---
title: HB 961. Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide
collection: bills
id: 2025-2026/hb961
cite_as: HB 961, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/hb961
md_url: https://georgiacommons.org/bills/2025-2026/hb961.md
text_url: https://georgiacommons.org/bills/2025-2026/hb961/text
source_url: https://www.legis.ga.gov/legislation/72210
date: 2026-03-06
status: engrossed
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 492
omitted_url: https://georgiacommons.org/bills/2025-2026/hb961.md?full=1
bill_number: HB 961
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: House
bill_type: bill
status_date: 2026-03-04
last_action: Senate Read and Referred
sponsors:
- Alan Powell
- Michelle Au
- Rick Jasperse
- Mary Oliver
- Sharon Cooper
- David Wilkerson
text_version: Comm Sub
has_text: true
legiscan_url: https://legiscan.com/GA/bill/HB961/2025
upstream_id: 2080504
summaries_model: claude-sonnet-5
topic_tags:
- surprise billing
- ambulance services
- health insurance coverage
- medical billing protections
- emergency medical services
---
# HB 961. Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide
## Text
House Bill 961 (COMMITTEE SUBSTITUTE)
By: Representatives Powell of the 33rd, Au of the 50th, Jasperse of the 11th, Oliver of the 84th,
Cooper of the 45th, and others
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 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.
Nothing in this chapter shall reduce a covered person's financial responsibilities with regard
to ground ambulance transportation.
(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
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 or 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.
(6) 'Medical necessity' means the need to use emergency ambulance transport when a
wounded, injured, sick, invalid, or incapacitated human being's condition would appear
to a ordinarily prudent person to make other forms of transport dangerous to the health
or condition of such human being to or from a place where medical or hospital care is
furnished.
(b) A healthcare plan shall consider emergency transport service as a covered service
when:
(1) Such emergency transport service is requested by a first responder or healthcare
practitioner responsible for the care of the individual receiving the emergency transport
service; or
(2) Such emergency transport service is requested by an individual not included in
paragraph (1) of this subsection but the use of such service was a medical necessity.
(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 300 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.
(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."
SECTION 2.
All laws and parts of laws in conflict with this Act are repealed.
## Summaries written by Georgia Commons
The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.
House Bill 961 would require Georgia health plans to cover out-of-network ground ambulance rides and set a minimum reimbursement rate for ambulance providers, so patients are not left to cover the full bill themselves.
### Plain-language summary
Currently, Georgia's Surprise Billing Consumer Protection Act (O.C.G.A. Chapter 20E of Title 33) does not guarantee coverage for ground ambulance transportation, meaning patients could be billed directly by out-of-network ambulance providers. This bill rewrites Code Section 33-20E-23 to change that.
Under the bill, a health plan must treat emergency ambulance transport as a covered service when a first responder or medical practitioner requests it, or when the transport was medically necessary. If there is no local government contract setting a reimbursement rate, insurers must pay out-of-network ambulance providers at least 300 percent of the Medicare reimbursement rate. Patients would only owe their normal copayment, coinsurance, or deductible, capped at what they would pay for an in-network ambulance. Insurers must pay clean claims within 30 days or explain any denial or request more information within that time.
### What it does
- Requires Georgia health plans to cover emergency ground ambulance transportation requested by a first responder, medical practitioner, or when medically necessary.
- Sets a minimum reimbursement rate for out-of-network ambulance providers, defaulting to 300 percent of the Medicare rate when no local government contract sets a different rate.
- Caps what patients pay in copayments, coinsurance, or deductibles for out-of-network ambulance service at the same level as in-network service.
- Bars insurers from billing patients further once they pay the ambulance provider, aside from normal copays, coinsurance, or deductibles.
- Requires insurers to pay a clean (properly documented) claim within 30 days or send written notice of denial or a request for more information within that time.
- Defines key terms including ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity.
### Who it affects
Georgians who use emergency ground ambulance services, health insurers and health plans operating in the state, ambulance providers (including local government-run ambulance agencies), first responders such as firefighters, paramedics, EMTs, and police, and county and municipal governments that may set local reimbursement rates by ordinance.
### Why it matters
Patients who call or need an out-of-network ambulance would be protected from large surprise bills, since insurers would have to pay ambulance providers directly at a guaranteed minimum rate and patients would only owe normal cost-sharing amounts, similar to what they'd pay for an in-network ambulance ride.
### Key provisions
- Section 1 rewrites O.C.G.A. ยง 33-20E-23, replacing language that left ground ambulance costs entirely to the patient's financial responsibility.
- Subsection (a) defines ambulance provider, clean claim, covered service, emergency transport service, first responder, and medical necessity for purposes of this Code section.
- Subsection (b) requires health plans to treat emergency ambulance transport as covered when requested by a first responder or practitioner, or when medically necessary.
- Subsection (c) sets the minimum reimbursement rate: a local government-negotiated rate if one exists, otherwise 300 percent of the Medicare Part A or B rate for ambulance services.
- Subsection (d) states that once an insurer pays the ambulance provider, the patient owes nothing further except normal copayments, coinsurance, or deductibles.
- Subsection (e) caps out-of-network ambulance copayments, coinsurance, or deductibles at the same level charged for in-network ambulance service.
- Subsection (f) requires insurers to pay clean claims within 30 days or, for incomplete claims, notify the ambulance provider within 30 days of a denial or request for more information.
- Section 2 repeals conflicting laws.
## Status
- Status: Engrossed (2026-03-04)
- Last action: Senate Read and Referred (2026-03-06)
- Sponsors: Alan Powell, Michelle Au, Rick Jasperse, Mary Oliver, Sharon Cooper, David Wilkerson
- Official page: https://www.legis.ga.gov/legislation/72210
> The history, votes, and amendments (492 characters) are at https://georgiacommons.org/bills/2025-2026/hb961.md?full=1