SB269 Alabama 2026 Session

Summary

Primary Sponsor

Bobby D. SingletonSenator

Democrat

Session

2026 Regular Session

Title

Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers

Summary

SB269 would ban balance billing for ground ambulance services and require health insurers to pay minimum rates to emergency medical service providers, with reporting and study provisions and a 2029 sunset.

What This Bill Does

If enacted, it requires insurers to contract with any willing EMS provider for in-network services; it sets minimum reimbursements for in-network emergency transport, treat-in-place, and out-of-network services based on CMS Ambulance Fee Schedule rates; payments are considered full and enrollees may only owe in-network cost-sharing. It also creates reporting requirements to the Alabama Department of Public Health and commissions an independent study to assess impact, ending the act in 2029.

Who It Affects

• Emergency medical service providers (EMS): guaranteed minimum reimbursements (in-network); cannot charge balance bills beyond the enrollee's in-network cost-sharing; must report data to ADPH.
• Health care insurers: must contract with willing EMS providers; must meet minimum reimbursement rates; must remit payments on a set timetable and handle disputes; must report data to ADPH.
• Enrollees/patients: protected from balance billing for EMS; pay only in-network cost-sharing amounts; may benefit from lower overall EMS costs.
• Alabama Department of Public Health: collects annual reports from EMS providers and insurers and oversees implementation.
• Three largest health insurers (by enrollment): fund the required impact study authorized in Section 5.

Key Provisions

• Insurers must contract with any willing EMS provider to provide covered services in-network under terms like other in-network providers (licensing requirements apply).
• Starting Oct 1, 2026, minimum in-network reimbursement for emergency ground transport is 200% of CMS Medicare Ambulance Fee Schedule (rate for ZIP 35462).
• Starting Jan 1, 2027, minimum in-network reimbursement for treat-in-place is 200% of CMS basic life support rate; cannot bill for treat-in-place if an emergency ground transport claim was filed for the same event.
• Starting Jan 1, 2027, minimum out-of-network reimbursement for covered services is 180% of CMS rate; treat-in-place out-of-network reimbursement does not apply.
• The payment under Section 2 is considered payment in full; EMS providers may not seek additional payment from enrollees beyond in-network cost-sharing; insurers must provide in-network cost-sharing amounts to out-of-network providers upon request; payment timelines for out-of-network claims are specified.
• EMS providers and insurers must report specified data to the Alabama Department of Public Health annually beginning 2027; reports cover operations, finances, and reimbursement details; data is confidential.
• A study by a designated business school, funded by the three largest insurers, will assess the act’s impact and provide recommendations; report due by December 1, 2028.
• The act becomes effective October 1, 2026 and is repealed June 1, 2029.

AI-generated summary using openai/gpt-5-nano-2025-08-07 on Apr 1, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance