Georgia CommonsHB 961: Surprise Billing Consumer Protection Act; insurance coverage for certain out-of-network ambulance transportation service; provide
Comm Sub version, the latest LegiScan holds · Last action March 6, 2026 · Engrossed
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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.