House approves HB400 (amended) to raise ambulance reimbursement and fund rural "treat-in-place" pilot

The Alabama House advanced HB400 on a voice vote after debating reimbursement levels for ambulance services, a new "treat-in-place" payment option for low-acuity calls and fiscal impacts on insurers and consumers.

Representative Oliver, who presented the bill, said the measure is designed to shore up rural emergency medical services after years of strain. "In-network, the minimum reimbursement rate shall be 200% of the Medicare ambulance fee schedule as published by CMS rate in effect on October 1, 2026," he said. He added that the out-of-network minimum would be 180% of that same Medicare ambulance fee schedule and described a super-rural add-on based on the Medicare rate for zip code 35462 that would yield an applicable rate of about 245% of the CMS reimbursement rate.

Oliver described "treat-in-place," an option allowing EMS to bill for on-site care without transport, as a way to preserve ambulance availability and provide lower-cost care: "come actually bill at the basic life support rate that an ambulance would use probably about $535 as opposed to transporting that person to an ER which would run about $1,400." The bill also requires EMS providers to submit annual data to the Alabama Department of Public Health and directs ADPH to contract with a consultant for an actuarial study not to exceed $50,000; sponsors said the three largest Alabama health insurers would pay for the study.

Members questioned insurer cooperation and fiscal impacts. One lawmaker asked what discussions had occurred with insurers; Oliver said Alabama's largest insurer has worked with sponsors on the bill for three years and that the legislation includes dispute-resolution language for denied claims. Representative Bose praised the treat-in-place option but asked how added mandates would affect consumer premiums; Oliver said the cost could be "as little as 60 cents or as much as $5." Representative Shyri raised concerns about mandating out-of-network reimbursement levels for private companies that may choose to remain out-of-network.

An amendment that replaced multiple lines across several pages to clarify reimbursement applicability and dispute resolution was read by Miss Hall, moved by Representative Lipkin, and adopted by voice vote. A final motion to pass HB400 as amended was made by Representative Hope Jones and seconded by Representative Binyard; the bill passed on a voice vote. Sponsors said the act would sunset June 1, 2029, and a report must be submitted to the president pro tem and the speaker no later than Dec. 1, 2028.

The transcript records the bill's passage by voice vote and does not show numerical roll-call tallies.