SB 1067: Health insurance; ambulance service provider; providing for establishment of certain database; modifying reimbursement rates and criteria for certain ambulance services. Effective date. - Oklahoma

Floor (House) → Floor (Senate) · 4 edits

MODERATE

The bill was transitioned from the House version to the Senate floor version, resulting in a reorganization of the text and the addition of a Committee Substitute header. The substantive policy content regarding ambulance reimbursement rates, database requirements, and effective dates remains identical to the House version, with no new definitions, funding changes, or scope modifications introduced in this specific markup.

TECHNICAL

Added a 'Committee Substitute' header and date (March 3, 2025), indicating the bill has been amended by a committee and is now ready for Senate floor consideration.

Reordered the text to place the Committee Substitute header and the bill title above the original House header and title, standardizing the format for Senate floor presentation.

Added a Committee Report section at the end of the bill text.

Removed the original House header, the 'Engrossed Senate' title, and the House Rules Committee report.

SB1067 (3-24-25) (ROSINO) FA1.PDF → Floor (House) · 4 edits

MODERATE

The bill was converted from a Senate version to a House Floor version, which completely replaced the original text with new provisions regulating out-of-network ambulance rates. The new version establishes a public database for local rates and sets specific minimum reimbursement percentages (325% or 275% of Medicare rates) to prevent surprise billing for patients.

Scope change

The bill's scope shifted from a procedural amendment to a substantive policy change that applies to health care insurers, ambulance service providers, and local governmental entities.

REQUIREMENT

Added a requirement for the Insurance Department to create a public website database listing all ambulance service rates submitted by local governmental entities.

Established new minimum reimbursement rates for out-of-network ambulance services, mandating payment of at least 325% of local rates or 275% of Medicare rates, whichever is lower.

ENFORCEMENT

Prohibited ambulance service providers from billing patients for any amounts exceeding what the health insurer pays under the new rate structure.

TIMELINE

Set the effective date of the act to January 1, 2026.

Committee Substitute → SB1067 (3-24-25) (ROSINO) FA1.PDF · 2 edits

MINOR

The bill was amended to remove the original text entirely and replace it with a formal floor amendment record. This change indicates that the substantive policy provisions regarding ambulance reimbursement rates and definitions were not included in this specific version of the document, likely because the bill was being re-submitted or modified during the legislative process.

Scope change

The bill's scope is currently undefined in this version as the original substantive sections were removed.

REQUIREMENT

Removed all original text defining ambulance service terms, reimbursement rates, and database requirements.

TECHNICAL

Added a formal floor amendment record indicating the intent to remove the original Section 1 and renumber subsequent sections.

Enrolled (final version) → Committee Substitute · 5 edits

MODERATE

The bill was converted from an enrolled final version to a committee substitute, which introduced significant substantive changes to the Out-of-Network Ambulance Service Provider Act. The most critical change is the reduction of the minimum reimbursement rate for ambulance services from 325% to 275% of the Medicare rate when local rates are not available. Additionally, the bill now includes new definitions for key terms like 'Ambulance service provider' and 'Health care insurer,' and expands the scope of the act to amend two separate sections of the statute rather than just one.

Scope change

The bill's scope was expanded to include amendments to Section 6050.2 (definitions) in addition to Section 6050.3 (reimbursement rates). The definition of 'Ambulance service provider' was narrowed to specifically include only ground transportation services, and the definition of 'Health care insurer' was updated to explicitly exclude state Medicaid contracted entities.

FISCAL

The minimum allowable reimbursement rate for out-of-network ambulance services was reduced from 325% to 275% of the current Medicare published rate when local government rates are not submitted.

DEFINITION

New definitions were added for 'Ambulance service provider' (limited to ground services), 'Covered ambulance services' (limited to unscheduled emergency ground services), 'Enrollee', 'Health care benefit plan', 'Health care insurer', 'Out-of-network', and 'Clean claim'.

SCOPE

The bill's scope was expanded to amend both Section 6050.2 (definitions) and Section 6050.3 (reimbursement), whereas the enrolled version only amended Section 6050.3.

ELIGIBILITY

The term 'Ambulance service provider' was restricted to providers offering ground transportation services, and 'Health care insurer' was clarified to exclude state Medicaid contracted entities.

REQUIREMENT

The requirement for the Insurance Department to submit a report to state officials was removed from the committee substitute version.

Engrossed → Enrolled (final version) · 5 edits · May 28, 2025

MODERATE

The bill was finalized as an Enrolled version, changing the effective date to January 1, 2026, and adding a sunset provision requiring legislative review by December 31, 2027. The reimbursement rules were modified to tie rates to submissions made by May 1, 2025, and a new requirement mandates that the Insurance Department submit a report to state leaders by January 1, 2027.

Scope change

The bill's scope was expanded to include ambulance service providers submitting rates, not just local governmental entities, and a new requirement was added for the Department to submit a report to the Governor and legislative leaders.

TIMELINE

The effective date for the new ambulance reimbursement rules was set to January 1, 2026.

A sunset clause was added, requiring the Legislature to modify the rates by December 31, 2027, or they will cease to be in effect.

REQUIREMENT

The Insurance Department is now required to submit a report to the Governor and legislative leaders by January 1, 2027.

The minimum reimbursement rate is now tied to rates submitted by local entities on May 1, 2025, rather than existing rates.

SCOPE

Ambulance service providers are now explicitly authorized to submit rates to the Insurance Department alongside local governmental entities.

Amended And Engrossed → Engrossed · 3 edits · May 21, 2025

MINOR

The bill was amended to expand the authority to submit rates to include ambulance service providers in addition to local governmental entities. The reimbursement calculation was modified to use 275% of Medicare/Medicaid rates instead of 325%, and the reporting deadline for the Insurance Department was moved from January 1, 2027, to January 1, 2026. The effective date for the act remains January 1, 2026.

Scope change

The scope of entities authorized to submit rates was expanded to include ambulance service providers, whereas previously only local governmental entities could do so.

ELIGIBILITY

Ambulance service providers are now authorized to submit rates to the Insurance Department, in addition to local governmental entities.

REQUIREMENT

The minimum allowable reimbursement rate was changed from 325% to 275% of the current Medicare and Medicaid published rate for the same services.

TIMELINE

The deadline for the Insurance Department to submit its annual report to the Governor and legislative leaders was advanced from January 1, 2027, to January 1, 2026.

Introduced → Amended And Engrossed · 4 edits · May 21, 2025

MODERATE

The bill was amended to shift focus from regulating ambulance reimbursement rates to establishing a public database for rate transparency. The changes authorize local governments to submit rates to the Insurance Department and require the Department to publish them online. Additionally, the bill now includes a sunset clause, requiring legislative review by December 31, 2027, to determine if the rates should continue.

Scope change

The bill's scope expanded from solely regulating reimbursement rates to include administrative requirements for data collection, public transparency, and a mandatory legislative review process.

REQUIREMENT

Added a requirement for the Insurance Department to create and maintain a public database listing all ambulance service rates submitted by local governments.

Authorized local governmental entities or ambulance service providers to annually submit approved rates to the Insurance Department.

TIMELINE

Established a sunset provision requiring the Oklahoma Legislature to review and potentially modify the rates by December 31, 2027.

ELIGIBILITY

Modified the effective date for rate implementation to May 1, 2025, and added a specific fallback mechanism for determining rates if local submissions are missing.

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

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