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Bill > AB720

WI AB720

WI AB720
Coverage and reimbursement of emergency ambulance services under health insurance policies and plans. (FE)

summary

Introduced
12/03/2025
In Committee
12/03/2025
Crossed Over
Passed
Dead

Introduced Session

Potential new amendment
2025-2026 Regular Session

Bill Summary

This bill makes several changes to the coverage and reimbursement of emergency ambulance services under health insurance policies and plans. Under the bill, defined network plans, preferred provider plans, and self- insured governmental plans that provide coverage of emergency medical services are required to cover emergency ambulance services provided by an ambulance service provider that is not a participating provider at one of the following rates, according to this order of priority: 1. A rate that is mutually agreed upon by the plan and the ambulance service provider. 2. A rate that is set or approved by a local governmental entity in the jurisdiction in which the emergency ambulance services originated. 3. A rate that is 350 percent of the Medicare program’s published rate for the services in the same geographic area or a rate that is equivalent to the rate billed by the ambulance service provider for the services, whichever is less. The bill provides that an ambulance service provider that is reimbursed at the applicable rate may not charge an enrollee an additional amount for the emergency ambulance services except for any cost-sharing responsibility, such as a copayment, coinsurance, or deductible. The bill also prohibits the plan from imposing a cost- sharing amount on an enrollee that is greater than the amount that would have applied had the ambulance service provider been a participating provider. The bill further requires that a health insurance policy or self-insured governmental health plan respond to claims for covered emergency ambulance services within 30 days by remitting payment directly to the ambulance service provider or by notifying the provider of any defect with the claim. The bill also provides that the policy or plan must remit payment for the transportation of a patient by ambulance (including transport from one facility to another to receive services not available at the first) as a medically necessary emergency ambulance service at a rate as described above if the ambulance service provider includes with its claim for payment a medical necessity certification statement signed by an individual who meets criteria established by federal regulations. For further information see the state fiscal estimate, which will be printed as an appendix to this bill. This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

AI Summary

This bill addresses the coverage and reimbursement of emergency ambulance services under health insurance policies and plans in Wisconsin. The bill requires defined network plans, preferred provider plans, and self-insured governmental plans to cover emergency ambulance services provided by non-participating providers at a rate determined by a specific priority system: first, a mutually agreed upon rate; second, a rate set by local government; and third, either 350 percent of the Medicare rate or the provider's billed rate, whichever is less. The bill prohibits ambulance service providers from charging patients additional amounts beyond standard cost-sharing responsibilities like copayments, and prevents insurance plans from imposing higher cost-sharing for out-of-network ambulance services than would apply for in-network services. Additionally, the bill mandates that insurance policies and plans must respond to emergency ambulance service claims within 30 days by either directly paying the provider or notifying the provider of any claim defects. The legislation also requires plans to reimburse patient transportation between facilities as a medically necessary service if the claim includes a medical necessity certification signed by a qualified individual. The bill will take effect on the first day of the fourth month after its publication and will initially apply to policy or plan years beginning on its effective date.

Committee Categories

Health and Social Services

Sponsors (21)

Last Action

Senator Marklein added as a cosponsor (on 01/30/2026)
(1 Companion Bills)

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