25.0744.05000
Sixty-ninth
Legislative Assembly
of North Dakota
Introduced by
Representative Weisz
Senator Roers
A BILL for an Act to create and enact a new section to chapter 23-27 and a new section to
chapter 26.1-47 of the North Dakota Century Code, relating to ambulance service balanced
billing and provider reimbursement; to amend and reenact section 23-27-04.8 of the North
Dakota Century Code, relating to emergency medical services communication; to provide for a
legislative management study; and to provide an appropriation.
BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
SECTION 1. AMENDMENT. Section 23-27-04.8 of the North Dakota Century Code is
amended and reenacted as follows:
23-27-04.8. Emergency medical services operation communications.
The department may regulate the primary communications methods and protocols for
emergency medical services operations in a mannerwhile permitting secondary
communications through other devices, including cell phones. The regulations must be
consistent with the protocols established by the department of emergency services.
SECTION 2. A new section to chapter 23-27 of the North Dakota Century Code is created
and enacted as follows:
Balance billing prohibited - Enforcement.
1.For purposes of this section, "ambulance service provider" means a service entity
licensed under chapter 23 - 27 as a basic life support or advanced life support
ambulance service. The term does not include an air ambulance provider.
2.An ambulance service provider may not collect or bill more than the covered
individual's deductible, coinsurance, copayment, or other cost-sharing amount the
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covered individual would be responsible for if services were provided by a participating
ambulance service provider.
SECTION 3. A new section to chapter 26.1-47 of the North Dakota Century Code is created
and enacted as follows:
Ambulance insurance coverage - Direct payment required - Determination of
reimbursement rate for out-of-network ambulance service providers.
1.As used in this section:
a."Ambulance service provider" means a service entity licensed under chapter
23 - 27 as a basic life support or advanced life support ambulance service. The
term does not include an air ambulance provider.
b."Covered person" means an individual eligible to receive coverage of covered
services by a health care insurer under a health benefit plan.
c."Covered services" means medically necessary patient care or transportation
provided by ambulance service providers.
d."Health care insurer" means an entity subject to state insurance regulation that
provides health benefit coverage in this state. The term includes:
(1)An insurance company;
(2)A health maintenance organization;
(3)A hospital or medical service corporation; and
(4)A risk-based provider organization.
e."Medicare reimbursement rate" means the reimbursement rate for a particular
health care service provided under the Health Insurance for the Aged and
Disabled Act, title XVIII of the federal Social Security Act of 1965 [42 U.S.C.
1395 et seq.], as amended.
2.All reimbursements made by a health care insurer for the provision of ambulance
services to a covered individual must be paid directly to the ambulance service
provider or the provider's designee.
3.If a covered person receives ambulance services from an out-of-network ambulance
service provider, the health care insurer shall pay the ambulance service provider the
lesser of:
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a.Two hundred fifty percent of the Medicare reimbursement rate for the same
service in the same geographic area; or
b.The ambulance provider's billed charges.
4.Any rate the health care insurer pays under this section may not be required to include
the coinsurance, copayment, and deductible owed or already paid by the covered
person.
5.The insurance commissioner may adopt rules to implement and enforce this section.
SECTION 4. LEGISLATIVE MANAGEMENT STUDY - DELINQUENT BILLING
REIMBURSEMENT. During the 2025-26 interim, the legislative management shall consider
studying the feasibility and desirability of establishing a delinquent billing reimbursement grant
system for ambulance service providers. The study must include input from stakeholders,
including the insurance department, and a survey of ambulance service providers. The
legislative management shall report its findings and recommendations, together with any
legislation required to implement the recommendations, to the seventieth legislative assembly.
SECTION 5. APPROPRIATION - LEGISLATIVE COUNCIL - DELINQUENT BILLING
REIMBURSEMENT - ONE-TIME FUNDING. There is appropriated out of any moneys in the
general fund in the state treasury, not otherwise appropriated, the sum of $20,000, or so much
of the sum as may be necessary, to the legislative council for the purpose of contracting for
consulting services for the study provided for in section 3 of this Act, for the biennium beginning
July 1, 2025, and ending June 30, 2027. The appropriation provided in this section is a one-time
funding item.
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