SB 568 — Coverage for Out-of-network Ground Ambulance Emergency Services

Words stricken are deletions;

words underlined are additions.

Florida Senate - 2024 SB 568 21-00606-24 2024568__ copayment, coinsurance, deductible, or other cost-sharing responsibilities required to be paid by the enrollee.

An ambulance service provider may not bill the enrollee any additional amount for such paid covered services.

(4) Copayment, coinsurance, deductible, and other cost- sharing responsibilities paid for an out-of-network ambulance service provider’s covered service may not exceed the in-network copayment, coinsurance, deductible, and other cost-sharing responsibilities for covered services received by the enrollee.

(5) A health insurer shall, within 30 days after receipt of a clean claim for covered services, promptly remit payment for covered services directly to the ambulance service provider and may not send payment to an enrollee.

A health insurer must remit payment for the transportation of any patient by ambulance as a medically necessary service if the transportation was requested by a first responder or a health care practitioner as defined in s.

456.001.

(6) If the claim is not a clean claim, the health insurer must, within 30 days after receipt of the claim, send a written notice acknowledging the date of receipt of the claim and informing the ambulance service provider of one of the following:

(a) That the insurer is declining to pay all or part of the claim, and the specific reason or reasons for the denial.

(b) That additional information is necessary to determine if all or part of the claim is payable, and the specific additional information that is required.

Paragraph (h) is added to subsection (5) of section 627.6699, Florida Statutes, to read:

627.6699 Employee Health Care Access Act.— (5) AVAILABILITY OF COVERAGE.— (h) A small employer carrier must comply with the reimbursement provisions of s.

627.42398 relating to nonparticipating ambulance service providers.

Section 3.

Page641.31078 3Coverage offor 6out-of-network CODING:ambulance services.— (1) As used in this section, the term:

(a) “Ambulance service provider” means a ground ambulance Page 3 of 5 CODING:

Florida Senate - 2024 SBCS 568 21-00606-24 2024568__ 641.31078 Coverage for out-of-networkSB ground568 ambulance597-01990-24 emergency2024568c1 services.—service (1)licensed Aspursuant usedto ins. this section, the term:

(a) “Ambulance service provider” means a ground ambulance service licensed pursuant to s.

(b) “Clean“Out-of-network claim”ambulance service provider” means a claimprovider that hasis nonot defectunder ofcontract impropriety,with includinga lackhealth ofmaintenance requiredorganization. substantiating documentation or particular circumstances requiring special treatment which prevent timely payment from being made on the claim.

(c)(2) “CoveredA services”health meansmaintenance thosecontract emergencythat offers individual or group major medical coverage that includes coverage for ground ambulance services thatmust require a subscriberhealth ismaintenance entitledorganization to receivereimburse underan theout-of-network termsambulance ofservice provider for providing covered ambulance services at a healthrate maintenancethat contract.is the lowest of the following:

The term does not include air ambulance services.

(d) “Out-of-network” means a provider that is not a provider under contract with the health maintenance organization of the subscriber receiving the covered health care services.

(2) A health maintenance contract must require a health maintenance organization to reimburse an out-of-network ambulance service provider for providing covered services at a rate that is the greatest of the following:

(b) Three hundred andtwenty-five fifty percent of the current published rate for ground ambulance services as established by the federal Centers for Medicare and Medicaid Services under Title XVIII of the Social Security Act for the same service provided in the same geographic area;area.

or(c) theThe ambulance service provider’s Pagebilled 4charges. of 6 CODING:

(3) Payment in full by the subscriber of his or her applicable copayment, coinsurance, or deductible constitutes an accord and satisfaction of, and constitutes a release of, any claim for additional moneys owed by the subscriber to the health insurer or to any person or entity in connection with the ground ambulance services.

(4) Copayment, coinsurance, deductible, and other cost- sharing responsibilities paid for an out-of-network ambulance service provider’s covered services may not exceed the in- network copayment, coinsurance, deductible, and other cost- Page 4 of 5 CODING:

Florida Senate - 2024 CS for SB 568 21-00606-24597-01990-24 2024568__2024568c1 billedsharing charges,responsibilities whicheverfor iscovered less.services received by the subscriber.

(c)(5) TheAn contractedambulance rateservice atprovider whichis theconsidered healtha maintenanceprovider, organizationand wouldthe reimburseclaims anof in-networkthe ambulance provider forare providingsubject suchto covereds. services.

(3)641.3155. Payment made in compliance with this section is payment in full for the covered services provided, except for any copayment, coinsurance, deductible, or other cost-sharing responsibilities required to be paid by the subscriber.

AnSection ambulance4. service provider may not bill the subscriber any additional amount for such paid covered services.

(4)This Copayment,act coinsurance,shall deductible,take andeffect otherJanuary cost-1, sharing2025. responsibilities paid for an out-of-network ambulance service provider’s covered services may not exceed the in- network copayment, coinsurance, deductible, and other cost- sharing responsibilities for covered services received by the subscriber.

(5)Page A5 health maintenance organization shall, within 30 days after receipt of a5 cleanCODING: claim for covered services, promptly remit payment for covered services directly to the ambulance service provider and may not send payment to a subscriber.

A health maintenance organization must remit payment for the transportation of any patient by ambulance as a medically necessary service if the transportation was requested by a first responder or a health care practitioner as defined in s.

456.001.

(6) If the claim is not a clean claim, the health maintenance organization must, within 30 days after receipt of the claim, send a written notice acknowledging the date of receipt of the claim and informing the ambulance service Page 5 of 6 CODING:

Words stricken are deletions;

words underlined are additions.

Florida Senate - 2024 SB 568 21-00606-24 2024568__ provider of one of the following:

(a) That the health maintenance organization is declining to pay all or part of the claim, and the specific reason or reasons for the denial.

(b) That additional information is necessary to determine if all or part of the claim is payable, and the specific additional information that is required.

Section 3.

This act shall take effect July 1, 2024.

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