The proposed bill establishes new reimbursement requirements for health care insurers regarding ground ambulance services in Alabama. It mandates that insurers must contract with any willing emergency medical service provider that agrees to the terms offered to in-network providers. The minimum reimbursement for in-network providers is set at either the contracted amount or 200% of the Medicare rate, effective January 1, 2025. For out-of-network providers, reimbursement will be the lesser of the provider's billed charge or 180% of the Medicare rate. Payments made under these rates will be considered payment in full for covered services, prohibiting providers from billing enrollees for amounts exceeding the minimum reimbursement, except for in-network cost-sharing amounts. Additionally, emergency medical service providers are required to submit annual operational and financial reports to the Alabama Department of Public Health, which will remain confidential.

The bill also amends specific sections of the Code of Alabama 1975, particularly §10A-20-6.16 and §27-21A-23, clarifying the applicability of insurance laws to corporations and health maintenance organizations (HMOs). It introduces new legal language stating that these entities will be subject to "Sections 2 and 3 of this act," which outlines additional regulations. Certain provisions requiring specific types of coverage will not apply when a corporation administers a self-funded benefit plan, and HMOs are exempt from certain medical practice regulations. The bill includes a repeal provision for Sections 1 through 6 on June 1, 2029, and establishes an effective date of January 1, 2026, for the act, with Section 7 becoming effective on June 1, 2029. The deletion of previous references to "Sections 2 and 3 of this act" indicates a significant shift in the regulatory landscape for these entities.

Statutes affected:
Introduced: 10A-20-6, 27-21A-23
Engrossed: 22-18-1