Raised Bill No. 5460, introduced in the February Session, 2024, aims to amend health insurance coverage laws for ambulance services in the state. The bill proposes to repeal and replace sections 38a-498a and 38a-525a of the general statutes, effective January 1, 2025. The new provisions would prevent individual and group health insurance policies from requiring an enrollee to obtain prior approval from the insurer or health care center before calling a 9-1-1 local prehospital emergency medical service system in the event of a life or limb threatening emergency, or after being transported by ambulance to a hospital when medically necessary. The definition of a "life or limb threatening emergency" is also updated to be any event the enrollee believes threatens their life or limb in such a way that immediate medical care is needed to prevent death or serious health impairment.

Additionally, the bill specifies that no insurer or health care center can deny payment to any ambulance provider responding to a 9-1-1 emergency call on the basis that the enrollee did not obtain prior approval before calling the emergency medical service system or after being transported to a hospital. The purpose of the bill is to prohibit insurers and health care centers from requiring prior authorizations for ambulance transport when medically necessary and from denying payment to ambulance providers if prior authorization was not obtained by the enrollee. The bill includes insertions that update the effective date of the provisions to January 1, 2025, and make gender-neutral language changes, while deletions remove the previous effective date of October 1, 1996.

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Raised Bill: