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HB400 INTRODUCED
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HB400
2JEQCSI-1
By Representative Oliver
RFD: Health
First Read: 05-Feb-26
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2JEQCSI-1 02/05/2026 JC (L)lg 2026-264
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First Read: 05-Feb-26
SYNOPSIS:
This bill would regulate the provision of
emergency ground ambulance services in the state by
imposing requirements on reimbursement by health
insurers for ambulance services.
This bill would prohibit surprise billing of
insurance enrollees by providing that the reimbursement
requirements be accepted as payment in full. A ground
ambulance provider could directly charge an individual
for no more than the in-network cost-sharing amount
under an insurance contract.
This bill would require that both ground
ambulance services and health care insurers submit
reports on their operations, with financial
information, to the Alabama Department of Public
Health.
This bill would also require the Alabama
Department of Public Health to retain an outside expert
to study and report on the effects of this act on
access to ground ambulance services in the state, with
recommended measures to improve access.
This bill would be repealed on June 1, 2029.
A BILL
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A BILL
TO BE ENTITLED
AN ACT
Relating to health insurance; to set requirements on
reimbursement rates by health care insurers for ground
ambulance services; to provide that the established
reimbursement rate is payment in full for ground ambulance
services; to impose reporting requirements by emergency
medical service providers that provide ground ambulance
services and health care insurers to the Alabama Department of
Public Health; to require the Alabama Department of Public
Health to contract with a consultant to report on the effects
of this act, with recommendations for improving access to
emergency medical transport; and to provide for repeal of this
act.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. For the purposes of this act, the following
words have the following meanings:
(1) CLEAN CLAIM. A clean electronic claim or a clean
written claim.
(2) CLEAN ELECTRONIC CLAIM. As defined in Section
27-1-17, Code of Alabama 1975.
(3) CLEAN WRITTEN CLAIM. As defined in Section 27-1-17,
Code of Alabama 1975.
(4) COLLECTION. Any written or oral communication made
to an enrollee for the purpose of obtaining payment for the
services rendered by an emergency medical service provider,
including invoicing and legal debt collection efforts.
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including invoicing and legal debt collection efforts.
(5) COST-SHARING AMOUNT. The enrollee's deductible,
coinsurance, copayment, or other amount due under a health
care benefit plan for covered services.
(6) COVERED SERVICES or COVERED SERVICE. Transport or
medical services provided by the ground ambulance of an
emergency medical service provider which are covered by an
enrollee's health care benefit plan, including emergency
ground transport and treat in place.
(7) EMERGENCY GROUND TRANSPORT. a. When an enrollee is
transported by an emergency medical service provider to a
hospital or definitive care facility as defined in Section
22-18-1, Code of Alabama 1975, and which may include basic
life support or advanced life support, in response to a
medical condition described in paragraph b.
b. An event as defined by the Centers for Medicare and
Medicaid Services (CMS) that manifests itself by acute
symptoms of sufficient severity, including severe pain, such
that a prudent layperson, who possesses an average knowledge
of health and medicine, could reasonably expect the absence of
immediate medical attention to result in:
1. Placing the patient's health in serious jeopardy;
2. Serious impairment to bodily functions; or
3. Serious dysfunction of any bodily organ or part.
(8) EMERGENCY MEDICAL SERVICE PROVIDER or PROVIDER. Any
public or private organization that is licensed to provide
emergency medical services as defined in Section 22-18-1, Code
of Alabama 1975.
(9) ENROLLEE. An individual who is covered by a health
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(9) ENROLLEE. An individual who is covered by a health
care benefit plan.
(10) HEALTH CARE BENEFIT PLAN. Any individual or group
plan, policy, or contract issued, delivered, or renewed in
this state by a health care insurer to provide, deliver,
arrange for, pay for, or reimburse health care services,
including those provided by an emergency medical service
provider, except for payments for health care made under
automobile or homeowners' insurance plan, accident-only plan,
specified disease plan, long-term care plan, supplemental
hospital or fixed indemnity plan, dental or vision plan, or
Medicaid.
(11) HEALTH CARE INSURER. Any entity that issues or
administers a health care benefit plan, including a health
care insurer, a health care services plan incorporated under
Chapter 20 of Title 10A, Code of Alabama 1975, a health
maintenance organization established under Chapter 21A of
Title 27, Code of Alabama 1975, or a nonprofit agricultural
organization that offers health benefits to its membership
pursuant to Chapter 33 of Title 2, Code of Alabama 1975.
(12) IN-NETWORK. When an emergency medical service
provider is in a contract with a health care insurer to
provide covered services in the health care insurer's provider
network.
(13) OUT-OF-NETWORK. When an emergency medical service
provider does not have a contract with a health care insurer
to provide covered services in the health care insurer's
provider network.
(14) TREAT IN PLACE. An emergency response event in
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(14) TREAT IN PLACE. An emergency response event in
which an emergency medical service provider assesses an
enrollee or Medicaid recipient and renders basic life support
at his or her location without emergency ground transport.
