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H 1159

An Act relative to payments for use of ambulance services

194th Legislature (2025-2026) Introduced by Dennis Gallagher and 2 co-sponsors

Requires insurers to directly and promptly pay ambulance service providers for emergency transports not under contract, at municipal transport rates.

Hearing scheduled for 10/27/2025 from 10:30 AM-04:00 PM in Gardner Auditorium
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Bill Summary · H 1159

Summary: H 1159 – An Act relative to payments for use of ambulance services

Overview

H 1159, introduced February 27, 2025 and filed January 7, 2025, seeks to modify how ambulance services are paid by insurers in emergency situations. The bill adds new provisions (Section 3C) to Chapter 176D of the General Laws. A hearing is scheduled for October 27, 2025, in Gardner Auditorium, from 10:30 AM to 4:00 PM. The measure is referred to the House Committee on Financial Services.

Purpose and intent

  • To ensure timely direct payment to ambulance service providers (ASPs) for emergency ambulance services when the provider is not under contract with the insured’s insurer.
  • To reduce the likelihood of delayed or disputed payments and to clarify the relationship among insurers, insureds, and ASPs in emergency transports.

Key provisions

  • Definitions (Section 3C(a))
    The bill defines essential terms, including:

    • “Ambulance service provider” – a licensed ambulance operator under Massachusetts law.
    • “Emergency ambulance services” – services provided when immediate medical attention is needed or potential need is perceived.
    • “Insurance policy/contract,” “insured,” and “insurer” – as used in the context of ambulance services and coverage.

  • Direct payment obligation (Section 3C(b))
    If an ASP provides emergency ambulance service to an insured and is not under contract with the insurer, the insurer must pay the ASP directly and promptly. Payment must be made despite any prohibition on assignment of benefits in the insured’s policy, provided the insured assigns benefits to the ASP (either directly, or in situations where the insured cannot execute an assignment). If the insurer pays the insured instead of the ASP, the ASP is not deemed paid and may sue the insurer for payment.

  • Rate of payment (Section 3C(c))
    Payment to the ASP under subsection (b) should be at a rate equal to the municipality’s established rate for the transport (with a notable exception for non-profit corporations licensed to operate critical care ambulance services that offer both ground and air transport).

  • Finality of payment (Section 3C(d))
    When payment is made under this framework, the ASP is considered paid in full for the service and cannot seek further payment from the insured, except for any coinsurance, copayments, or deductibles required by the insured’s policy.

  • Protections and limitations (Section 3C(e))
    The bill does not limit an insured’s rights to benefits under a policy and does not create an entitlement to coverage if the policy does not provide ambulance coverage.

Affected parties

  • Ambulance service providers (ASPs) – potential direct payment from insurers; capped claims to insureds.
  • Insurers – required direct payment to ASPs for emergency transports not under contract.
  • Insureds – some assignment rights enhanced; shielded from additional billing beyond policy terms.
  • Municipalities (rate-setting authority) and critical care ASPs (exemption in certain cases).

Procedural and timeline notes

  • Legislative actions show referral to the Committee on Financial Services on February 27, 2025.
  • A hearing is scheduled for October 27, 2025, in Gardner Auditorium (10:30 AM–4:00 PM).
  • Related/previously similar matter: House 992 (2023-2024); the current measure is listed as House Docket No. 268 and is described as replacing that prior matter.

Potential impact and considerations

  • Shifts payment flows toward ASPs in emergency scenarios, potentially reducing uninsured or insured disputes about ambulance charges.
  • Ties payment to municipal transport rates, which could standardize reimbursement but may raise questions about regional rate adequacy and cross-border billing.
  • Balances insurer risk with patient protections by clarifying assignment of benefits to ASPs and eliminating barriers to payment in emergency contexts.

Related bills

  • Related matter filed in 2023-2024 (HD 992).
  • Related House Docket: HD 268 (the current filing, replacing prior iterations).

Compiled from official sources — confirm details with the bill’s official record.

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