Senate panel reaches compromise language to prohibit balance billing, sets temporary EMS rate at 325% of Medicare

The Senate Health and Human Services Committee agreed on compromise language related to House Bill 316 that would prohibit balance billing and establish a temporary in‑network rate for ambulance services set at 325% of Medicare for a two‑year period, senators said during the committee meeting.

The compromise — described by Senator Susan Prentiss as the product of negotiations with the House, the Department of Insurance and ambulance stakeholders — would ban balance billing, set a temporary rate that sunsets in two years and create a commission to review long‑term system and rate issues. “We are committed to prohibiting balance billing. We are committed to stabilizing the EMS system,” Senator Prentiss said.

Why it matters: Committee members said the measures are intended to protect consumers from surprise bills while preventing further erosion of ambulance coverage in parts of the state. Senator Birdsall, who joined the negotiations, said the agreement is aimed at ensuring someone shows up when a voter dials 911. “We have an agreement that will achieve the objectives that we all set out to do,” Birdsall said.

Key provisions described in the committee discussion: - A ban on balance billing for covered emergency care. - A temporary in‑network minimum rate of 325% of Medicare for ambulance services for two years; the rate is described in the compromise as a bridge while contracting and system issues are addressed. - A requirement that ambulance providers initiate a standardized, department‑created form (described by sponsors as similar to a memorandum of intent) to begin the contracting process with plans, intended to synchronize provider and carrier steps toward contracting. - An “any willing provider” provision and standardized contract language to incentivize providers to enter networks; higher in‑network rates and penalties for providers or carriers that fail to follow the initiation and contracting timelines were discussed as enforcement mechanisms. - Creation of a commission to examine system‑level issues (including periodic rate review tied to CPI), and a plan for a second cost study to address methodological concerns raised about the first study.

Representatives from the Department of Insurance, identified in committee remarks as Michelle Heaton and Jennifer Smith, were present as technical resources; senators said the department would produce the standardized form to initiate contracting.

Committee action and next steps: Committee members agreed to re‑refer/prepare the compromise language to be introduced as a floor amendment; sponsors said they will present the amendment on the floor with the temporary rate schedule and the commission language. Committee members indicated ongoing work will include a second cost study and coordination of standardized contracting language. No final floor passage occurred in the meeting.

Context and limits: Senators repeatedly emphasized the measure is intended as a temporary bridge and that moving ambulance providers into network status cannot be compelled by the committee — the compromise uses incentives, standardized forms and regulatory tools to encourage contracting. Committee members also noted additional detail on timelines, penalties and commission membership would be developed before the floor presentation.

What’s next: The bill will be brought to the floor with the compromise language as an amendment; sponsors and the Department of Insurance will continue drafting the standardized contracting form and commission language and will complete a follow‑up cost study.