The proposed bill amends chapter 376 of the Revised Statutes of Missouri by adding a new section, 376.684, which establishes regulations regarding payments to ambulance providers. It defines key terms such as "ambulance provider," "clean claim," "covered services," "enrollee," "health benefit plan," "health carrier," and "out-of-network ambulance provider." The bill mandates that health carriers must reimburse out-of-network ambulance providers at a minimum rate, which is either determined by local governmental entities or set at 325% of the current Medicare rate for similar services, whichever is lower. Additionally, the bill stipulates that payments made under this section will be considered full payment for covered services, excluding any co-payments or deductibles that the enrollee is responsible for. It prohibits ambulance providers from billing enrollees for any additional amounts beyond what is covered. Health carriers are required to remit payment directly to ambulance providers within thirty days of receiving a clean claim and must notify providers within the same timeframe if a claim is not clean, detailing the reasons for denial or the additional information needed. This new section will take precedence over any conflicting laws.

Statutes affected:
Introduced (6386H.01): 376.684