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Committee backs compromise to curb ambulance balance billing, orders two-year cost study
Summary
The subcommittee and full committee moved SB 245 as amended to prohibit surprise ambulance balance billing, set an interim reimbursement floor tied to Medicare, require prompt insurer payment and commission a two-year independent cost study to measure ambulance operating costs.
The House Health Insurance subcommittee and then the full committee approved an amended version of Senate Bill 245 aimed at eliminating surprise balance billing for ambulance transports and stabilizing payment to ambulance providers.
The bill, advanced by Representative Miles and seconded by Representative Spear, bars balance billing for emergency ambulance transports and sets a minimum reimbursement rule when no locally approved rate exists: insurers must pay at least 3.25 times the Medicare rate for the transport. The measure removes prior authorization for emergency dispatches, establishes a presumption of medical necessity for services dispatched by protocol, and requires insurers to process payments promptly.
Supporters said the bill fills a gap left by federal law that excluded emergency ground ambulance services from the No Surprises Act. Representative Miles, an emergency nurse and sponsor, said the package is intended to keep ambulances operating statewide, to protect patients from surprise bills and to give providers a predictable revenue path. The amendment adopted during subcommittee and carried to the floor included a transitional two‑year period and an independent cost study to collect detailed operating-cost data for ambulance services.
Speakers on the record urged the committee to balance fair payment with measures to encourage ambulances to join insurer networks. Representatives on the panel discussed procedural details in the amendment: carriers were given a shorter deadline to respond to network requests (45 days) while providers were given a longer, 60‑day window to complete contracting steps, reflecting differences in organizational capacity between insurers and local providers.
Subcommittee and committee votes: the subcommittee recorded an 8–0 “ought to pass” vote on the amendment; the full committee later approved SB 245 as amended and placed it on the consent calendar (recorded roll-call vote 16–0). The bill includes a two‑year sunset on certain transitional provisions so that lawmakers can review the independent cost study and the market effects before making changes permanent.
What the bill does not change: it does not alter federal payment rules for Medicare or Medicaid; speakers repeatedly noted that government program rates (Medicare/Medicaid) remain set outside state authority and that the bill addresses only commercial/other payers’ treatment of ambulance transports.
The committee recorded that the two‑year study and the statutory transition are intended to give providers time to adjust operations and for the state to pursue federal engagement (for example, with CMS) about program reimbursement levels. The full text of the amendment specifies the 3.25× Medicare floor, the 45/60 day timing differences, and the study mandate.
The committee’s action means the measure will move forward to further consideration with the adopted amendments; sponsors noted they expect further legislative review after the cost study completes.
