Section 27-65-2
306 words·~1 min read·
/al/title-27-insurance/chapter-65/27-65-2·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)(1) A health care insurer shall contract with any willing emergency medical service provider to provide covered services in the health care insurer’s provider network under terms extended to comparable providers that are in-network.
(2)An in-network provider shall meet licensing requirements provided by law.
(b)(1) Beginning October 1, 2026, the minimum reimbursement from a health insurer to an emergency medical service provider that is in-network for emergency ground transport shall be 200 percent of the Medicare Ambulance Fee Schedule rate as published by the Centers for Medicare & Medicaid Services (CMS).
(2)a. Beginning January 1, 2027, the minimum reimbursement from a health insurer to an emergency medical service provider that is in-network for treat in place shall be 200 percent of the Medicare Ambulance Fee Schedule rate for basic life support as published by CMS which is in effect on January 1, 2027.
b. Submission of a claim for reimbursement for treat in place is prohibited if the emergency medical service provider has submitted a claim for emergency ground transport for the same event or occurrence.
(c)(1) Beginning January 1, 2027, the minimum reimbursement amount from a health care insurer to an emergency medical service provider that is out-of-network for covered services shall be 180 percent of the Medicare Ambulance Fee Schedule rate as published by CMS.
(2)The minimum reimbursement rate for treat in place provided in paragraph (b)(2)a. shall not apply to an out-of-network emergency medical service provider.
(d)(1) For purposes of this section, the Medicare Ambulance Fee Schedule rate shall be the rate applicable to zip code 35462, including the applicable Medicare base rate and mileage components.
(2)The reimbursement rate established under this section shall be applied uniformly on a statewide basis, without regard to the geographic locality, population density, or zip code in which the ground ambulance service is provided.