Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Health Finance Ems Billing topic
No spam. Unsubscribe anytime.
Committee advances EMS surprise-billing bill setting insurer payment formula and limiting patient balance billing
Summary
The Senate Health Committee adopted a committee substitute to Senate Bill 632 and reported it to the full Senate; the substitute would limit patient balance billing for out-of-network ground ambulance services and set insurer payment criteria and timing.
The Senate Health Committee reported a committee substitute to Senate Bill 632 to the full Senate with a recommendation that it pass and with referral to the Committee on Finance under the original double reference.
Counsel explained the substitute prohibits out-of-network emergency medical services (EMS) agencies from surprise-billing a covered enrollee or their insurer for ground ambulance services, clarifies that insurer payment is payment in full except for any insurer-required cost-sharing, and prohibits the EMS agency from billing the individual beyond applicable cost-sharing. Counsel said the substitute sets the insurer payment to the nonparticipating EMS agency as either 400% of the currently published Medicare/ CMS rate for the same service in the same geographic area or the agency’s billed charges, whichever is less, and requires the insurer to remit payment to the nonparticipating EMS agency within 30 days of receipt of a clean claim, with specified exceptions; if an insurer denies a claim it must provide written notice containing required information.
Counsel said the committee substitute includes a provision that the section does not apply to insurers that have a contract with the bureau for medical services related to Medicaid or CHIP. Counsel stated a fiscal note was requested, the West Virginia Insurance Commission would be the affected government agency and the effective date in the substitute is January 1, 2026.
The committee heard testimony from Dr. Mike Thomas, chief government affairs officer for Jancare Ambulance, who said the measure would make EMS agencies whole for commercial-insurance payments and prevent balance billing of patients. Thomas said the 400% figure is intended to make agencies whole compared with current commercial payments and that 13 other states have adopted similar approaches. He said the measure would not apply to Medicare/Medicaid and, to his knowledge, would not create a state cost. Thomas testified that EMS agencies have faced closures in recent years and that the bill would help stabilize payment to those providers.
After testimony and questions from senators, the committee voted to adopt the committee substitute and to report the bill to the full Senate, with the chair recording that the ayes have it. Counsel noted Finance will need a fiscal impact analysis when the bill reaches that committee.