Section 2. (a)(1) A health care insurer shall contract
with any willing emergency medical service provider to provide
covered services in the health care insurer's provider network
under terms extended to comparable providers that are
in-network.
(2) An in-network provider shall meet licensing
requirements provided by law.
(b)(1) Beginning October 1, 2026, the minimum
reimbursement from a health insurer to an emergency medical
service provider that is in-network for emergency ground
transport shall be 200 percent of the Medicare Ambulance Fee
Schedule rate as published by the Centers for Medicare &
Medicaid Services (CMS).
(2)a. Beginning October 1, 2026, the minimum
reimbursement from a health insurer to an emergency medical
service provider that is in-network for treat in place shall
be 200 percent of the Medicare Ambulance Fee Schedule rate for
basic life support as published by CMS which is in effect on
January 1, 2027.
b. Submission of a claim for reimbursement for treat in
place is prohibited if the emergency medical service provider
has submitted a claim for emergency ground transport for the
same event or occurrence.
(c) Beginning January 1, 2027, the minimum
reimbursement amount from a health care insurer to an
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reimbursement amount from a health care insurer to an
emergency medical service provider that is out-of-network for
covered services shall be 180 percent of the Medicare
Ambulance Fee Schedule rate as published by CMS.
(d)(1) For purposes of this section, the Medicare
Ambulance Fee Schedule rate shall be the rate applicable to
zip code 35462, including the applicable Medicare base rate
and mileage components.
(2) The reimbursement rate established under this
section shall be applied uniformly on a statewide basis,
without regard to the geographic locality, population density,
or zip code in which the ground ambulance service is
furnished.
Section 3. (a)(1) Payment in accordance with Section 2
shall be payment in full for covered services.
(2) An emergency medical service provider, whether
in-network or out-of-network, including the provider's agent,
contractor, or assignee, may not bill or seek collection of
any amount from an enrollee except for the enrollee's
in-network cost-sharing amount.
(3) The health care insurer shall certify an enrollee's
in-network cost-sharing amount to an out-of-network provider
upon request.
(b)(1) Not later than 30 days after receipt of a clean
electronic claim, or not later than 45 days after receipt of a
clean written claim, a health care insurer shall remit payment
to an out-of-network emergency medical service provider and
shall not send payment to an enrollee.
(2) If a claim for reimbursement submitted by an
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(2) If a claim for reimbursement submitted by an
emergency medical service provider to a health care insurer is
not a clean claim, not later than 30 days after receiving the
claim, the health care insurer shall send the provider a
written receipt acknowledging the claim, accompanied with one
of the following applicable statements:
a. The insurer is declining to pay all or a part of the
claim, with the specific reason for the denial.
b. Additional information is necessary to determine if
the claim is payable, with the specific additional information
that is required.
(3) In no event shall a health care insurer require the
provider to submit either of the following as a condition to
the acceptance and processing of an initial claim as a clean
claim:
a. Data elements in excess of those required on the
standard electronic health insurance claim format designated
by Section 27-1-16, Code of Alabama 1975.
b. Information or data elements in excess of those
required on the standard health insurance claim form
designated by Section 27-1-16, Code of Alabama 1975.
(4) Any dispute between a health care insurer and an
emergency medical service provider over the amount to be paid,
or over full or partial denial of a claim, may be settled by
one of the following means:
a. Affording the provider access to the insurer's
internal forum for resolving provider disputes concerning
coverage and reimbursement amounts.
b. Selecting an independent dispute resolution
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b. Selecting an independent dispute resolution
contractor mutually agreeable to the insurer and the provider.
Section 4. (a) Beginning in the year 2028, and in each
year thereafter, an emergency medical service provider shall
submit to the Alabama Department of Public Health a report
that includes, but is not limited to, the following
information for the preceding calendar year:
(1) The number and type of emergency medical service
vehicles that are in service.
(2) The number of employees, both full-time and
part-time, classified by position or emergency medical service
provider license classification.
(3) The total number of ground ambulance transports
rendered.
(4) The average response time for collecting and
transporting a patient to a definitive care facility.
(5) The gross income received by the emergency medical
service provider in the State of Alabama and the net profit.
(6) If the emergency medical service provider
distributes ownership shares to the public, the number and
amount of dividends issued.
(7) For the calendar year 2027, the amount of receipts
collected by the emergency medical service provider that are
remitted to a parent entity, both before and after
implementation of any change in payment or reimbursement by a
health care insurer.
(8) For the calendar year 2027, the amount paid or
reimbursed to an emergency medical service provider by health
care insurers, presented on a monthly or quarterly basis.
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care insurers, presented on a monthly or quarterly basis.
(b)(1) Beginning in the year 2027, a health care
insurer shall submit to the Alabama Department of Public
Health a report on claims for reimbursement submitted by
emergency medical service providers which presents, for each
of the three calendar years preceding January 1, 2027:
a. The number of denied claims;
b. The aggregate dollar value of denied claims;
c. The percentage of denied claims to approved claims;
d. The applicable out-of-pocket charge under each
health care benefit plan issued by the health care insurer on
an approved claim for covered services; and
e. The total amount paid on claims for covered
services, including in comparison to the total amount paid out
on all claims for health care services.
