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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 2872 By: Wallace
COMMITTEE SUBSTITUTE
An Act relating to ambulances; creating the Out-of-
Network Ambulance Provider Act ; defining terms;
setting minimum allowable rates; requiring certain
payment to be payments in full; restricting billing
to certain persons; setting certain limits on certain
payments; requiring certain payment s to certain
entities; requiring certain timelines for certain
payments; providing for certain processes for
specific purposes; providing for codification; and
providing an effective date .
BE IT ENACTED BY THE PEOPL E OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A ne w section of law to be codified
in the Oklahoma Statutes as Section 6050.1 of Title 36, unless there
is created a duplication in numbering, reads as follows:
This act shall be known and may be cited as the "Out-of-Network
Ambulance Provider Act ".
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6050.2 of Title 36, unless there
is created a duplication in numbering, rea ds as follows:
As used in the Out-of-Network Ambulance Provider Act:
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1. "Ambulance service provider" means any ground ambulance
service provider as defined by this act as any ground vehicle which
is or should be approved by th e Commissioner of Health, des igned and
equipped to transport a patient or patients on -scene and en route
patient stabilization and care as required. Ground vehicles used as
ambulances shall meet s uch standards as may be required by the
Oklahoma State Board of Health for approval, and shall display
evidence of such approval at all times ;
2. "Covered services" means those ground ambulance services
which an enrollee is entitled to receive under the t erms of a health
care benefit plan;
3. "Enrollee" means a person who is entit led to receive covered
health care services under the terms of a health care benefit plan;
4. "Health care benefit plan" means a plan, policy, contract,
certificate, agreement, or other evidence of coverage for health
care services offered, issued, renewed, or extended in this state by
a health care insurer;
5. "Health care insurer" means an entity that is subject to
state insurance regulation and provides coverage for health benefits
in this state and includes the following:
a. an insurance company,
b. health maintenance organization,
c. hospital and medical service co rporation,
d. risk-based provider organization, or
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e. sponsor or self-funded plan;
6. "Out-of-network" means a provider that does not contract
with the health care insurer of the enrollee receiving the covered
benefits; and
7. "Clean claim" means a claim that has no defect of
impropriety, including any lack of required substantiating
documentation or particular circumstances requiring special
treatment that prevents timely payment from being made on the claim.
SECTION 3. NEW LAW A new section of law t o be codified
in the Oklahoma Statutes as Section 6050.3 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. The minimum allowable reimbursement rate under any health
care benefit plan issued by a health care insurer to an out-of-
network ambulance service provider for providing ground services
shall be at the rates set or approved , whether in contract or
ordinance, by a local governmen tal entity in the jurisdiction in
which the covered health care services originates.
B. In the absence of the rates as provided in subsection A of
this section, the rate shall be the lesser of:
1. Three hundred twenty-five percent (325%) of the current
published rate for ambulance services as established by the Centers
for Medicare and Medic aid Services under Title XVIII of the Social
Security Act for the same services provided in the same geographic
area; or
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2. The ambulance service provi der's billed charges.
C. Payment made in compliance with this section shall be
considered payment in f ull for the covered services provided, except
for any copayment, coinsurance, deductible , and other cost-sharing
feature amounts required to be paid by the enrollee. An ambulance
service provider is proh ibited from billing the enrollee for any
additional amounts for the paid covered services in excess of what
the health care insurer pays.
D. All copayments, coinsurance, deductible , and other cost-
sharing feature amounts provided by subsection A of this section
shall not exceed the in-network copayment, coinsurance, deductible,
and other cost-sharing features for the covered health care services
received by the enrollee.
E. A health care insurer shall, within thirty (30) days after
of a clean claim for covered services, promptly remit payment for
ambulance services directly to the ambulance service provider and
shall not send payment to an enrollee.
F. If the claim is not a cl ean claim, the health care insurer
shall, within thirty (30) days after receipt of the claim, send a
written notice acknowledging the date of the receipt of the claim
and shall provide one of the following items:
1. That the insurer is decl ining to pay all or part of the
claim and the specific reason or reasons for the denial; or
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2. That additional information i s necessary to determine if all
or part of the claim is payable as well as the specific additional
information that is required.
SECTION 4. This act shall become effective November 1, 2024.
59-2-10394 JM 02/22/24