HASBSB109 MCCLOUDT 2917
SENATE SUMMARY OF HOUSE AMENDMENTS
SB 109 2023 Regular Session Talbot
KEYWORD AND SUMMARY AS RETURNED TO THE SENATE
INSURANCE POLICIES: Provides for balance billing by and reimbursement of covered
health services provided by out-of-network emergency ambulance services. (8/1/23) (REF
INCREASE SG EX See Note)
SUMMARY OF HOUSE AMENDMENTS TO THE SENATE BILL
1. Make technical changes.
DIGEST OF THE SENATE BILL AS RETURNED TO THE SENATE
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 law..
(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.
Proposed law provides 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. 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.
Effective August 1, 2023.
(Adds R.S. 22:1880.2) HASBSB109 MCCLOUDT 2917
______________________
Beth O'Quin
Attorney