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Oklahoma House Bill HB2872

Oklahoma 2024 Regular Session

Oklahoma House Bill HB2872 Compare Versions

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1-An Act
2-ENROLLED HOUSE
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3+ENGR. S. A. TO ENGR. H. B. NO. 2872 Page 1 1
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28+ENGROSSED SENATE AMENDMENT
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30+ENGROSSED HOUSE
331 BILL NO. 2872 By: Wallace and Moore of the
432 House
533
634 and
735
836 Rosino of the Senate
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1442 An Act relating to ambulances; creating the Out -of-
15-Network Ambulance Service Provider Act; defining
16-terms; setting minimum allowable rates; requiring
17-certain payment to be considered payment in full;
18-setting certain limits on certain payments; requiring
19-compliance with certain claims requirements;
20-providing for codification; and providing an
21-effective date.
43+Network Ambulance Provider Act; defining terms;
44+setting minimum allowable rates; requiring certain
45+payment to be payments in full; restricting billing
46+to certain persons; setting certain limits on certain
47+payments; requiring certain payments to certain
48+entities; requiring certain timelines for certain
49+payments; providing for ce rtain processes for
50+specific purposes; providing for codification; and
51+providing an effective date.
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26-SUBJECT: Ambulances
56+AMENDMENT NO. 1. Page 1, strike the title, enacting clause and
57+entire bill and insert
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60+“An Act relating to ambulances; creating the Out -of-
61+Network Ambulance Service Provider Act; providing
62+short title; defining terms; setting minimum
63+allowable rates; requiring certain payment to be
64+payments in full; restricting billing to certain
65+persons; setting certain limits on certain payments;
66+requiring compliance w ith certain claims
67+requirements; providing for codification; and
68+providing an effective date.
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2773
2874 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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29100
30101 SECTION 1. NEW LAW A new section of law to be codified
31102 in the Oklahoma Statutes as Section 6050.1 of Title 36, unless there
32103 is created a duplication in numbering, reads as follows:
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34104 This act shall be known and may be cited as the “Out -of-Network
35105 Ambulance Service Provider Act”.
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37106 SECTION 2. NEW LAW A new section of law to be codified
38107 in the Oklahoma Statutes as Section 6050.2 of Title 36, unless there
39108 is created a duplication in numbering, reads as follows:
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41109 As used in the Out-of-Network Ambulance Service Provider Act:
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43110 1. “Ambulance service provider” means an ambu lance service as
44111 defined by Section 1 -2503 of Title 63 of the Oklahoma Statutes
45-except that, for the purposes of this ac t, the term shall be limited ENR. H. B. NO. 2872 Page 2
112+except that, for the purposes of this act, the term shall be limited
46113 to an ambulance service provider that provides ground transportation
47114 services;
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49115 2. “Covered ambulance servi ces” means those ground ambulance
50116 services which an enrollee is entitled to receive under the terms of
51117 a health care benefit plan;
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53118 3. “Enrollee” means a person who is entitled to receive covered
54119 ambulance services under the terms of a health care benefit plan;
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56120 4. “Health care benefit plan” means a plan, policy, contract,
57121 certificate, agreement, or other evidence of coverage for health
58122 care services offered, issued, renewed, or extended in this state by
59123 a health care insurer, or government -sponsored self-insured plans.
60124 Health care benefit plan does not include any health plan offered by
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61151 a contracted entity as defined in Section 4002.2 of Title 56 of the
62152 Oklahoma Statutes that provides coverage to members of the state
63153 Medicaid program;
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65154 5. “Health care insu rer” means an entity that is subject to
66155 state insurance regulation and provides coverage for health benefits
67156 in this state and includes the following:
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69157 a. an insurance company,
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71158 b. a health maintenance organization,
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73159 c. a hospital and medical service corporat ion,
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75160 d. a risk-based provider organization, or
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77161 e. a sponsor or self-funded plan.
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79162 Health care insurer does not include a contracted entity as defined
80163 in Section 4002.2 of Title 56 of the Oklahoma Statutes that provides
81164 coverage to members of the state Medic aid program;
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83165 6. “Out-of-network” means a provider that does not contract
84166 with the health care insurer of the enrollee receiving the covered
85167 ambulance services; and
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87168 7. “Clean claim” means a claim that has no defect of
88169 impropriety, including any lack of re quired substantiating
89170 documentation or particular circumstances requiring special
90-treatment that prevents ti mely payment from being made on the claim. ENR. H. B. NO. 2872 Page 3
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171+treatment that prevents timely payment from being made on the claim.
