This bill aims to regulate billing practices by ambulance service providers and establish reimbursement standards for out-of-network emergency medical services in South Dakota. It amends existing law to clarify that a health benefit plan includes various types of medical policies but excludes certain insurance types. New definitions are introduced, including "ambulance service," "emergency medical services," and "out-of-network provider." The bill prohibits ambulance service providers from billing patients for out-of-network emergency services beyond the required coinsurance, copayment, or deductible. It also mandates that health benefit plans reimburse out-of-network providers at a rate not less than the local rate established by the political subdivision or, if no local rate exists, at the lesser of the provider's billed charge or 325% of the Medicare allowable rate.

Additionally, the bill requires the Division of Insurance to compile and publish ambulance reimbursement rates by January 1, 2027, and to update these rates annually. It stipulates that both ambulance service providers and health benefit plans must provide patients with clear explanations of benefits and amounts owed. Patients are not liable for any charges beyond their plan's required payments for emergency services, except for non-covered services. The bill also allows individuals aggrieved by violations of these provisions to file complaints with the Division of Insurance, which can investigate and impose penalties. However, the regulations do not apply to self-funded employer health plans, Medicaid, Medicare, or other federally regulated programs.

Statutes affected:
Introduced, 02/03/2026: 58-17-63