Senate Bill 269 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 regulate emergency ground ambulance reimbursement and balance billing, requiring minimum insurer payments to EMS providers, with reporting and a sunset repeal in 2029.

What This Bill Does

If enacted, the bill would require health insurers to contract with willing emergency medical service providers to be in-network for covered ambulance services. It sets minimum reimbursements tied to CMS Medicare rates (200% of the Medicare Ambulance Fee Schedule for in-network emergency transport starting Oct 1, 2026; 200% of the CMS basic life support rate for treat‑in‑place starting Oct 1, 2026; 180% for out‑of‑network treat‑in‑place beginning Jan 1, 2027) and prohibits balance billing by EMS providers, allowing them to collect only the in-network cost-sharing amount. It requires insurers to remit payments promptly (30 days for clean electronic claims, 45 days for clean written claims) and to handle non‑clean claims with written denials or information requests. The act also mandates annual reporting by EMS providers and insurers to the Alabama Department of Public Health, plus appointment of an outside expert to study the act’s impact and publish recommendations, with all sections repealed on June 1, 2029.

Who It Affects

• Enrolled individuals/patients who receive emergency ground ambulance transport would be protected from surprise charges and limited to in-network cost-sharing amounts.
• Emergency medical service providers and health care insurers would face contractual, pricing, and reporting requirements, plus a need to adjust billing and reimbursement practices to meet the new minimums and reporting mandates.

Key Provisions

• Minimum reimbursement rates set as 200% of CMS Medicare rates for in-network emergency ground transport starting Oct 1, 2026; 200% of CMS basic life support rate for treat-in-place starting Oct 1, 2026 (CMS rate in effect Jan 1, 2027); 180% of CMS rate for out-of-network treat-in-place starting Jan 1, 2027; rates apply statewide.
• Balance billing ban: providers may not bill beyond the enrollee’s in-network cost-sharing amount; payment to the provider is the agreed in-network rate, irrespective of network status for the enrollee.
• Claims and payments: insurers must remit payment within 30 days for clean electronic claims or 45 days for clean written claims; if a claim is not clean, insurers must acknowledge with a denial reason or ask for additional information.
• Reporting to ADPH: EMS providers and insurers must submit annual and other data on operations, finances, and claims; starting 2028, providers submit yearly reports, and insurers report on denials, payments, and related figures.
• Independent study: ADPH must hire a consultant to study the act’s impact on access to emergency services, with a cost cap of $50,000 paid by the three largest insurers by state enrollment.
• Sunset repeal: Sections 1–5 are repealed on June 1, 2029.
• Regulatory alignment: the bill amends existing insurance and health service plan statutes to implement these provisions, including provisions related to self-funded plans, reporting, and contractor requirements.

AI-generated summary using openai/gpt-5-nano on Feb 12, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Insurance