APPROVED CHAPTER
JULY 27, 2023 468
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-THREE
_____
S.P. 634 - L.D. 1602
An Act to Implement the Recommendations of the Stakeholder Group
Convened by the Emergency Medical Services' Board on Financial Health of
Ambulance Services
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §8712, sub-§2, as amended by PL 2021, c. 423, Pt. A, §6, is
further amended to read:
2. Payments. The organization shall create a publicly accessible interactive website
that presents reports related to payments for services rendered by health care facilities and
practitioners to residents of the State. The services presented must include, but not be
limited to, imaging, preventative health, radiology, surgical services, ambulance services,
comparable health care services as defined in Title 24‑A, section 4318‑A, subsection 1,
paragraph A and other services that are predominantly elective and may be provided to a
large number of patients who do not have health insurance or are underinsured. The
website must also be constructed to display prices paid by individual commercial health
insurance companies, 3rd-party administrators and, unless prohibited by federal law,
governmental payors. Beginning October 1, 2012, price information posted on the website
must be posted semiannually and beginning October 1, 2022 must be posted annually, must
display the date of posting and, when posted, must be current to within 12 months of the
date of submission of the information. Payment reports and price information posted on
the website must include data submitted by payors with regard to all health care facilities
and practitioners that provide comparable health care services as defined in Title 24‑A,
section 4318‑A, subsection 1, paragraph A or services for which the organization reports
data pertaining to the statewide average price pursuant to this subsection or Title 24‑A,
section 4318‑B. Upon notice made by a health care facility or practitioner that data posted
by the organization pertaining to that facility or practitioner is inaccurate or incomplete,
the organization shall remedy the inaccurate or incomplete data within the earlier of 30
days of receipt of the notice and the next posting date.
Sec. 2. 24-A MRSA §4303-F, as enacted by PL 2021, c. 241, §3, is amended to
read:
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§4303-F. Reimbursement for ambulance services and participation of ambulance
service providers in carrier networks
1. Reimbursement for ambulance services. Until December 31, 2023, with With
respect to a bill for covered emergency services rendered by an ambulance service provider,
a carrier shall reimburse the ambulance service provider or enrollee, as applicable, as
follows.
A. If the ambulance service provider participates in the carrier's network, the carrier
shall reimburse at the ambulance service provider's rate or 200% of the Medicare rate
for that service, whichever is less, plus any adjustment required by paragraph C.
B. If the ambulance service provider is an out-of-network provider, the carrier shall
reimburse at the ambulance service provider's rate or 180% of the Medicare rate for
that service, whichever is less, plus any adjustment required by paragraph C.
C. If the ambulance service provider is located in a rural or super rural area as
designated by the federal Department of Health and Human Services, Centers for
Medicare and Medicaid Services and eligible for additional Medicare reimbursement
for services that were provided to a Medicare enrollee, the carrier shall increase the
reimbursement to that ambulance service provider in the same amount as the additional
Medicare reimbursement.
D. If, on the effective date of this subsection, an ambulance service provider's charge
for ambulance services is below 200% of the Medicare rate for that service, the
ambulance service provider may not increase the charge for that service by more than
5% annually.
E. A carrier may not require an ambulance service provider to obtain prior
authorization before transporting an enrollee to a hospital, between hospitals or from a
hospital to a nursing home, hospice care facility or other health care facility, as defined
in Title 22, section 328, subsection 8.
This subsection is repealed December 31, 2023.
Notwithstanding this subsection, a carrier is not required to reimburse an ambulance service
provider at the reimbursement rates required in this subsection for covered services
delivered through community paramedicine in accordance with Title 32, section 84,
subsection 4 and a carrier may require an ambulance service provider to obtain prior
authorization before providing services through community paramedicine.
1-A. Reimbursement for nontransport services. With respect to a health plan with
an effective date on or after January 1, 2024, when an ambulance service provider responds
to a call for emergency services and an enrollee refuses transport to a hospital, a carrier
shall reimburse that ambulance service provider for any services other than transport
provided to the enrollee as follows.
A. If the ambulance service provider participates in the carrier's network, the carrier
shall reimburse the ambulance service provider at the ambulance service provider's rate
or 200% of the average of the Medicare rate for basic life support services and the
Medicare rate for advanced life support services, whichever is less, plus any adjustment
required by paragraph C.
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 B. If the ambulance service provider is an out-of-network provider, the carrier shall
reimburse the ambulance service provider at the ambulance service provider's rate or
180% of the average of the Medicare rate for basic life support services and the
Medicare rate for advanced life support services, whichever is less, plus any adjustment
required by paragraph C.
C. If the ambulance service provider is located in a rural or super rural area as
designated by the federal Department of Health and Human Services, Centers for
Medicare and Medicaid Services and eligible for additional Medicare reimbursement
for services that were provided to a Medicare enrollee, the carrier shall increase the
reimbursement to that ambulance service provider in the same amount as the additional
Medicare reimbursement.
D. If, on the effective date of this subsection, an ambulance service provider's rate for
ambulance services is below 200% of the average of the Medicare rate for basic life
support and advanced life support services, the ambulance service provider may not
increase the rate for that service by more than 5% annually.
2. Network participation; standard contract. A carrier shall offer a standard
contract to all ambulance service providers willing to participate in the carrier's provider
network with the following provisions:
A. The reimbursement rate paid for ambulance services conforms to the requirements
of subsection 1.;
This paragraph is repealed December 31, 2023;
B. The contract term is for a minimum of 24 months;
C. The contract may be terminated as long as the party seeking to terminate the contract
provides at least 180 days' prior notice; and
D. The contract provides that an ambulance service provider has a minimum of 120
days to submit a claim.
3. Exemption. This section does not apply to air ambulance services.
4. Medical necessity. A carrier shall consider the requirements of the federal
Department of Health and Human Services, Centers for Medicare and Medicaid Services
related to medical necessity of ambulance services when establishing the carrier's own
policies and guidelines related to the medical necessity and reasonableness of covered
services provided by ambulance service providers.
Sec. 3. 32 MRSA §88, sub-§2, ¶L, as enacted by PL 2021, c. 241, §5 and
reallocated by RR 2021, c. 2, Pt. A, §113, is amended to read:
L. The board shall establish by rule a program for collecting and reporting cost and
performance metrics related to emergency medical treatment services, including
ambulance services. The cost and performance metrics for ambulance services adopted
in rule must include, at a minimum, data on the volume of services provided per capita
and per square mile of geographic area, the type of entity, the payer mix, the impact on
length of stay in a health care facility due to lack of available ambulance transport,
demographics on personnel and level of licensure, the number of vacancies and the
number of volunteer hours dedicated to emergency medical services. Rules adopted
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 pursuant to this paragraph are routine technical rules pursuant to Title 5, chapter 375,
subchapter 2‑A.
Sec. 4. Appropriations and allocations. The following appropriations and
allocations are made.
PUBLIC SAFETY, DEPARTMENT OF
Emergency Medical Services 0485
Initiative: Establishes one limited-period Management Analyst I position and provides
appropriations for related costs to collect and report cost and performance information
related to emergency services. This position begins November 1, 2023 and ends June 7,
2025.
GENERAL FUND 2023-24 2024-25
Personal Services $51,878 $82,151
All Other $5,000 $5,000
__________ __________
GENERAL FUND TOTAL $56,878 $87,151
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Statutes affected:
Bill Text LD 1602, SP 634: 22.8712, 24-A.4303, 32.88
Bill Text ACTPUB , Chapter 468: 22.8712, 24-A.4303, 32.88