Health insurance; ambulance service provider; providing for establishment of certain database; modifying reimbursement rates and criteria for certain ambulance services. Effective date.

Added requirement for local governmental entities to submit ambulance service rates to the Insurance Department annually

Added mandate for Insurance Department to maintain a public database of all submitted ambulance rates

Established minimum reimbursement rates for out-of-network ambulance services at the lesser of submitted local rates, 325% of Medicare rates, or billed charges

Added prohibition on billing enrollees for amounts exceeding what insurers pay for covered ambulance services

Added limits on copayments, coinsurance, and deductibles to match in-network rates for ambulance services

Set effective date of January 1, 2026

Changed bill scope from a general amendment motion to specific statutory amendments addressing out-of-network ambulance billing

Removed Section 1 which contained all statutory definitions for key terms used throughout the Out-of-Network Ambulance Service Provider Act.

Renumbered subsequent sections (previously Section 2 and 3) to become the new Section 1 and Section 2 after removing the definitions section.

Updated the bill title to reflect the removal of the definitions section and conform to the amended structure.

The minimum allowable reimbursement rate for out-of-network ambulance services was reduced from 325% of Medicare rates to 275% of Medicare rates when local governmental entities have not submitted their own rates.

New statutory definitions were added for key terms including 'Ambulance service provider', 'Covered ambulance services', 'Enrollee', 'Health care benefit plan', 'Health care insurer', 'Out-of-network', and 'Clean claim'.

The bill now amends Sections 2 and 3 of Chapter 356 instead of just Section 3, with Section 2 containing the new definitions and Section 3 containing the reimbursement rate provisions.

The act title was updated to reflect that it modifies definitions in addition to the reimbursement rate provisions, and the effective date section was moved to Section 3.

Effective date changed from unspecified to January 1, 2026, with rates from May 1, 2025 submissions becoming the baseline for reimbursement.

Department must establish a public database by January 1, 2026, and submit a report to Governor and legislative leaders by January 1, 2027.

Insurers must limit cost-sharing to in-network levels for covered ambulance services.

Reimbursement rates now include a Medicare-based option (325% of CMS rates) and billed charges as alternatives when local rates aren't submitted.

Ambulance service providers can now submit rates directly, not just local governmental entities.

Added sunset provision requiring legislative action by December 31, 2027, to keep new reimbursement rates in effect.

Changed from only local governmental entities being able to submit rates to now also allowing ambulance service providers to submit rates to the Insurance Department.

Adjusted the minimum allowable reimbursement rate calculation from 325% of Medicare rates to 275% of Medicare rates for out-of-network ambulance services.

Reorganized subsections and removed references to a report submission deadline of January 1, 2027, while keeping the database requirement intact.

Removed the sunset provision that would have ended the rate modifications on December 31, 2027, unless the Legislature acted before then.

Changed from ambulance service providers submitting rates to local governmental entities or their representatives submitting rates to the Insurance Department.

Added requirement for the Insurance Department to establish and maintain a public database listing all submitted ambulance rates by January 1, 2026.

Added requirement for the Department to submit an annual report by January 1, 2027, to the Governor, Senate President Pro Tempore, and House Speaker.

Modified effective date provisions and added sunset clause requiring legislative action by December 31, 2027, to continue the rate provisions.

Added new subsections clarifying that copayments, deductibles, and cost-sharing amounts cannot exceed in-network levels and that payment compliance prohibits additional billing to enrollees.