HB506: HB506 Social services; Medicaid coverage for tobacco cessation treatments; provide

26 HB 506/AP House Bill 506 (AS PASSED HOUSE AND SENATE) By: Representatives Hilton of the 48th, Mathiak of the 82nd, Silcox of the 53rd, Stephens of the 164th, and Au of the 50th A BILL TO BE ENTITLED AN ACT To amend Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise1 Billing Consumer Protection Act," so as to provide for insuranc e coverage for certain2 out-of-network ambulance transportation service; to provide for the minimum allowable3 reimbursement rate for such service; to provide for maximum amo unts on copayments,4 coinsurance, or deductibles for such service; to provide for definitions; to provide for related5 matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Chapter 20E of Title 33 of the Official Code of Georgia Annotat ed, the "Surprise Billing9 Consumer Protection Act," is amended by revising Code Section 3 3-20E-23, relating to10 financial responsibilities for ground ambulance transportation, as follows:11 "33-20E-23.12 Nothing in this chapter shall reduce a covered person's financial responsibilities with regard13 to ground ambulance transportation.14 (a) As used in this Code section, the term:15 (1) 'Ambulance provider' means an agency, including an agency of any political16 subdivision of this state, or a company which is operating under a valid license from the17 H. B. 506 - 1 - 26 HB 506/AP Emergency Health Section of the Department of Public Health and which provides18 emergency transport service; provided, however, that such term shall not include an air19 ambulance service as such term is defined in Code Section 31-11-2.20 (2) 'Clean claim' means a claim for reimbursement of service rendered by an ambulance21 provider that has no defect of impropriety, including any lack of required substantiating22 documentation, which would reasonably prevent timely payment for a claim.23 (3) 'Covered service' means emergency transport service which a covered person is24 entitled to receive under the terms of a healthcare plan.25 (4) 'Emergency transport service' means the provision of emerg ency transportation on26 the public streets and highways of this state by an ambulance p rovider for a wounded,27 injured, sick, invalid, or incapacitated human being to or from a place where medical or28 hospital care is furnished.29 (5) 'First responder' means any firefighter of a municipal, co unty, or volunteer fire30 department; paramedic as defined in Code Section 31-11-2; emerg ency medical31 technician as defined in Code Section 31-11-2; peace officer as defined in Code Section32 35-8-2; or communications officer as defined in Code Section 37-12-1.33 (b) A healthcare plan shall consider emergency transport service as a covered service when34 such emergency transport service is requested by a first responder.35 (c)(1) The minimum allowable reimbursement rate under any healthcare plan other than36 a state healthcare plan for covered service to an out-of-network ambulance provider shall37 be the rate agreed to by contract with or through passage of an ordinance, resolution, rule,38 or regulation by a county, municipality, special district, or a uthority for such service39 within the respective jurisdiction.40 (2) When no agreement on a minimum reimbursement rate exists a s set forth in41 paragraph (1) of this subsection, the minimum allowable reimbursement amount shall be42 the lesser of:43 H. B. 506 - 2 - 26 HB 506/AP (A) Three hundred and twenty-five percent of the reimbursement rate under the44 Medicare program, Part A or B of Title XVIII of the federal Soc ial Security Act, 4245 U.S.C. Section 1395, et seq., as amended, for ambulance services; or46 (B) The charges billed by the ambulance provider.47 (d) Any payment made to an ambulance provider pursuant to this Code section shall48 release a covered person from any further payment responsibilit y other than any49 copayment, coinsurance, or deductible owed by the covered person.50 (e) Any copayment, coinsurance, or deductible paid for covered service provided by an51 out-of-network ambulance provider shall not exceed the amount o f a copayment,52 coinsurance, or deductible amount owed for similar service prov ided by an ambulance53 provider that belongs to the provider network in a healthcare plan.54 (f) No later than 30 days after the receipt of a clean claim for covered service, an insurer55 shall remit payment for such service directly to the ambulance provider and shall not remit56 any payment to a covered person. When an insurer receives a cl aim that is not a clean57 claim, such insurer shall, within 30 days after receipt of such claim, send written notice to58 the ambulance provider making such claim that acknowledges the receipt of such claim and59 informs the ambulance provider that:60 (1) The insurer has declined to pay all or part of the claim, including the reasons for such61 denial; or62 (2) Additional information is necessary to make a determination regarding payment of63 all or part of the claim submitted, including the specific information required."64 SECTION 2.65 This Act shall become effective on January 1, 2027.66 H. B. 506 - 3 - 26 HB 506/AP SECTION 3.67 All laws and parts of laws in conflict with this Act are repealed.68 H. B. 506 - 4 -