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Committee advances bill to bar surprise ambulance balance billing, set out‑of‑network payment rules
Summary
House Bill 10‑88 would prohibit balance billing by public ambulance agencies and require insurers to pay out‑of‑network ground ambulance claims at set rates (325% of Medicare or higher if a locally set rate is justified); the committee voted the bill to appropriations with a favorable recommendation.
Representative McCormick, co‑sponsored by Representative Brown, presented House Bill 10‑88 as a consumer‑protection measure to eliminate surprise ambulance balance billing and to create a stable reimbursement framework for both public and private ambulance services.
The bill would prohibit ambulance agencies—public and private—from sending patients balance bills for emergency and nonemergency transports after insurers have paid, establish a default reimbursement floor of 325% of Medicare for out‑of‑network ground ambulance services, and allow locally set rates above that floor if justified by a third‑party cost analysis and adopted through an open local process. The measure would also require insurers to pay political‑subdivision‑adopted rates that meet statutory conditions and to post those rates on a public website.
Supporters, including West Metro Fire Rescue, the Emergency Medical Services Association of Colorado, AARP Colorado and the Colorado Consumer Health Initiative, said the bill protects patients who have no choice of ambulance provider during emergencies and helps sustain rural EMS operations. "This bill would prohibit surprise balance billing for all emergency and non emergency transports, provide fair reimbursement to providers to sustain these services and create pricing safeguards to promote transparency and accountability," said Todd Heinel, division chief of EMS for West Metro Fire Rescue.
Insurance‑industry witnesses and the Division of Insurance urged amendments. Jill Mullen of the Division of Insurance testified in an amend position and asked for additional guardrails around locally set rates and further discussion of the correct reimbursement approach for nonemergency medical transport. Kevin McFatridge of the Colorado Association of Health Plans said emergent and nonemergent transports are “fundamentally different” and urged a different reimbursement approach for nonemergent trips to avoid incentives for unnecessary transports.
Sponsors said the bill followed federal advisory committee recommendations and the state EMS sustainability task force report and noted research from other states shows little or no effect on premiums from similar policies. Representative Brown said the default 325% multiplier was intended to create a fair floor while allowing local jurisdictions to justify higher rates through a transparent process.
The bill drew extensive public testimony from individuals who received large ambulance bills, rural EMS leaders who said local rates reflect fixed costs and sparsity, and billing operators who said current insurer payments lack parameters. Witnesses gave examples of how surprise bills have caused financial hardship and said public agencies (which provide roughly 75% of Colorado ambulance services, witnesses said) were excluded from the 2019 surprise‑billing statute.
The committee voted to send House Bill 10‑88 to appropriations with a favorable recommendation; roll call recorded 12 yes votes and 1 no vote.
What happens next: The bill proceeds to the Appropriations Committee for review of fiscal impacts and any amendments. Sponsors signaled they expect continued stakeholder discussions with the Division of Insurance, insurers and provider groups about nonemergent transport definitions and guardrails for locally set rates.
