bill tying Medicaid ambulance pay to rural Medicare rates

The text as introduced · 414 words

89R16032 AB-D

By: Longoria
H.B. No. 4410

A BILL TO BE ENTITLED

AN ACT

relating to Medicaid reimbursement rates for certain ground

ambulance services.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 32.028, Human Resources Code, is amended

by adding Subsection (o) to read as follows:

(o) The executive commissioner shall ensure that the rules

governing the determination of medical assistance reimbursement

base rates paid to a provider for providing ground ambulance

services are at least equal to 40 percent of the rate paid under

Medicare for providing ground ambulance services originating in a

rural area.

SECTION 2. Subchapter F, Chapter 540, Government Code, as

effective April 1, 2025, is amended by adding Section 540.0281 to

read as follows:

Sec. 540.0281. REIMBURSEMENT RATE FOR CERTAIN GROUND

AMBULANCE SERVICE PROVIDERS. A contract to which this subchapter

applies must require the contracting Medicaid managed care

organization to:

(1) reimburse a provider who is in the organization's

provider network and who provides ground ambulance services at a

rate that is at least equal to the rate paid under Medicare for the

provision of ground ambulance services originating in a rural area;

and

(2) annually increase the reimbursement rate by three

percent.

SECTION 3. (a) The Health and Human Services Commission

shall, in a contract between the commission and a managed care

organization under Chapter 540, Government Code, as effective April

1, 2025, that is entered into or renewed on or after the effective

date of this Act, require that the managed care organization comply

with Section 540.0281, Government Code, as added by this Act.

(b) The Health and Human Services Commission shall seek to

amend contracts entered into with managed care organizations before

the effective date of this Act to require those managed care

organizations to comply with Section 540.0281, Government Code, as

added by this Act. To the extent of a conflict between Section

540.0281, Government Code, as added by this Act, and a provision of

a contract with a managed care organization entered into before the

effective date of this Act, the contract provision prevails.

SECTION 4. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 5. This Act takes effect September 1, 2025.