Oregon DFR reviews draft rules to implement House Bill 3243 on ground ambulance balance billing

Lisa Emerson, senior policy adviser with the Division of Financial Regulation (DFR), opened a virtual rulemaking advisory committee meeting to review a discussion draft of administrative rules to implement House Bill 3243 on ground ambulance balance billing. The session covered definitions, a public database of established local rates, backup reimbursement calculations and timelines for insurer reimbursements, and invited further written comments ahead of an October comment deadline.

The rules team emphasized statutory alignment. "We do now have the actual, Oregon laws 2025 chapter 614, which is where House Bill 3243, the act, is codified," Emerson said, noting the draft aims to place the new rules in an appropriate location of the Oregon Administrative Rules (chapter 836, division 053 in the draft). The draft removes the term "out of network" from the definitions because that wording is not in the statute and can cause confusion.

Providers and advocates urged operational clarity for a publicly accessible rates database. Sabrina Riggs of the Oregon State Ambulance Association recommended a model like Washington’s and warned of enforcement gaps: "some insurers are even when there is a locally established rate that is included in that good Washington database, it's not being paid and insurers are just defaulting to the backup Medicare rate." She asked the department to include clear reporting pathways and enforcement language so EMS providers can flag problems to DFR for follow-up.

Insurers and payer representatives said the rules should reflect Oregon’s statutory language and be operationally feasible. Antoinette, a senior public and regulatory affairs specialist commenting for Cambia Health/Regence, said the rulemaking should "focus exclusively on provisions that require operational clarity under Oregon's specific statutory framework," asked DFR to define new terms such as mutual aid, transport and allowed amount, and proposed using the Medicare rate effective Jan. 1 of each calendar year to align with benefit cycles. She also recommended mechanisms (a 60-day reliance period) to allow carriers to rely on most-recently submitted rates when updates are late.

Members debated how to compute backup reimbursement and the timing for insurer payments. Emerson confirmed the draft follows the statute’s backup approach—if a local established rate is not reported, reimbursement may fall back to a multiple of the Medicare rate (the draft cites 325% of the Medicare rate as the statutory benchmark). Stakeholders disagreed on payout timing: Charlie Fisher urged keeping a 30-business-day reimbursement requirement to protect consumers, saying it is unreasonable for patients to wait months for refunds after an emergency. Rural providers and several chiefs said 30 days is often impractical because of governance and cash-flow constraints; they asked that the rule allow up to 90 days or otherwise recognize small providers’ operational limits.

The committee discussed several definitional and reporting questions that will affect implementation. Participants proposed a working mutual-aid definition for transports that originate outside a provider’s designated area and occur at the request of or under agreement with the responding agency; RAC members asked DFR to adopt examples and to vet any resident/nonresident definitions against real-world operational practices (ZIP code, service-area rules and local rate-setting differences). DFR staff described planned database fields (legal name, NPI, effective dates, ZIP codes, procedure and mileage codes, resident/nonresident flags) and said they are consulting Washington OIC staff on lessons learned.

Timing and process items flagged for further work included: written comments due by October 3, an annual submission/publication timing discussion (participants suggested dates ranging from October 1/October 6 to mid-January or January 15), and technical assistance and validation steps ahead of any public rollout of the rates database. Emerson said DFR will follow up and intends to mirror useful elements of Washington’s implementation, including an online opt-in form for self-funded plans and publication of entities that opt in.

Next steps: DFR will incorporate stakeholder feedback into further drafts, seek clarifications on the reimbursement-language (remove unintended "lesser of" phrasing where it conflicts with the statute), and continue internal discussions about operational timing. Staff will accept written comments through the stated deadline and will circulate a calendar invite for the next RAC meeting scheduled for October 16. The rulemaking team asked stakeholders to submit suggested definitions and operational examples in writing for use in the next draft.

Quotes used in this article are drawn from the RAC meeting record and attributed to speakers included in the meeting transcript. The meeting closed after a brief public-comment window and scheduling reminders.