prohibit certain billing practices by ambulance service providers and establish reimbursement standards for out-of-network emergency medical services.
What changed between versions
Added new definitions for 'ambulance service,' 'emergency medical services,' and 'out-of-network provider' to establish clear terminology for the new regulations.
Prohibits ambulance service providers from billing patients for out-of-network emergency services except for applicable coinsurance, copayment, or deductible amounts under the patient's health benefit plan.
Mandates that ambulance providers and health plans furnish patients with clear explanations of benefits and statements of any patient liability for emergency ambulance services.
Requires health benefit plans to reimburse out-of-network ambulance providers at rates not less than local political subdivision rates, or the lesser of billed charges or 275% of Medicare allowable rates if no local rate exists.
Exempts self-funded employer health plans, Medicaid, Medicare, and other federally regulated programs from the new ambulance billing restrictions.
