Senate committee advances bill to curb ambulance balance billing, set minimum out‑of‑network rates

Pierre — The Senate Health and Human Services Committee on Monday voted to send Senate Bill 211 to the Senate floor with a due‑pass recommendation after more than an hour of testimony on ambulance billing and reimbursement standards.

Sponsor Tim Reed (District 7) told the committee the bill aims to prevent balance billing and to stabilize emergency medical services that he said are operating under “significant financial strain.” Under the amendment adopted for committee consideration, a health benefit plan must reimburse an out‑of‑network ambulance service for emergency medical services at a rate not less than a rate adopted or recognized by the political subdivision where the transport originated; if no local rate exists, insurers must reimburse the lesser of the provider’s billed charge or 275% of the Medicare/Medicaid allowable rate. The bill also requires clear explanations of benefits and limits patient liability to applicable copayments, coinsurance and deductibles, except for noncovered services.

“When a South Dakotan calls 911, no one asks whether the ambulance is in network,” Reed said in his opening testimony. He and EMS witnesses said low and inconsistent insurer payments — combined with rising costs and volunteer losses — are forcing local governments and taxpayers to cover shortfalls.

Several EMS representatives described the financial impact. Bridal Hambach, executive director of Spearfish Ambulance and president of the South Dakota Ambulance Association, said Medicare reimbursements and some private insurer payments cover only a fraction of the true cost of a ground ambulance transport. “Medicare … is only paying 55% of what it cost me to roll tires out the door,” Hambach said, and said an average ground ambulance transport in the state is about $2,400, with Medicare around $1,000 — leaving roughly a $1,400 gap on average.

Proponents argued the bill pairs patient protection from surprise bills with an enforceable reimbursement standard so providers receive timely payment and local jurisdictions are not forced to continually subsidize services.

Insurers and some health systems urged caution. Dylan Wheeler of Sanford Health and Melissa Clayman of Blue Cross said they support prohibiting balance billing but cautioned that mandating high multipliers of Medicare — and allowing uncapped billed charges — could destabilize insurance markets, raise premiums, and reduce incentives for providers to remain in network. Darla Pullman Rogers, representing AHIP and a state agents’ association, warned a mandated methodology keyed to billed charges or 275% of Medicare would “lead to inflated costs” and discourage contracting.

Opponents also pointed to alternative avenues for study. Several witnesses and committee members referenced an upcoming or companion study (SB 89) to evaluate whether EMS should be designated an essential service and how to fund it.

Committee action: Senator Davis moved SB 211 as amended to the 40th first day and later offered a substitute due‑pass motion. The committee recorded a due‑pass recommendation by voice/roll call (tally recorded in committee: 5 yeas, 2 nays) and advanced the bill to the Senate floor.

What’s next: SB 211 will move to the full Senate calendar. Sponsors and proponents said they expect additional debate in the House and welcomed further study of EMS funding and the technical work of rate setting.

(Reporting in this article is based on committee testimony and motions recorded during the Senate Health and Human Services Committee meeting; direct quotes and numeric details are drawn from witness statements and the sponsor’s presentation.)