SB269 • 2026

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

Healthcare

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor: Singleton
Last action: 2026-04-06
Official status: Enacted
Effective date: 2026-10-01

Plain English Breakdown

The official source material does not specify details regarding dispute resolution guidelines or requirements for impact reports, which were removed from the candidate explanation.

Ground Ambulance Services; Prohibiting Balance Billing and Setting Minimum Reimbursement Rates

This act sets minimum reimbursement rates for ground ambulance services by insurers, prohibits balance billing to patients, and requires annual reporting on emergency ambulance responses.

What This Bill Does

Requires health care insurers to reimburse in-network and out-of-network emergency medical service (EMS) providers at specified minimum rates according to Medicare reimbursement rates.
Prohibits EMS providers from billing patients for outstanding ambulance fees in excess of the amount reimbursed by insurance, protecting patients from unexpected costs.
Establishes dispute resolution guidelines when there are disagreements between insurers and EMS providers about reimbursement rates.
Requires annual reporting by EMS providers and health care insurers to the Alabama Department of Public Health on emergency ambulance responses and claims.

Who It Names or Affects

Health care insurers
Emergency medical service (EMS) providers
Patients receiving ground ambulance services

Terms To Know

clean claim: A properly submitted electronic or written claim for health insurance.
emergency ground transport: Transporting a patient by ambulance to a hospital or care facility due to an acute medical condition.

Limits and Unknowns

The act only applies until June 1, 2029.
It does not specify what happens if insurers do not comply with the new rules.

Amendments

These notes stay tied to the official amendment files and metadata from the legislature.

XD1P9Z7-1

R 682 • Singleton

Adopted

Plain English: XD1P9Z7-1 02/23/2026 JC (L) lg 2026-750 SUB SB269 BANKING AND INSURANCE SUBSTITUTE TO SB269 OFFERED BY SENATOR SINGLETON Page 1 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.

XD1P9Z7-1 02/23/2026 JC (L) lg 2026-750 SUB SB269 BANKING AND INSURANCE SUBSTITUTE TO SB269 OFFERED BY SENATOR SINGLETON Page 1 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 amendment summary is using official source text because generated interpretation was skipped for this run.

Bill History

2026-04-06 Senate
Enacted
2026-03-31 House
Motion to Read a Third Time and Pass - Adopted Roll Call 1066 (Yeas 103, Nays 0)
2026-03-31 House
Third Reading in Second House (Yeas 102, Nays 0)
2026-03-31 Senate
Delivered to Governor
2026-03-31 House
Signature Requested
2026-03-31 Senate
Enrolled
2026-03-31 Senate
Ready to Enroll
2026-03-17 House
Read for the Second Time and placed on the Calendar
2026-03-17 House
Reported Out of Committee Second House
2026-03-05 House
Pending Committee Action in Second House
2026-03-05 House
Read for the first time and referred to the House Committee on Insurance
2026-03-03 Senate
Motion to Read a Third Time and Pass as Amended - Adopted Roll Call 683 (Yeas 27, Nays 2)
2026-03-03 Senate
Singleton motion to Adopt - Adopted Roll Call 682 (Yeas 25, Nays 1)
2026-03-03 Senate
Third Reading in House of Origin (Yeas 25, Nays 2)
2026-03-03 Senate
Engrossed
2026-03-03 Senate
Banking and Insurance 1st Substitute Offered
2026-02-26 Senate
Read for the Second Time and placed on the Calendar
2026-02-26 Senate
Reported Out of Committee House of Origin
2026-02-26 Senate
Banking and Insurance 1st Substitute
2026-02-05 Senate
Pending Committee Action in House of Origin
2026-02-05 Senate
Read for the first time and referred to the Senate Committee on Banking and Insurance

Official Summary Text

This act, until June 1, 2029: (1) requires health care insurers to reimburse in-network and out-of-network emergency medical service (EMS) providers for responding to emergency calls at minimum rates according to Medicare reimbursement rates; (2) prohibits EMS providers from billing patients for outstanding ambulance fees in excess of the amount reimbursed by insurance; (3) imposes dispute resolution guidelines when insurers and EMS providers disagree regarding reimbursement; (4) requires EMS providers and insurers to annually report to the Alabama Department of Public Health certain data concerning emergency ambulance response and emergency ambulance-related claims; and (5) requires the Alabama Association of Ambulance Services to contract with a consultant with expertise in risk management and insurance to submit a report on the impacts of this act's requirements to the Legislature by December 1, 2028. This act also amends Sections 10A-20-6.16 and 27-21A-23, Code of Alabama 1975, to subject health care service plan corporations and health maintenance organizations to this act.

Current Bill Text

Read the full stored bill text

SB269 ENROLLED
Page 0
SB269
XD1P9Z7-3
By Senator Singleton
RFD: Banking and Insurance
First Read: 05-Feb-26
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SB269 Enrolled
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First Read: 05-Feb-26
Enrolled, 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 provide for a report on the effects of this
act, with recommendations for improving access to emergency
medical transport; and to provide for the 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.
(5) COST-SHARING AMOUNT. The enrollee's deductible,
coinsurance, copayment, or other amount due under a health
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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, which may include
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
care benefit plan.
(10) HEALTH CARE BENEFIT PLAN. The term includes any
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(10) HEALTH CARE BENEFIT PLAN. The term includes 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 an 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
which an emergency medical service provider that would
otherwise provide the emergency ground transport assesses an
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otherwise provide the emergency ground transport assesses an
enrollee 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 January 1, 2027, 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)(1) Beginning January 1, 2027, the minimum
reimbursement amount from a health care insurer to an
emergency medical service provider that is out-of-network for
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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.
(2) The minimum reimbursement rate for treat in place
provided in paragraph (b)(2)a. shall not apply to an
out-of-network emergency medical service provider.
(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
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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
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:
a. Affording the provider access to the insurer's
internal forum for resolving provider disputes concerning
coverage and reimbursement amounts; and
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coverage and reimbursement amounts; and
b. If the dispute is not resolved in the insurer's
internal forum, submission of the dispute to an independent
dispute resolution contractor selected by mutual agreement of
the insurer and the provider.
Section 4. (a) Beginning in the year 2027, 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.
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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.
(b)(1) 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
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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
financial data or information in addition to the information
required under subsections (a) and (b).
Section 5. (a) The Alabama Association of Ambulance
Services shall contract with a business school, accredited by
the Association to Advance Collegiate Schools of Business,
located at a doctoral granting regional institution with
research college and university Carnegie classification
status, which has expertise in risk management and insurance,
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,
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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.
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.
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(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.
(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
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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,
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.
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(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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1, 2026.
________________________________________________
President and Presiding Officer of the Senate
________________________________________________
Speaker of the House of Representatives
SB269
Senate 03-Mar-26
I hereby certify that the within Act originated in and passed
the Senate, as amended.
Patrick Harris,
Secretary.
House of Representatives
Passed: 31-Mar-26
By: Senator Singleton
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