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, except for applicable coinsurance, copayment, or deductible amounts.

Additionally, the bill mandates that health benefit plans reimburse out-of-network ambulance service providers at a rate not less than the local rate established by the political subdivision from which the transport originated. If no local rate exists, reimbursement will be based on the provider's billed charge or 275% of the Medicare allowable rate. The legislation also requires clear communication of benefits and amounts owed to patients, stating that patients are not liable for charges beyond their plan's required payments for emergency services. However, these provisions 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
Senate Health and Human Services Engrossed, 02/20/2026: 58-17-63