DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 439 Original 2018 Regular Session Talbot
Abstract: Prohibits balance billing for out-of-network air ambulance services and establishes an
independent dispute resolution process for reimbursement claims.
Proposed law establishes legislative findings and the purpose and scope of proposed law.
Proposed law defines "balance billing", "covered person", "disputed air ambulance service provider
charge", "health benefit plan", and "registered air ambulance service provider".
Proposed law prohibits a health benefit plan that does not have an adequate network of air
ambulance service providers in this state from using an allowed amount for air ambulance
reimbursement that is less than the applicable average rates published by registered air ambulance
service providers.
Proposed law requires a health benefit plan, if a covered person receives services from a registered
air ambulance service provider that is not part of the health benefit plan's network, to assume the
covered person's responsibility for amounts charged by the registered air ambulance service provider
other than any applicable copayments, coinsurance, and deductibles.
Proposed law prohibits, with the exception of amounts owed for applicable copayments, coinsurance,
and deductibles, the registered air ambulance service from doing any of the following in connection
with the amount assumed by the health benefit plan:
(1)Bill, collect, or attempt to collect from the covered person..
(2)Report to a consumer reporting agency that the covered person is delinquent.
(3)Obtain a lien on the covered person's property..
(4)Take any other action adverse to the covered person.
Proposed law requires the health benefit plan to make payment based on any of the following:
(1)The billed charges of the registered air ambulance service.
(2)Another amount negotiated with the registered air ambulance service. (3)The maximum amount the health benefit plan would pay to an in-network air ambulance
service provider for the services performed, unless the plan fails to have an adequate network
of air ambulance providers, in which case the average amount as determined by the Dept. of
Insurance (DOI).
Proposed law authorizes a health benefit plan or registered air ambulance service provider who
disputes the reasonableness of a payment to invoke the independent dispute resolution process
established pursuant to proposed law, if good-faith settlement negotiations fail to resolve the dispute.
Proposed law requires DOI to establish and administer a program of independent dispute resolution
for disputed air ambulance service charges. Proposed law authorizes DOI to charge any fees
necessary to cover the costs of implementation and administration.
Proposed law requires DOI to maintain a list of qualified reviewers.
Proposed law requires an air ambulance service provider wishing to participate in the independent
dispute resolution program to register with DOI. Proposed law provides that registration shall
automatically renew quarterly unless the registered air ambulance service provider gives notice of
the intent to not renew the registration not less than 30 days prior to the end of the quarter.
Proposed law provides that all disputed charges incurred during the quarter of a registered air
ambulance service provider's registration shall be subject to independent dispute resolution.
Proposed law requires a registered air ambulance provider to publish the air ambulance transport
rates charged by the air ambulance provider in this state and to provide de-identified, itemized
billings for each of the air ambulance provider's transports in this state.
Proposed law requires DOI to keep and maintain records of each independent dispute resolution
proceeding and to analyze the results of the independent dispute resolution proceedings. Proposed
law further requires DOI to publish on its website an annual report concerning statistics of the
program.
Proposed law limits the sole issue to be considered and determined in an independent dispute
resolution proceeding to the reasonable charge for the air ambulance service provided based upon
the overall fixed and variable cost for providing the air ambulance services.
Proposed law permits either the registered air ambulance service provider or the health benefit plan
to request adjudication of a disputed charge by submitting a request for independent dispute
resolution to DOI.
Proposed law requires DOI, if the parties have not designated an independent reviewer by mutual
agreement within 30 days of the request for independent dispute resolution, to select an independent
reviewer from the department's list of qualified reviewers.
Proposed law requires an individual acting as an independent reviewer to be knowledgeable and experienced in applicable principles of contract and insurance law and the healthcare industry
generally and prohibits an individual with a conflict of interest that would adversely impact the
individual's independence and impartiality.
Proposed law establishes the procedures for an independent dispute resolution proceeding.
Proposed law provides that the decision of the independent reviewer shall be final and binding on
the parties and the prevailing party may seek enforcement of the independent reviewer's decision in
any court of competent jurisdiction.
Proposed law applies to all new policies, plans, certificates, and contracts issued on or after Jan. 1,
2019. Existing policies, plans, certificates, and contracts shall include the coverage required by
proposed law on renewal, but in no case later than Jan. 1, 2019.
(Adds R.S. 22:1885.1-1885.6)