92172 SECTION 3. NEW LAW A new section of law to be codified
93173 in the Oklahoma Statutes a s Section 6050.3 of Title 36, unless there
94174 is created a duplication in numbering, reads as follows:
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96201 A. The minimum allowable reimbursement rate under any health
97202 care benefit plan issued by a health care insurer to an out -of-
98203 network ambulance service provi der for providing covered ambulance
99204 services shall be at the rates set or approved, whether in contract
100205 or ordinance, by a local governmental entity in the jurisdiction in
101206 which the covered ambulance services originate.
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103207 B. In the absence of the rates as p rovided in subsection A of
104208 this section, the rate shall be the lesser of:
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106209 1. Three hundred twenty -five percent (325%) of the current
107210 published rate for ambulance services as established by the Centers
108211 for Medicare and Medicaid Services under Title XVIII o f the Social
109212 Security Act for the same services provided in the same geographic
110213 area; or
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112214 2. The ambulance service provider’s billed charges.
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114215 C. Payment made in compliance with this section shall be
115216 considered payment in full for the covered ambulance ser vices
116217 provided, except for any copayment, coinsurance, deductible, and
117218 other cost-sharing feature amounts required to be paid by the
118219 enrollee. An ambulance service provider is prohibited from billing
119220 the enrollee for any additional amounts for the paid co vered
120221 ambulance services in excess of what the health care insurer pays.
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122222 D. All copayments, coinsurance, deductible, and other cost -
123223 sharing feature amounts provided by subsection A of this section
124224 shall not exceed the in -network copayment, coinsurance, de ductible,
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125251 and other cost-sharing features for the covered ambulance services
126252 received by the enrollee.
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128253 E. In administering and paying claims, a health care insurer
129254 shall comply with Section 1219 of Title 36 of the Oklahoma Statutes.
255+SECTION 4. This act shall become effective January 1, 2025. ”
256+Passed the Senate the 22nd day of April, 2024.
130257
131-SECTION 4. This act shall become effective January 1, 2025. ENR. H. B. NO. 2872 Page 4
132-Passed the House of Representatives the 23rd day of May, 2024.
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260+ Presiding Officer of the Senate
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263+Passed the House of Representatives the ____ day of __________,
264+2024.
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268+ Presiding Officer of the House
269+ of Representatives
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296+ENGROSSED HOUSE
297+BILL NO. 2872 By: Wallace and Moore of the
298+House
299+
300+ and
301+
302+ Rosino of the Senate
303+
304+
305+
306+An Act relating to ambulances; creating the Out-of-
307+Network Ambulance Provider Act ; defining terms;
308+setting minimum allowable rates; requiring certain
309+payment to be payments in full; restricting billing
310+to certain persons; setting certain limits on certain
311+payments; requiring certain payment s to certain
312+entities; requiring certain timelines for certain
313+payments; providing for certain processes for
314+specific purposes; providing for codification; and
315+providing an effective date .
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320+BE IT ENACTED BY THE PEO PLE OF THE STATE OF OKLAHOMA:
321+SECTION 5. NEW LAW A ne w section of law to be codified
322+in the Oklahoma Statutes as Sectio n 6050.1 of Title 36, unless there
323+is created a duplication in numbering, reads as follows:
324+This act shall be kno wn and may be cited as the "Out-of-Network
325+Ambulance Provider Act".
