The proposed bill establishes new requirements for health care insurers in Alabama regarding reimbursement rates for ground ambulance services. 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 rates are set at either the contracted amount or 200% of the Medicare rate for in-network providers, and for out-of-network providers, the lesser of the billed charge or 180% of the Medicare rate. Additionally, the bill stipulates that payments made in accordance with these rates constitute full payment for services, prohibiting providers from billing enrollees for amounts exceeding the minimum reimbursement, except for in-network cost-sharing amounts. The bill also imposes reporting requirements on emergency medical service providers, mandating annual submissions to the Alabama Department of Public Health, and tasks the Department with evaluating the act's impact on emergency medical services.

Furthermore, the bill amends specific sections of the Code of Alabama 1975, particularly §10A-20-6.16 and §27-21A-23, by introducing new legal language that specifies that certain corporations and health maintenance organizations (HMOs) will be subject to "Sections 2 and 3 of this act," while deleting the previous requirement for these sections to apply. This change aims to streamline the regulatory framework for these entities. The bill clarifies that provisions requiring specific types of coverage do not apply when a corporation administers a self-funded benefit plan and exempts HMOs from certain medical practice laws. It also states that individuals involved in HMO arrangements, other than direct healthcare providers, are not liable for negligence or malpractice. The act is set to take effect on January 1, 2026, with certain sections repealed by June 1, 2029, ensuring a phased implementation of the new regulations.

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