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Department outlines two‑year compromise to ban ambulance balance billing, set temporary rates and launch deeper cost study
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Summary
The Department of Insurance presented a negotiated compromise to prohibit ambulance balance billing and adopt temporary in‑network and out‑of‑network rates while a second, more detailed cost study is completed. The amendment will be drafted and returned to the subcommittee next week; no formal vote was taken.
The subcommittee heard a compromise plan from Department of Insurance staff intended to end surprise ambulance balance bills while stabilizing emergency medical services (EMS) providers.
Under the outline presented, balance billing would be prohibited. A temporary two‑year rate structure would apply while the department conducts an expanded cost study and prepares rulemaking for a permanent rate: an in‑network payment set at 325% of Medicare and an out‑of‑network benchmark at 100% of Medicare. To encourage providers to contract with carriers, the draft would include an “any willing ambulance provider” provision and a standardized provider contract for use in negotiations.
Department staff said the in‑network rate would be available once providers file required paperwork with a carrier and copy the department; carriers would have roughly 45 days to finalize the contract after receiving complete materials. Providers would have 60 days to respond to carrier requests for additional information or they revert to the out‑of‑network rate until they reengage. The department will track negotiations and can take enforcement action where carriers or providers do not proceed in good faith.
The plan also calls for a second, deeper cost study that would take longer than the department’s initial study this year and allow additional stakeholder collaboration and data verification. The department said the initial study was constrained by time and that a more detailed study should better capture provider cost nuances across municipal, private and volunteer providers. After the second study, rates would be set through rulemaking and thereafter adjusted annually for health care inflation.
Department staff framed the compromise as a two‑part win: immediate consumer protection from surprise bills and a two‑year stabilization and analytic period so EMS providers can examine business models and negotiate network contracts. “For the first time in 40 years, we've put forward something that stops some immediate problems and puts in place a process to which we can get to a permanent sustainable solution to these issues,” a Department representative told the committee.
Lawmakers asked practical questions about implementation. Representative Gibbs said contracts and network participation historically reduce administrative friction and questioned how the compromise would incentivize providers to join networks; the department responded that being in contract reduces overhead and the uncertainty that leads to billing disputes. Representative Sharissa asked about the new cost study and why it was needed when the department produced an earlier study; department staff said the vendor for the earlier study worked under a tight deadline and the new study would have more time to validate data, audit submissions and incorporate provider feedback.
The subcommittee did not take a vote. The Department of Insurance will draft the amendment reflecting the compromise language and provide it to the committee before the next meeting; members plan to resume consideration next Tuesday.
