HB 1322 — Summary (North Dakota): Ambulance balanced billing & provider reimbursement

Status: Filed with Secretary of State 04/28 (Introduced to the Sixty‑ninth Legislative Assembly)

Primary focus: create protections against surprise ambulance balance billing and set insurer reimbursement rules for out‑of‑network ambulance transport; amend EMS communications authority; direct a legislative study and provide a one‑time appropriation.

Purpose

Reduce surprise out‑of‑network ambulance bills for patients, require direct insurer payments to ambulance providers, establish a default reimbursement benchmark for out‑of‑network ground ambulance services, and study options to reimburse ambulance providers for delinquent/unpaid bills.

Key provisions

• Definitions and scope

  • Applies to ground ambulance service entities licensed under chapter 23‑27 as Basic Life Support (BLS) or Advanced Life Support (ALS) providers.
  • Explicitly excludes air ambulance providers.

• Direct payment requirement

  • All reimbursements by a health care insurer for ambulance services to a covered person must be paid directly to the ambulance service provider or the provider’s designee.

• Out‑of‑network reimbursement benchmark

  • For ambulance services provided by an out‑of‑network provider, the insurer must pay the ambulance service provider the lesser of:
  • 250% of the Medicare reimbursement rate for the same service in the same geographic area; or
  • the ambulance provider’s billed charges.
  • (Note: the statute also specifies that insurer payments need not include amounts corresponding to the covered person’s coinsurance, copayment, or deductible.)

• Balance‑billing prohibition (patient financial protection)

  • An ambulance service provider may not collect from the covered individual more than the deductible, coinsurance, copayment, or other cost‑sharing the individual would owe if services had been provided by an in‑network (participating) ambulance provider.

• Enforcement & rulemaking

  • The insurance commissioner may adopt rules to implement and enforce the insurance‑related provisions.

• EMS communications (amendment to 23‑27‑04.8)

  • The department may regulate primary communications methods and protocols for emergency medical services while permitting secondary communications through other devices (including cell phones); regulations must be consistent with Department of Emergency Services protocols.

Legislative study and appropriation

• Legislative management study (2025–26 interim)

  • The Legislative Management is to consider studying the feasibility/desirability of a delinquent billing reimbursement grant system for ambulance providers, including stakeholder input and a provider survey, and report findings and recommendations (with any required legislation) to the Seventieth Legislative Assembly.

• Appropriation

  • One‑time appropriation of $20,000 from the general fund to the Legislative Council to contract for consulting services for the study for the 2025–27 biennium.

Who is affected

• Ambulance service providers (ground BLS/ALS): limits on balance billing and new reimbursement benchmark for out‑of‑network payments.
• Health care insurers and health plans operating in the state: new payment and direct‑pay obligations; subject to rulemaking.
• Covered individuals/patients: protected from surprise out‑of‑network ambulance balance bills beyond normal in‑network cost‑sharing.
• State agencies: Department with EMS communications authority; Insurance Commissioner (rulemaking); Legislative Council (study contract).

Potential impacts / considerations

• Patient protection: reduces unexpected financial liability for ambulance transport.
• Provider revenue / insurer costs: the 250%‑of‑Medicare cap (when lower than billed charges) may reduce some providers’ out‑of‑network recoveries; conversely, paying the lesser of billed charges or 250% Medicare could benefit providers who bill below that threshold.
• Rural & volunteer ambulance services: fiscal effects depend on local payer mixes and typical billed charges; the interim study intends to explore delinquent billing reimbursement mechanisms to address provider cash‑flow gaps.
• Implementation details (billing workflows, disputes, applicability to ER transports) will depend on rulemaking and future legislative action informed by the study.

Timeline / next steps

• Insurance commissioner rulemaking authority granted for implementation.
• Legislative Management to study delinquent‑billing reimbursement during the 2025–26 interim and report to the Seventieth Legislative Assembly.
• One‑time $20,000 funding available to the Legislative Council to support the study (biennium July 1, 2025 – June 30, 2027).