Georgia HB 961: Local government; chief executive officer/county commission form of government shall not be authorized for county governing authorities in this state; provide

Bill Text

26 LC 46 1466S
House Bill 961 (COMMITTEE SUBSTITUTE)
By: Representatives Powell of the 33
rd, Au of the 50
th, Jasperse of the 11
th, Oliver of the 84
th,
Cooper of the 45
th, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise1
Billing Consumer Protection Act," so as to provide for insurance coverage for certain2
out-of-network ambulance transportation service; to provide for the minimum allowable3
reimbursement rate for such service; to provide for maximum amounts on copayments,4
coinsurance, or deductibles for such service; to provide for definitions; to provide for related5
matters; to repeal conflicting laws; and for other purposes.6
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
SECTION 1.8
Chapter 20E of Title 33 of the Official Code of Georgia Annotated, the "Surprise Billing9
Consumer Protection Act," is amended by revising Code Section 33-20E-23, relating to10
financial responsibilities for ground ambulance transportation, as follows:11
"33-20E-23.12
Nothing in this chapter shall reduce a covered person's financial responsibilities with regard13
to ground ambulance transportation.14
(a) As used in this Code section, the term:15
(1) 'Ambulance provider' means an agency, including an agency of any political16
subdivision of this state, or a company which is operating under a valid license from the17
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Emergency Health Section of the Department of Public Health and which provides18
emergency transport service; provided, however, that such term shall not include an air19
ambulance service as such term is defined in Code Section 31-11-2.20
(2) 'Clean claim' means a claim for reimbursement of service rendered by an ambulance21
provider that has no defect or impropriety, including any lack of required substantiating22
documentation, which would reasonably prevent timely payment for a claim.23
(3) 'Covered service' means emergency transport service which a covered person is24
entitled to receive under the terms of a healthcare plan.25
(4) 'Emergency transport service' means the provision of emergency transportation on26
the public streets and highways of this state by an ambulance provider for a wounded,27
injured, sick, invalid, or incapacitated human being to or from a place where medical or28
hospital care is furnished.29
(5) 'First responder' means any firefighter of a municipal, county, or volunteer fire30
department; paramedic as defined in Code Section 31-11-2; emergency medical31
technician as defined in Code Section 31-11-2; peace officer as defined in Code32
Section 35-8-2; or communications officer as defined in Code Section 37-12-1.33
(6) 'Medical necessity' means the need to use emergency ambulance transport when a34
wounded, injured, sick, invalid, or incapacitated human being's condition would appear35
to a ordinarily prudent person to make other forms of transport dangerous to the health36
or condition of such human being to or from a place where medical or hospital care is37
furnished.38
(b) A healthcare plan shall consider emergency transport service as a covered service39
when:40
(1) Such emergency transport service is requested by a first responder or healthcare41
practitioner responsible for the care of the individual receiving the emergency transport42
service; or43
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(2) Such emergency transport service is requested by an individual not included in44
paragraph (1) of this subsection but the use of such service was a medical necessity.45
(c)(1) The minimum allowable reimbursement rate under any healthcare plan other than46
a state healthcare plan for covered service to an out-of-network ambulance provider shall47
be the rate agreed to by contract with or through passage of an ordinance, resolution, rule,48
or regulation by a county, municipality, special district, or authority for such service49
within the respective jurisdiction.50
(2) When no agreement on a minimum reimbursement rate exists as set forth in51
paragraph (1) of this subsection, the minimum allowable reimbursement amount shall52
be 300 percent of the reimbursement rate under the Medicare program, Part A or B of53
Title XVIII of the federal Social Security Act, 42 U.S.C. Section 1395, et seq., as54
amended, for ambulance services.55
(d) Any payment made to an ambulance provider pursuant to this Code section shall56
release a covered person from any further payment responsibility other than any57
copayment, coinsurance, or deductible owed by the covered person.58
(e) Any copayment, coinsurance, or deductible paid for covered service provided by an59
out-of-network ambulance provider shall not exceed the amount of a copayment,60
coinsurance, or deductible amount owed for similar service provided by an ambulance61
provider that belongs to the provider network in a healthcare plan.62
(f) No later than 30 days after the receipt of a clean claim for covered service, an insur