The bill aims to enhance consumer protections against unexpected charges for out-of-network health care services, specifically by prohibiting balance billing for ground ambulance services. It introduces new definitions, such as "ground ambulance services" and "ground ambulance services organization," which clarify the scope of these services and the entities that provide them. The legislation also amends existing laws to ensure that consumers enrolled in fully insured health plans are not unfairly billed for necessary emergency services. Starting January 1, 2025, nonparticipating ground ambulance services organizations will be prohibited from balance billing enrollees, who will only be responsible for in-network cost-sharing amounts as specified in their health plans.

Additionally, the bill mandates that health carriers treat cost-sharing amounts for nonparticipating ground ambulance services similarly to in-network services, ensuring refunds for any excess payments made by enrollees within 30 business days. It requires health carriers to provide coverage for ground ambulance transports to behavioral health emergency services without prior authorization and calls for an actuarial analysis of costs associated with ground ambulance services. The bill also establishes a framework for local governmental entities to submit rates for ambulance services to the insurance commissioner, who will maintain a publicly accessible database of these rates. Furthermore, it repeals certain existing reporting requirements related to ground ambulance services, streamlining the regulatory framework.

Statutes affected:
Original Bill: 48.43.005, 48.49.003, 48.49.060, 48.49.070, 48.49.090, 48.49.100, 18.130.040, 48.49.190