Pennsylvania House Bill HB1152

Pennsylvania 2025-2026 Regular Session

• Introduced: 4/4/25
• Refer: 4/4/25

Caption

In casualty insurance, further providing for billing.

Impact

If enacted, HB 1152 is expected to streamline the reimbursement process for EMS agencies, reducing delays in payments from insurers and enhancing financial stability for nonnetwork service providers. By mandating timely payments from insurers and prohibiting EMS agencies from billing patients directly (except for certain cost-sharing elements), the bill aims to create a more predictable and reliable financial framework for emergency medical services. This change is anticipated to benefit both EMS agencies and patients who require urgent medical assistance.

Summary

House Bill 1152 seeks to amend the Insurance Company Law of 1921, specifically focusing on the billing practices of emergency medical services (EMS) agencies. The bill stipulates that insurers must directly reimburse nonnetwork EMS agencies for dispatched 911 services. This reimbursement is set at three hundred fifty percent of the current rate established by the Centers for Medicare and Medicaid Services (CMS), ensuring that EMS agencies are adequately compensated for their services without directly billing the covered individual for non-cost-sharing amounts.

Sentiment

The sentiment surrounding the bill appears to be generally positive among EMS agencies, with proponents highlighting the bill as a significant step towards resolving long-standing issues regarding reimbursement delays and financial burdens on emergency service providers. However, there may also be concerns from insurers regarding the financial implications of mandated reimbursement rates, as well as how it may affect their overall costs and contracts with service providers.

Contention

A notable point of contention arises from the potential impact on existing contracts between insurers and EMS providers. Insurers may argue that mandated reimbursement rates could disrupt their managed care arrangements and financial models. Opponents might also raise questions about the enforcement of the provisions and the administrative burden placed upon EMS agencies to comply with new billing requirements. The debate centers on achieving a balance between fair compensation for EMS agencies while considering the financial sustainability of insurance providers.