(2) Beginning in the year 2028, and in each year
thereafter, a health care insurer shall submit to the Alabama
Department of Public Health a report that includes, but may
not be limited to, each item of information required under
subdivision (1) for the preceding calendar year.
(c) The financial information required for submission
under subsections (a) and (b) shall be confidential and may
not be made public by the Alabama Department of Public Health
or any contractor of the department.
(d) The Alabama Department of Public Health shall adopt
rules to implement this section, and may prescribe reporting
periods, deadlines, or formatting of information to be
reported, and may require an emergency medical service
provider or health care insurer to submit operational and
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provider or health care insurer to submit operational and
financial data or information in addition to the information
required under subsections (a) and (b).
Section 5. (a) The Alabama Department of Public Health
shall contract with a consultant with expertise in health care
delivery and health care financing to study the impact of
Sections 1 through 4 on the provision of emergency medical
services.
(b) The consultant shall produce a report on the
findings, which shall not exceed fifty thousand dollars
($50,000) in cost, the cost to be borne by the three largest
health care insurers as measured by the number of enrollees in
the state, and which also offer individual health care benefit
plans on the Health Insurance Marketplace.
(c) In addition to findings on the impact of Sections 1
through 4 on the provision of emergency medical services, the
report shall include, but not be limited to, the following:
(1) Measures taken by other states on the provision of
emergency medical services and the effectiveness of those
measures.
(2) Recommendations of measures that would balance the
goals of ensuring adequate access to emergency medical
services with the cost burden of such measures on the state,
its employers, and residents.
(d) The report shall be submitted to the President Pro
Tempore of the Senate and the Speaker of the House of
Representatives no later than December 1, 2028.
Section 6. Sections 1 through 5 are repealed on June 1,
2029.
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2029.
Section 7. Sections 10A-20-6.16 and 27-21A-23, Code of
Alabama 1975, are amended to read as follows:
"§10A-20-6.16
(a) No statute of this state applying to insurance
companies shall be applicable to any corporation organized
under this article and amendments thereto or to any contract
made by the corporation; except the corporation shall be
subject to the following:
(1) The provisions regarding annual premium tax to be
paid by insurers on insurance premiums.
(2) Chapter 55 of Title 27.
(3) Article 2 and Article 3 of Chapter 19 of Title 27.
(4) Section 27-1-17.
(5) Chapter 56 of Title 27.
(6) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(7) Chapter 54 of Title 27.
(8) Chapter 57 of Title 27.
(9) Chapter 58 of Title 27.
(10) Chapter 59 of Title 27.
(11) Chapter 54A of Title 27.
(12) Chapter 12A of Title 27.
(13) Chapter 2B of Title 27.
(14) Chapter 29 of Title 27.
(15) Chapter 62 of Title 27.
(16) Chapter 63 of Title 27.
(17) Chapter 45A of Title 27.
(18) Sections 1 through 5.
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(18) Sections 1 through 5.
(b) The provisions in subsection (a) that require
specific types of coverage to be offered or provided shall not
apply when the corporation is administering a self-funded
benefit plan or similar plan, fund, or program that it does
not insure."
"§27-21A-23
(a) Except as otherwise provided in this chapter,
provisions of the insurance law and provisions of health care
service plan laws shall not be applicable to any health
maintenance organization granted a certificate of authority
under this chapter. This provision shall not apply to an
insurer or health care service plan licensed and regulated
pursuant to the insurance law or the health care service plan
laws of this state except with respect to its health
maintenance organization activities authorized and regulated
pursuant to this chapter.
(b) Solicitation of enrollees by a health maintenance
organization granted a certificate of authority shall not be
construed to violate any provision of law relating to
solicitation or advertising by health professionals.
(c) Any health maintenance organization authorized
under this chapter shall not be deemed to be practicing
medicine and shall be exempt from the provisions of Section
34-24-310, et seq., relating to the practice of medicine.
(d) No person participating in the arrangements of a
health maintenance organization other than the actual provider
of health care services or supplies directly to enrollees and
their families shall be liable for negligence, misfeasance,
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their families shall be liable for negligence, misfeasance,
nonfeasance, or malpractice in connection with the furnishing
of such services and supplies.
(e) Nothing in this chapter shall be construed in any
way to repeal or conflict with any provision of the
certificate of need law.
(f) Notwithstanding the provisions of subsection (a), a
health maintenance organization shall be subject to all of the
following:
(1) Section 27-1-17.
(2) Chapter 56.
(3) Chapter 54.
(4) Chapter 57.
(5) Chapter 58.
(6) Chapter 59.
(7) Rules adopted by the Commissioner of Insurance
pursuant to Sections 27-7-43 and 27-7-44.
(8) Chapter 12A.
(9) Chapter 54A.
(10) Chapter 2B.
(11) Chapter 29.
(12) Chapter 62.
(13) Chapter 63.
(14) Chapter 45A
(15) Sections 1 through 5 ."
Section 8. This act shall become effective on October
1, 2026.
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