SB 269 Alabama Senate · 2026 Regular Session

Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers

SB 269 regulates how health insurers pay for ground ambulance services in Alabama. It prohibits surprise billing by requiring insurers to pay providers a set minimum rate (200% of Medicare’s ambulance rate for in-network services, 180% for out-of-network) as full payment, meaning patients can only be charged their standard in-network copay or deductible. Ambulance providers and insurers must report financial data to the Alabama Department of Public Health, and an independent expert will study the law’s impact on access to ambulance services. The law expires on June 1, 2029. It directly affects emergency medical service providers and patients covered by health insurance plans.

Issues: ✓ Healthcare

Bill status signed all 5 stages cleared

Introduction

Feb 2026

Committee Review

Mar 2026

Senate Passage

Mar 2026

House Passage

Mar 2026

Signed into Law

Apr 2026

Introduced Feb 5, 2026 Signed Apr 6, 2026

Maddy AI version diff · 2 comparisons

What changed between versions

Engrossed → Enrolled · 4 edits · Apr 6, 2026

MODERATE

The bill was finalized as Enrolled, incorporating technical formatting updates and adding a new definition for 'COLLECTION' to clarify debt recovery efforts. A critical new provision was added to prevent providers from billing for both 'treat in place' services and ground transport for the same emergency event, which helps reduce unnecessary billing. The reimbursement rates and effective dates for these services remain unchanged from the previous version.

TECHNICAL

Updated the bill title from 'Engrossed' to 'Enrolled' and adjusted the internal document identifier number.

Added a missing phrase 'to provide covered services' to the definition of 'OUT-OF-NETWORK' to ensure consistency with the 'IN-NETWORK' definition.

DEFINITION

Added a new definition for 'COLLECTION' to explicitly include invoicing and legal debt collection efforts when communicating with enrollees.

REQUIREMENT

Added a prohibition preventing emergency medical service providers from submitting reimbursement claims for both 'treat in place' services and ground transport for the same event.

Floor votes

How they voted

This bill passed the Senate by voice vote (no roll call recorded).

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Mar 31, 2026

Lower · Passed

Motion to Read a Third Time and Pass - Adopted Roll Call 1066

lower

Mar 17, 2026

Lower · Passed

Reported Out of Committee Second House

lower

Mar 5, 2026

Lower · Passed

Pending Committee Action in Second House (Insurance)

lower

Mar 3, 2026

Upper · Passed

Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 683

upper

Mar 3, 2026

Upper · Passed

Singleton motion to Adopt - Adopted Roll Call 682

upper

Mar 3, 2026

Introduced

Banking and Insurance 1st Substitute Offered (Banking and Insurance)

upper

Feb 26, 2026

Upper · Passed

Reported Out of Committee House of Origin

upper

Feb 5, 2026

Upper · Passed

Pending Committee Action in House of Origin (Banking and Insurance)

upper

1 primary · 0 co-sponsors