This bill aims to prohibit surprise billing for ground ambulance services and establishes specific reimbursement guidelines for both participating and non-participating ambulance service providers. It mandates that health carriers provide reimbursement for ground emergency ambulance services, including those responding to 9-1-1 calls, at rates set by local governmental entities or, in their absence, at a minimum of 325% of the current Medicare rates. The bill also stipulates that non-participating ambulance service providers cannot bill covered individuals for amounts exceeding their copayment, coinsurance, or deductible, with a cap of $100 on copayments for these services. Additionally, health carriers are prohibited from requiring prior authorization for emergency transports and must reimburse non-participating providers within 30 days of claim receipt, with penalties for late payments.

The bill includes several key insertions and deletions to current law, such as the establishment of a new section (420-J:8-i) in the Managed Care Law specifically addressing ground ambulance reimbursement. It also clarifies that health carriers must indicate the type of plan from which claims are paid and allows for negotiation of reimbursement rates with non-participating providers, while ensuring that the established rates in the bill apply until a contract is made. The effective date for these provisions is set for January 1, 2026. The fiscal impact of the bill is expected to increase health insurance premiums due to higher reimbursement rates, with estimates suggesting a potential increase of $1.13 to $1.38 per member per month.