The proposed bill establishes new reimbursement requirements for health care insurers in Alabama regarding 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 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. Additionally, payments made under these rates will be considered payment in full, preventing providers from billing enrollees for amounts exceeding the minimum reimbursement, except for in-network cost-sharing amounts. The bill also requires emergency medical service providers to submit annual operational and financial reports to the Alabama Department of Public Health, which will contract a consultant to assess the bill's impact on services.

Furthermore, the bill amends Sections 10A-20-6.16 and 27-21A-23 of the Code of Alabama 1975, clarifying that certain corporations and health maintenance organizations (HMOs) must comply with specific provisions of insurance law, including annual premium tax requirements. New language has been added to indicate that these entities are subject to Sections 2 and 3 of this act, which were previously deleted. The bill also states that specific coverage requirements do not apply when a corporation administers a self-funded benefit plan and clarifies that HMOs are not considered to be practicing medicine, thus exempt from certain medical practice regulations. The act is set to take effect on January 1, 2026, with certain sections repealed on June 1, 2029, allowing for a transitional compliance period.

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