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 20, 2024
BILL NUMBER: HB 1385 BILL AMENDED: Feb 19, 2024
SUBJECT: Payment for Ambulance Services.
FIRST AUTHOR: Rep. Barrett BILL STATUS: As Passed Senate
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;
(2) at the rate of 400% of the published rate for ambulance services established under the Medicare
law for the same ambulance service provided in the same geographic area; or
(3) according to the nonparticipating ambulance provider's billed charges; whichever is less.
It provides that certain payments for ambulance services do not apply to state employee health plans.
The bill 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.
It 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 The bill 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.
It 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.
The bill repeals the requirement that a health plan operator negotiate rates and terms with any ambulance
service provider willing to become a participating provider, but retains the requirement that the state
negotiate rates and terms with any ambulance service provider willing to become a participating provider.
It also repeals the requirement that the Department of Insurance, not later than May 1, 2024, submit a report
concerning these negotiations.
Effective Date: January 1, 2025.
Explanation of State Expenditures: 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.]
Explanation of State Revenues: The provisions regarding rates paid to applicable nonparticipating
ambulance service providers 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.
Additional Information: If there is no rate set or approved by the county or municipality of origin, the health
operator will pay the lesser amount of either 400% of current Medicare rates or the amount billed by the
nonparticipating ambulance provider. These provisions exclude all health system ambulances and only apply
to nonparticipating ambulance service providers that hold an Indiana certificate under IC 16-31-3.
Explanation of Local Expenditures: The bill impacts local units of government that offer health 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.
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 400% of current Medicare rates or the amount billed by
the nonparticipating ambulance provider. These provisions exclude all health system ambulances and only
apply to nonparticipating ambulance service providers that hold an Indiana certificate under IC 16-31-3.
HB 1385 2 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.
Local Agencies Affected: Local units that offer health insurance.
Information Sources:
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