An Act
ENROLLED 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; defining
terms; setting minimum allowable rates; requiring
certain payment to be considered payment in full;
setting certain limits on certain payments; requiring
compliance with certain claims requirements;
providing for codification; and providing an
effective date.
SUBJECT: Ambulances
BE IT ENACTED BY THE PEOPL E 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 36, unless there
is created a duplication i n numbering, reads as follows:
This act shall be kno wn 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 T itle 36, unless there
is created a duplication in num bering, reads as follows:
As used in the Out-of-Network Ambulance Service Provider Act:
1. “Ambulance service provider” means an ambu lance service as
defined by Section 1 -2503 of Title 63 of the Oklah oma Statutes
except that, for the purposes of this ac t, the term shall be limited ENR. H. B. NO. 2872 Page 2
to an ambulance service provider that provides ground transportation
services;
2. “Covered ambulance servi ces” means those ground ambulance
services which an enrollee is en titled 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, contr act,
certificate, agreement, or other evidence of cov erage 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 hea lth 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 insu rer” means an entity that is subject to
state insurance regulat ion and provides coverage for health benefits
in this state and includes the following:
a. an insurance company,
b. a health maintenance organization,
c. a hospital and medical service corporat ion,
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 Medic aid 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 re quired substantiating
documentation or particular circu mstances requiring special
treatment that prevents ti mely payment from being made on the claim. ENR. H. B. NO. 2872 Page 3
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes a s 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 provi der for providing covered ambulance
services shall be at the rates set or approved, whether in 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 p rovided in subsection A of
this section, the rate sh all 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 Medicaid Services under Title XVIII o f the Social
Security Act for the same services pro vided 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 ser vices
provided, except for any copayment, coinsur ance, deductible, and
other cost-sharing feature amou nts required to be paid by the
enrollee. An ambulance service provider is prohibited from billing
the enrollee for any additional amounts for the paid co vered
ambulance services in excess of what the he alth care insurer pays.
D. All copayments, coinsura nce, deductible, and other cost -
sharing feature amounts provided by subsection A of this section
shall not exceed the in -network copayment, coinsurance, de ductible,
and other cost-sharing features for th e 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 effective January 1, 2025. ENR. H. B. NO. 2872 Page 4
Passed the House of Representatives the 23rd day of May, 2024.
Presiding Officer of the House
of Representatives
Passed the Senate the 22nd day of April, 2024.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _____ ____
day of ___________________, 20_ ______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _____ __ o'clock _______ M.
By: _________________________________