326+SECTION 6. NEW LAW A new section of law to be codif ied
327+in the Oklahoma Statutes as Section 6050.2 of Title 36, unless there
328+is created a duplication in numbering, r eads as follows:
329+As used in the Out-of-Network Ambulance Provider Act:
330+1. "Ambulance service provider" means any ground ambulance
331+service provider as defined by this act as any ground vehicle which
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358+is or should be approved by th e Commissioner of Health, d esigned and
359+equipped to transport a patient or patients on-scene and en route
360+patient stabilization and care as required. Ground vehicles used as
361+ambulances shall meet such standards as may be required by the
362+Oklahoma State Board of Health for approval, a nd shall display
363+evidence of such approval at all times ;
364+2. "Covered services" means those ground ambulance services
365+which an enrollee is enti tled to receive under the terms of a health
366+care benefit plan;
367+3. "Enrollee" means a person who is entit led to receive covered
368+health care services under the terms of a health care benefit plan;
369+4. "Health care benefit plan" means a plan, policy, contract,
370+certificate, agreement, or other evidence of coverage for health
371+care services offered, issued, renewed, or extended in this state by
372+a health care insurer, or government-sponsored self-insured plans;
373+5. "Health care insurer" means an entity that is subject to
374+state insurance regulation and provides coverage for health benefits
375+in this state and includes the following:
376+a. an insurance company,
377+b. health maintenance organization,
378+c. hospital and medical service corporation,
379+d. risk-based provider organization, or
380+e. sponsor or self-funded plan;
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407+6. "Out-of-network" means a provider that does not contract
408+with the health care insurer of the enrollee receiving the covered
409+benefits; and
410+7. "Clean claim" means a claim that has no defect of
411+impropriety, including any lack of required substantiating
412+documentation or particular circumstances requiring special
413+treatment that prevents timely payment from being made o n the claim.
414+SECTION 7. NEW LAW A new section of law t o be codified
415+in the Oklahoma Statutes as Section 6050.3 of Title 36, unless there
416+is created a duplication in numbering, reads as follows:
417+A. The minimum allowable reimbursemen t rate under any health
418+care benefit plan issued by a h ealth care insurer to an out-of-
419+network ambulance service provider for providing ground services
420+shall be at the rates set or approved , whether in contract or
421+ordinance, by a local governmen tal entity in the jurisdiction in
422+which the covered health care services originates.
423+B. In the absence of the rates as provided in subsection A of
424+this section, the rate shall be the lesser of:
425+1. Three hundred twenty-five percent (325%) of the current
426+published rate for ambulance services as established by the Centers
427+for Medicare and Medic aid Services under Title XVIII of the Social
428+Security Act for the same services provided in the same geographic
429+area; or
430+2. The ambulance service provi der's billed charges.
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457+C. Payment made in compliance with this section shall be
458+considered payment in f ull for the covered services provided, except
459+for any copayment, coinsurance, deductible , and other cost-sharing
460+feature amounts required to be paid by the enrollee. An ambulance
461+service provider is proh ibited from billing the enroll ee for any
462+additional amounts for the paid covered services in excess of what
463+the health care insurer pays.
464+D. All copayments, coinsurance, deductible , and other cost-
465+sharing feature amounts provided by subsection A of this section
466+shall not exceed the in-network copayment, coinsurance, deductible,
467+and other cost-sharing features for the covered health care services
468+received by the enrollee.
469+E. A health care insurer shall, within thirty (30) days after
470+of a clean claim for covered services, promptly remit payment for
471+ambulance services directly to the ambulance service provider and
472+shall not send payment to an enrollee.
473+F. If the claim is not a cl ean claim, the health care insurer
474+shall, within thirty (30) days after receipt of the claim, send a
475+written notice acknowledging the date of the receipt of the claim
476+and shall provide one of the following items:
477+1. That the insurer is decl ining to pay all or part of the
478+claim and the specific reason or reasons for the denial; or
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505+2. That additional information i s necessary to determine if all
506+or part of the claim is payable as well as the specific additional
507+information that is required.
508+SECTION 8. This act shall become effective November 1, 2024.
509+Passed the House of Representatives the 4th day of March, 2024.
510+
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136514 Presiding Officer of th e House
137515 of Representatives
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141-Passed the Senate the 22nd day of April, 2024.
519+Passed the Senate the ___ day of __________, 2024.
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145524 Presiding Officer of the Senate
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149-OFFICE OF THE GOVERNOR
150-Received by the Office of the Governor this ____________________
151-day of ___________________, 20_______, at _______ o'clock _______ M.
152-By: _________________________________
153-Approved by the Governor of the State of Oklahoma this _____ ____
154-day of ___________________, 20_ ______, at _______ o'clock _______ M.
155-
156-
157- _________________________________
158- Governor of the State of Oklahoma
159-
160-OFFICE OF THE SECRETARY OF STATE
161-Received by the Office of the Secretary of State this __________
162-day of ___________________, 20_______, at _____ __ o'clock _______ M.
163-By: _________________________________