To require insurance companies to reimburse ambulance agencies for providing treatment in place or transportation to alternative destinations

2025 Regular Session Introduced by Joe Statler

HB 2106 allows EMS to treat patients on-site or transport them to urgent care, ensuring insurance reimburses them fairly, improving patient care and access.

To House Homeland Security

#publicsafety

Purpose and Intent

House Bill 2106 (HB 2106) aims to enhance the flexibility and efficiency of emergency medical services (EMS) by requiring insurance companies to reimburse ambulance agencies for providing treatment in place or transporting patients to alternative destinations. This legislation seeks to improve patient care by allowing EMS agencies to triage patients and direct them to appropriate facilities based on their medical needs, rather than defaulting to emergency rooms.

Key Provisions

The bill includes several significant provisions:

Triage and Treatment Options:

EMS agencies can triage patients and either treat them on-site or transport them to alternative destinations, such as urgent care centers or behavioral health facilities, when coordinated with medical professionals via telehealth services.

Insurance Coverage Requirements:

Health insurance policies issued or renewed after July 1, 2020, must cover:
- Treatment in place when coordinated through telehealth with a physician or behavioral health specialist.
- Transportation to alternative destinations under similar coordination.
- Encounters where patients decline transport against medical advice, provided that care coordination is maintained.

Reimbursement Rates:

EMS agencies will be reimbursed at the same rate for triaging, treating, and transporting patients to alternative destinations as they would be for transporting patients to emergency rooms.

Protocols and Implementation Timeline:

The bill mandates the establishment of protocols for EMS agencies to follow by October 1, 2024, and requires the submission of proposed legislative rules by May 28, 2025, to ensure compliance and standardization across the state.

Affected Parties

Emergency Medical Services Agencies: Will gain the authority to provide more flexible patient care options and receive appropriate reimbursement for their services.

Insurance Companies: Will be required to adjust their policies to comply with the new coverage mandates.

Patients: Will benefit from improved access to care and potentially reduced wait times by being directed to more suitable healthcare facilities.

Procedural Aspects

Introduced: January 29, 2025, by Rep. Tony M. McCombie.

Current Status: The bill is currently in the House Homeland Security committee.

Legislative Timeline:

The bill has undergone several readings and committee reviews, with significant actions including:
March 12, 2025: Passed the Executive Committee.
March 27, 2025: Held for second reading.
May 31, 2025: Extended deadline for third reading.

Conclusion

HB 2106 represents a significant step towards modernizing emergency medical services in Illinois by allowing for more appropriate patient care options and ensuring that these services are adequately reimbursed by insurance providers. If passed, this bill could lead to improved health outcomes and more efficient use of emergency resources.

Bill