This bill amends the managed care law to prohibit balance billing for ambulance services and establishes payment criteria for nonparticipating ambulance service providers. Specifically, it mandates that health plan carriers 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, once payment is made, the nonparticipating ambulance service provider cannot bill the covered individual for any remaining balance, except for applicable copayments, coinsurance, or deductibles, which cannot exceed what would be charged if the service were provided by a participating provider.

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 act is set to take effect on January 1, 2026, and is expected to have indeterminable fiscal impacts on state and local revenues and expenditures, particularly as it may lead to increased insurance premiums due to higher reimbursement rates for ambulance services.