AN ACT to create and enact a new section to chapter 23-27 and a new section to chapter 26.1-47 of the North Dakota Century Code, relating to ambulance service balanced billing and provider reimbursement; to amend and reenact section 23-27-04.8 of the North Dakota Century Code, relating to emergency medical services communication; to provide for a legislative management study; and to provide an appropriation.

Out-of-network ambulance reimbursement rate reduced from 400% to 250% of Medicare reimbursement rate for the same service in the same geographic area.

Added new section requiring insurance commissioner to adopt rules to implement and enforce the balance billing prohibition.

Added explicit exclusion of air ambulance providers from the definition of 'ambulance service provider'.

Added $20,000 appropriation for a legislative management study on delinquent billing reimbursement systems for ambulance service providers during the 2025-26 interim.

Bill renumbered from 25.0744.01000 to 25.0744.03000 and reorganized structure to amend existing emergency medical services communications section before adding new ambulance reimbursement chapter.