This bill introduces a new section to the Managed Care Law, specifically addressing ambulance billing practices. It prohibits balance billing for ambulance services provided by nonparticipating ambulance service providers, ensuring that health plan carriers must pay these providers an amount equal to the lesser of either the rate set by local authorities, 325% of the Medicare rate for similar services, or the provider's billed charges. Additionally, the bill mandates that once a health carrier makes a payment to a nonparticipating provider, that payment is considered full compensation for the service, barring any copayments or deductibles required from the covered individual. The nonparticipating provider is prohibited from billing the individual for any additional amounts.

The bill also outlines the process for health carriers to handle claims from nonparticipating ambulance service providers, requiring them to remit payment directly to the provider within 30 days of receiving a clean claim. If the claim is not clean, the carrier must either pay the provider or notify them of the claim's status and any additional information needed. The effective date for this legislation is set for January 1, 2026. Overall, the bill aims to enhance the financial protections for individuals receiving ambulance services while establishing clear payment criteria for nonparticipating providers.