ambulance surprise-billing protections get two more years

The text as introduced · 748 words

89R9695 DNC-F

By: Zaffirini
S.B. No. 916

A BILL TO BE ENTITLED

AN ACT

relating to consumer protections against certain medical and health

care billing by emergency medical services providers.

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

SECTION 1. Section 773.061, Health and Safety Code, is

amended by adding Subsection (a-1) to read as follows:

(a-1) In addition to other permissible actions or penalties

and regardless of whether an emergency medical services provider is

directly operated by a governmental entity, the department may

revoke, suspend, or refuse to renew a license or certificate of the

provider if the department confirms that the provider has:

(1) intentionally submitted incorrect information

required under Section 38.006, Insurance Code; or

(2) engaged in a pattern of violations of Section

1271.159, 1275.054, 1301.166, 1551.231, 1575.174, or 1579.112,

Insurance Code.

SECTION 2. Section 38.006(b), Insurance Code, is amended to

read as follows:

(b) This section expires September 1, 2027 [ 2025 ].

SECTION 3. Sections 1271.159(c) and (g), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ health

maintenance organization shall ] adjust a rate submitted under

Section 38.006 [ payment required by Subsection (b)(1) each plan

year ] by not more than [ increasing the payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(g) This section expires September 1, 2027 [ 2025 ].

SECTION 4. Sections 1275.054(c) and (f), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ The administrator

shall ] adjust a rate submitted under Section 38.006 [ payment

required by Subsection (b)(1) each plan year ] by not more than

[ increasing the payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(f) This section expires September 1, 2027 [ 2025 ].

SECTION 5. Sections 1301.166(c) and (g), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ An insurer shall ]

adjust a rate submitted under Section 38.006 [ payment required by

Subsection (b)(1) each plan year ] by not more than [ increasing the

payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(g) This section expires September 1, 2027 [ 2025 ].

SECTION 6. Sections 1551.231(c) and (f), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ The administrator

shall ] adjust a rate submitted under Section 38.006 [ payment

required by Subsection (b)(1) each plan year ] by not more than

[ increasing the payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(f) This section expires September 1, 2027 [ 2025 ].

SECTION 7. Sections 1575.174(c) and (f), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ The administrator

shall ] adjust a rate submitted under Section 38.006 [ payment

required by Subsection (b)(1) each plan year ] by not more than

[ increasing the payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(f) This section expires September 1, 2027 [ 2025 ].

SECTION 8. Sections 1579.112(c) and (f), Insurance Code,

are amended to read as follows:

(c) A political subdivision may annually [ The administrator

shall ] adjust a rate submitted under Section 38.006 [ payment

required by Subsection (b)(1) each plan year ] by not more than

[ increasing the payment by ] the lesser of :

(1) the Medicare Ambulance Inflation Factor; [ Index ]

or

(2) 10 percent of the provider's previous calendar

year rates.

(f) This section expires September 1, 2027 [ 2025 ].

SECTION 9. The changes in law made by this Act apply only to

emergency medical services provided on or after the effective date

of this Act. Emergency medical services provided before the

effective date of this Act are governed by the law in effect

immediately before the effective date of this Act, and that law is

continued in effect for that purpose.

SECTION 10. This Act takes effect September 1, 2025.