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SENATE FLOOR VERSION
April 11, 2024
COMMITTEE SUBSTITUTE
FOR ENGROSSED
HOUSE BILL NO. 2872 By: Wallace and Moore of the
House
and
Rosino of the Senate
An Act relating to ambulances; creating the Out -of-
Network Ambulance Service Provider Act; providing
short title; 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 compliance with certain claims
requirements; providing for codification; and
providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6050.1 of Title 3 6, 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 Service 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, reads as follows:
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As used in the Out-of-Network Ambulance Service Provider Act:
1. “Ambulance service provider” means an ambulance service as
defined by Section 1-2503 of Title 63 of the Oklahoma Statutes
except that, for the purposes of this act, the term shall be limited
to an ambulance service provider that provides ground transportation
services;
2. “Covered ambulance services” means those ground ambul ance
services which an enrollee is entitled to receive under the terms of
a health care benefit plan;
3. “Enrollee” means a person who is entitled to receive covered
ambulance 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, or government -sponsored self-insured plans.
Health care benefit plan does not include any health plan offered by
a contracted entity as defined in Section 4002.2 of Title 56 of the
Oklahoma Statutes that provides coverage to members of the state
Medicaid program;
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. a health maintenance organization,
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c. a hospital and medical service corporation,
d. a risk-based provider organization, or
e. a sponsor or self-funded plan.
Health care insurer does not include a contracted entity as defined
in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides
coverage to members of the state Medicaid program ;
6. “Out-of-network” means a provider that does not contract
with the health care insurer of the enrollee receiving the covered
ambulance services; 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 to 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 covered ambulance
services shall be at the rates set or approved, whether i n contract
or ordinance, by a local governmental entity in the jurisdiction in
which the covered ambulance services originate.
B. In the absence of the rates as provided in subsection A of
this section, the rate shall be the lesser of:
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1. Three hundred twenty -five percent (325%) of the current
published rate for ambulance services as established by the Centers
for Medicare and Medicaid Services under Title XVIII of the Social
Security Act for the same services provided in the same geographic
area; or
2. The ambulance service provider ’s billed charges.
C. Payment made in compliance with this section shall be
considered payment in full for the covered ambulance services
provided, except for an y copayment, coinsurance, deductible, and
other cost-sharing feature amounts required to be paid by the
enrollee. An ambulance service provider is prohibited from billing
the enrollee for any additional amounts for the paid covered
ambulance 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 ambulance services
received by the enrollee.
E. In administering and paying claims, a health care insurer
shall comply with Section 1219 of Title 36 of the Oklahoma Statutes .
SECTION 4. This act shall become e ffective January 1, 2025.
COMMITTEE REPORT BY: COMMITTEE ON HEAL TH AND HUMAN SERVICES
April 11, 2024 - DO PASS AS AMENDED BY CS