage rates varying among urban and rural areas. The total rate is indeterminate.
Explanation of Local Revenues:
State Agencies Affected: Department of Insurance; State Personnel Department; all.
Local Agencies Affected: Local units providing EMS; local units that offer health insurance.
Information Sources: Christy Tittle, State Personnel Department; Susan Barnhart, State Personnel
Department;
https://www.cms.gov/medicare/payment/fee-schedules/ambulance/ambulance-fee-schedule-public-use-files.
Fiscal Analyst: Jasmine Noel, 317-234-1360.
HB 1385 3