HB 1373

Bill Subjects

Abstract

Provides for the attending physician, or the physician's designee, of a patient needing transportation by ambulance to sign an order that states the level of ambulance service needed for the patient and the condition or diagnosis of the patient that makes the transportation of the patient by ambulance necessary. Amends the law on emergency medical services to make that law apply to nonemergency ambulance services as well as emergency ambulance services. Requires a health plan to fairly negotiate rates and terms with any ambulance service provider willing to become a participating provider with respect to the health plan. Requires a health plan to pay ambulance service benefits directly to a nonparticipating ambulance service provider (nonparticipating provider) that provides ambulance service to a covered individual if the covered individual executes a written assignment of benefits in favor of the nonparticipating provider. Provides that a nonparticipating provider that provides ambulance service to a covered individual and that is paid less for the service by the health plan than the amount it billed may bill the covered individual for the balance. Provides that if the dispute concerning the amount to be paid to the nonparticipating provider for the ambulance service is not resolved through negotiation, the health plan operator or the nonparticipating provider may initiate binding arbitration to resolve the dispute. Provides that an accident and sickness insurance policy or HMO contract that provides coverage for emergency medical services must also provide reimbursement for: (1) emergency ambulance services; and (2) specialty care transport; provided by an emergency medical services provider organization. Provides that reimbursement provided for basic and 0advanced life support services through an accident and sickness insurance policy or HMO contract must be provided on an equal basis regardless of whether the services involve transportation of the patient by ambulance.