TO AMEND THE TRANSPORTATION BENEFIT MANAGER ACT; AND TO DECLARE AN EMERGENCY.

2025 Regular Session Introduced by Missy Irvin and 2 co-sponsors

Act 836 standardizes ambulance service reimbursements in Arkansas, ensuring providers receive 250% of Medicare rates and protecting patients from surprise bills.

Notification that HB1863 is now Act 836

Purpose and Intent

House Bill 1863, now known as Act 836, aims to amend the Transportation Benefit Manager Act in Arkansas. The primary goal of this legislation is to clarify and standardize reimbursement rates for ambulance services, addressing existing conflicts between in-network and out-of-network reimbursement practices. The bill also includes an emergency clause, indicating the urgency of its implementation to resolve confusion among ambulance providers, insurers, and the State Insurance Department.

Key Provisions

The bill introduces several significant changes to the existing law:

Claims Payment Requirements:

Ambulance service claims for which prior authorization has been received must be paid within 30 days by contracting entities, unless:
- The authorized services were not performed.
- There is evidence of fraud or material misrepresentation related to the claim.

Reimbursement Rates:

Healthcare insurers and transportation benefit managers are required to pay 250% of the Medicare Ambulance Fee Schedule, Rural Rate for ambulance services.
Ambulance providers must accept this payment as full compensation and cannot balance bill subscribers beyond their deductible, copayment, or coinsurance.

Audit Protection:

Authorized ambulance services that have received prior authorization and are not rescinded are protected from audit recoupment.

Annual Rate Collection:

Starting July 1, 2025, the Arkansas Ambulance Association will be responsible for collecting rates approved or contracted between ambulance providers and local government entities, with annual reporting to the commissioner.

Affected Parties

Ambulance Providers: Will benefit from clearer reimbursement rates and protections against balance billing.

Healthcare Insurers: Must comply with the new payment structures and timelines.

Subscribers: Patients using ambulance services will have clearer expectations regarding their financial responsibilities.

Procedural Aspects

The bill was introduced on March 19, 2025, and underwent several legislative actions, including:

Passed by the House and Senate on April 14, 2025.
Enrolled and transmitted to the Governor's Office on April 15, 2025.
Officially became Act 836 on April 17, 2025.

The emergency clause ensures that the act takes effect immediately upon approval by the Governor or if not vetoed within the standard timeframe.

Conclusion

Act 836 represents a significant step towards resolving reimbursement issues in the ambulance service sector in Arkansas. By establishing clear payment guidelines and protections for both providers and subscribers, the legislation aims to enhance the efficiency and transparency of ambulance service reimbursements.

Bill