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 "Surprise
Billing Consumer Protection Act," so as to provide for insurance coverage for certain
out-of-network ambulance transportation service; to provide for the minimum allowable
reimbursement rate for such service; to provide for maximum amounts on copayments,
coinsurance, or deductibles for such service; to provide for definitions; to provide for related
matters; to provide for an effective date; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise Billing
Consumer Protection Act," is amended by revising Code Section 33-20E-23, relating to
financial responsibilities for ground ambulance transportation, as follows:
"33-20E-23.
<del>Nothing in this chapter shall reduce a covered person's financial responsibilities with regard
to ground ambulance transportation.
</del> <ins>(a) As used in this Code section, the term:
(1) 'Ambulance provider' means an agency, including an agency of any political
subdivision of this state, or a company which is operating under a valid license from the
</ins>
<ins>Emergency Health Section of the Department of Public Health and which provides
emergency transport service; provided, however, that such term shall not include an air
ambulance service as such term is defined in Code Section 31-11-2.
(2) 'Clean claim' means a claim for reimbursement of service rendered by an ambulance
provider that has no defect of impropriety, including any lack of required substantiating
documentation, which would reasonably prevent timely payment for a claim.
(3) 'Covered service' means emergency transport service which a covered person is
entitled to receive under the terms of a healthcare plan.
(4) 'Emergency transport service' means the provision of emergency transportation on
the public streets and highways of this state by an ambulance provider for a wounded,
injured, sick, invalid, or incapacitated human being to or from a place where medical or
hospital care is furnished.
(5) 'First responder' means any firefighter of a municipal, county, or volunteer fire
department; paramedic as defined in Code Section 31-11-2; emergency medical
technician as defined in Code Section 31-11-2; peace officer as defined in Code Section
35-8-2; or communications officer as defined in Code Section 37-12-1.
(b) A healthcare plan shall consider emergency transport service as a covered service when
such emergency transport service is requested by a first responder.
(c)(1) The minimum allowable reimbursement rate under any healthcare plan other than
a state healthcare plan for covered service to an out-of-network ambulance provider shall
be the rate agreed to by contract with or through passage of an ordinance, resolution, rule,
or regulation by a county, municipality, special district, or authority for such service
within the respective jurisdiction.
(2) When no agreement on a minimum reimbursement rate exists as set forth in
paragraph (1) of this subsection, the minimum allowable reimbursement amount shall be
the lesser of:
</ins>
<ins>(A) Three hundred and twenty-five percent of the reimbursement rate under the
Medicare program, Part A or B of Title XVIII of the federal Social Security Act, 42
U.S.C. Section 1395, et seq., as amended, for ambulance services; or
(B) The charges billed by the ambulance provider.
(d) Any payment made to an ambulance provider pursuant to this Code section shall
release a covered person from any further payment responsibility other than any
copayment, coinsurance, or deductible owed by the covered person.
(e) Any copayment, coinsurance, or deductible paid for covered service provided by an
out-of-network ambulance provider shall not exceed the amount of a copayment,
coinsurance, or deductible amount owed for similar service provided by an ambulance
provider that belongs to the provider network in a healthcare plan.
(f) No later than 30 days after the receipt of a clean claim for covered service, an insurer
shall remit payment for such service directly to the ambulance provider and shall not remit
any payment to a covered person. When an insurer receives a claim that is not a clean
claim, such insurer shall, within 30 days after receipt of such claim, send written notice to
the ambulance provider making such claim that acknowledges the receipt of such claim and
informs the ambulance provider that:
(1) The insurer has declined to pay all or part of the claim, including the reasons for such
denial; or
(2) Additional information is necessary to make a determination regarding payment of
all or part of the claim submitted, including the specific information required."
</ins> SECTION 2.
This Act shall become effective on January 1, 2027.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.