Bill > SB211

This bill aims to protect patients from unexpected medical bills related to ambulance services by prohibiting ambulance providers from billing patients directly for out-of-network emergency medical services, except for standard patient cost-sharing like coinsurance, copayments, or deductibles. It defines key terms such as "ambulance service" as a licensed ground ambulance provider, "emergency medical services" as ambulance transportation and prehospital care, and "out-of-network provider" as an ambulance service without a contract with the patient's health insurance plan. The bill also establishes reimbursement standards for these out-of-network services, requiring health benefit plans to pay ambulance providers at a rate no less than the local rate from where the transport originated, or if no local rate exists, the lesser of the provider's billed charge or 275% of the Medicare allowable rate. Furthermore, it mandates that both providers and health plans provide clear explanations of benefits and patient financial responsibility, and clarifies that patients are generally not liable for more than their plan's cost-sharing for emergency ambulance services, with exceptions for non-covered services. Importantly, these provisions do not apply to self-funded employer health plans, Medicaid, Medicare, or other federally regulated programs.

Health and Social Services

https://sdlegislature.gov/#/Session/Bill/27221