Senate committee backs bill to curb surprise ambulance bills, sets 325% of Medicare as out-of-network ceiling

ATLANTA — The Senate Health and Human Services Committee on Monday voted to advance SB 462, a bill aimed at limiting surprise out-of-network ground ambulance bills by setting a statutory ceiling of 325% of the Medicare reimbursement rate for covered emergency transports and prohibiting balance billing beyond standard co-payments, co-insurance and deductibles.

Sponsor Senator Still said the bill responds to cases in which patients who have no choice about which ambulance responds to a 911 call later receive large out-of-network bills. "This bill seeks to rectify the problem with in network versus out of network on that collection," he told the committee, explaining the proposal applies only to ground transport and does not change air ambulance coverage.

Under the bill, a health-care plan would be required to treat emergency transport requested by a first responder or health-care practitioner as a covered service. The measure sets the minimum allowable reimbursement for an out-of-network ambulance provider at the lesser of the billed charge or 325% of the Medicare rate (including applicable mileage and modifiers), and requires insurers to pay within 30 days, sponsors said. Patient cost-sharing would be limited to amounts no greater than what the insured would owe for similar in-network services.

Supporters — including county EMS directors, hospital associations and ambulance providers — said the ceiling is needed to prevent unsustainable unpaid bills from threatening local emergency services. Bud Owens, a county commissioner who also identified himself as vice president of mobile medicine for Atrium Health, described routine operational strains and collection challenges when insurers send reimbursement checks to patients instead of providers. "They will typically go out and spend the check on their own personal needs instead of paying their EMS bills," Owens said.

Ambulance providers and associations told the committee that Medicare reimbursement for ambulance services has not kept pace with cost. Terrence Ramitar of the Georgia Ambulance Providers Association cited a CMS cost study and said Medicare base rates are "less than a third of the cost," which is why many states have adopted statutory multipliers in the 325–400 percent range to cover provider costs while banning balance billing.

Health-plan representatives acknowledged patient protection is important but cautioned against a fixed statutory ceiling that could discourage contracting. Jesse Weddington, president of the Georgia Association of Health Plans, said a flat 325% of Medicare may be "a bit too high" and recommended considering either a lower percent or an approach tied to median in-network rates so the statutory number does not disincentivize negotiations.

Committee members pressed witnesses on several technical issues, including whether ERISA plans (large employer-sponsored plans governed by federal law) would be excluded, how mileage and rural modifiers are incorporated into the Medicare calculation, and whether patients may still be liable for any difference between the statutory ceiling and an ambulance's billed charge. Witnesses said ERISA plans are likely beyond state regulation, mileage is part of typical Medicare claims, and patient liability would be limited to in-network-like co-pays and deductibles; providers would generally absorb the remaining difference.

Local EMS officials gave concrete budget examples. Sam Pulk, assistant chief for EMS operations in Henry County, said that if the bill had been in effect in 2025 his county would have received about $1.9 million more in reimbursement. Industry witnesses warned that without a fair reimbursement floor, many rural and small providers face budget shortfalls that could force increased local taxes or reduced coverage.

The committee moved and seconded SB 462 and approved it unanimously. Sponsors and witnesses said they expect more technical questions and fiscal analyses as the bill proceeds through the legislative process.

What happens next: SB 462 was reported favorably from committee and will proceed according to Senate rules and scheduling; technical drafting questions remain about ERISA applicability, precise Medicare-multiplier calculations and the potential fiscal effect on state-subsidized exchange plans if federal rules change.