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Senate committee backs substitute for SB 51 to set ambulance reimbursement minimums and bar balance billing
Summary
A Senate committee gave SB 51 a favorable report after adopting a substitute that sets minimum ambulance reimbursement rates tied to CMS, requires annual EMS data reporting to ADPH, funds an actuarial study, and prohibits balance billing; the act is written to repeal in 2029.
A Senate committee on an unspecified date gave SB 51 a favorable report after adopting a substitute that sets minimum reimbursement levels for ambulance services, prohibits balance billing, requires annual data reporting by EMS providers and commissions an actuarial study.
Supporters said the substitute aims to reduce surprise billing for patients while finding a reimbursement level that helps EMS providers maintain and expand services, especially in rural communities. Ryan DeGraff, a representative of the Alabama Ambulance Association, told the committee the substitute "sets in the law, a minimum reimbursement rate" and that "one of the most important parts of this is the elimination of balance billing."
The substitute sets a minimum reimbursement tied to the Centers for Medicare & Medicaid Services (CMS) rates: a 200% CMS rate is specified for out-of-network providers effective Jan. 1, 2025. The presentation to the committee also described a secondary payment benchmark described in the substitute language as the "lesser of 180% of CMS or the charge," as read into the record during the hearing. The measure preserves the ability of insurers and providers to enter in-network contracts.
The substitute requires annual submission of financial and programmatic data by EMS providers to the Alabama Department of Public Health (ADPH); the testimony said financial information would be held in confidence. The bill directs ADPH to contract for an actuarial study, with a report due to the legislature by Dec. 1, 2028. Committee testimony said the three largest insurance companies would pay for the contractor for the study, with a cap on that cost of $50,000.
A committee member noted that some ambulance services are owned by private equity and expressed concerns raised during negotiations about funds leaving the state rather than being reinvested in services. DeGraff said the Alabama Ambulance Association accepted a temporary statutory limitation on balance billing in part to secure data and a pathway to a longer-term solution; the substitute includes a repeal date of June 1, 2029, so the legislature may revisit rates after receiving the actuarial report.
The committee adopted the substitute and reported SB 51 favorably. The record shows a voice vote on adoption; the chair announced that SB 51 "receives a favorable report." No floor vote on the bill itself was recorded in the provided transcript.
Background: Committee discussion referenced the federal No Surprises Act enacted in 2021 and ongoing debates between EMS providers and insurers, including Blue Cross Blue Shield, over appropriate reimbursement levels and the practice of balance billing.
Votes at a glance: The committee adopted the substitute for SB 51 (substitute adoption announced in committee; substitute mover not named in the record, seconded by Senator Coleman) and the committee reported SB 51 favorably to the floor.
