SB51 Alabama 2025 Session

Summary

Primary Sponsor

Bobby D. SingletonSenator

Democrat

Session

2025 Regular Session

Title

Health insurers; to set a minimum reimbursement rate for ambulance services that are out-of-network.

Summary

SB51 aims to end surprise billing for ground ambulance services by setting minimum and maximum reimbursements, requiring insurers to pay providers directly, and adding reporting and study requirements.

What This Bill Does

It sets in-network reimbursement as the greater of the contract amount or 200% of the Medicare rate, and out-of-network reimbursement as the lesser of the billed charge or 180% of the Medicare rate, effective for covered ambulance services. It requires health insurers to pay ambulance providers directly and prohibits charging enrollees more than their in-network cost-sharing. It also requires insurers to certify an enrollee’s in-network cost-sharing to out-of-network providers and establishes timelines for claim payment and handling non-clean claims. The bill imposes annual reporting by EMS providers to the Alabama Department of Public Health, funds a consultant to study the act’s impact, and lays out a reporting deadline and possible recommendations.

Who It Affects

• Enrollees/patients: protected from surprise balance billing and charged only their in-network cost-sharing amount; insurers pay providers directly.
• Ground ambulance providers (EMS): reimbursements are capped by the in-network minimum and out-of-network maximum rules, and they must accept those payments; they must report data to the state.
• Health care insurers: must contract with willing EMS providers, pay at least the specified minimums for in-network and at most the specified amounts for out-of-network, and process clean claims within defined timelines.
• Alabama Department of Public Health: collects annual EMS data, adopts implementing rules, and oversees the study and reporting requirements.
• The three largest health insurers by state enrollment: fund the required study ($50,000) through their payment of the consultant.

Key Provisions

• In-network minimum reimbursement to EMS providers: greater of the contract amount or 200% of the Medicare rate in effect on January 1, 2025, for the geographic area where the service is provided.
• Out-of-network maximum reimbursement to EMS providers: lesser of the provider's billed charge or 180% of the Medicare rate in effect on January 1, 2025, for the geographic area where the service is provided.
• Payment in full: reimbursement under Section 2 is payment in full for covered services; no extra charges allowed beyond the enrollee’s in-network cost-sharing.
• Direct insurer payment: health insurers must pay the ambulance service directly, not the enrollee.
• Cost-sharing certification: insurers must certify an enrollee’s in-network cost-sharing to an out-of-network provider upon request.
• Claim payment timelines: insurers must remit payment within 30 days for clean electronic claims and within 45 days for clean written claims.
• Non-clean claims: insurers must acknowledge non-clean claims within 30 days with a denial reason or list of additional information needed.
• Provider reporting: EMS providers must annually report to the Alabama Department of Public Health on various operational and financial metrics (vehicles, staff, transports, response times, income, profits, dividends, etc.).
• ADPH rules and consultant study: ADPH will adopt implementation rules, may require additional reporting data, and contract a consultant to study the act’s impact with a report by December 1, 2028; cost not to exceed $50,000, funded by Alabama’s three largest insurers.
• Sunset and amendments: the act revises certain insurance laws to implement these provisions, with effective date January 1, 2026; sections 1-6 repealed June 1, 2029.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance