RDCSB109 3264 3870
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)]
SB 109 Reengrossed 2023 Regular Session Talbot
Proposed law defines "ambulance provider", "clean claim", "covered services", "enrollee",
"healthcare benefit plan", "healthcare insurer", and "out-of-network".
Proposed law requires the minimum allowable reimbursement rate under any healthcare
benefit plan issued by a healthcare insurer to an out-of-network ambulance provider to be
one of the following:
(1)At the rate set or approved, whether in contract or ordinance, by a local
governmental entity in the jurisdiction in which the covered healthcare services
originate or as provided in present law (R.S. 33:4791).
(2)325% of the current published rate for ambulance services as established by the
Centers for Medicare and Medicaid Services for the same service provided in the
same geographic area or the ambulance provider's billed charges, whichever is less.
Payment made in compliance with proposed law is considered payment in full for the
covered services provided, excluding any copayment, coinsurance, deductible, and other
cost-sharing amounts required to be paid by the enrollee.
Proposed law prohibits an ambulance provider from billing the enrollee for any additional
amounts for paid covered services.
Proposed law prohibits all copayment, coinsurance, deductible, and other cost-sharing
amounts from exceeding the in-network amounts for covered healthcare services received
by the enrollee.
Proposed law requires a healthcare insurer to promptly remit payment for ambulance
services directly to the ambulance provider within 30 days after receipt of a clean claim for
covered services. Further prohibits the healthcare insurer from sending payment to an
enrollee.
Proposed law provides that if a claim is not a clean claim, the healthcare insurer is required,
within 30 days after receipt of the claim, to send a written notice to the provider
acknowledging the date of the receipt of the claim. Further requires the healthcare insurer
to state one of the following:
(1)That the insurer is declining to pay all or part of the claim and the specific reason or
reasons for the denial.
(2) That additional information is necessary to determine if all or part of the claim is
payable and the specific additional information that is required.
(Adds R.S. 22:1880.2)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill
1. Provides an air ambulance is not included as an ambulance service provider.
2. Provides definitions for a "clean claim" and "covered services".
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3. Makes technical changes.
Senate Floor Amendments to engrossed bill
1. Changes the definition name from "ambulance service provider" to
"ambulance provider".
2. Makes technical changes.
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
reengrossed bill:
1. Make technical changes.
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