An Act To Implement the Recommendations of the Stakeholder Group Convened by the Emergency Medical Services' Board Related to Reimbursement Rates for Ambulance Services by Health Insurance Carriers and To Improve Participation of Ambulance Service Providers in Carrier Networks
Maine Legislature, Session 130, LD 1258
Committee: Health Coverage, Insurance and Financial Services
Amends: 24-A MRSA §4303-C, 24-A MRSA §4303-F, 32 MRSA §86, 32 MRSA §88

Legislative Document
No. 1258
H.P. 925
House of Representatives, March 26, 2021
An Act To Implement the Recommendations of the Stakeholder 
Group Convened by the Emergency Medical Services' Board 
Related to Reimbursement Rates for Ambulance Services by Health 
Insurance Carriers and To Improve Participation of Ambulance 
Service Providers in Carrier Networks
Reported by Representative TEPLER of Topsham for the Joint Standing Committee on 
Health Coverage, Insurance and Financial Services pursuant to Public Law 2019, chapter 668, 
section 5.
Received by the Clerk of the House on March 24, 2021.  Referred to the Committee on 
Health Coverage, Insurance and Financial Services pursuant to Joint Rule 308.2 and ordered 
printed.
ROBERT B. HUNT
Clerk
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  24-A MRSA §4303-C, sub-§2, ¶D, as enacted by PL 2019, c. 668, §2, is 
amended to read:
D.  A Until December 31, 2023, unless the carrier and out-of-network provider agree 
otherwise, a carrier shall reimburse an out-of-network provider for ambulance services 
that are covered emergency services at the out-of-network provider's rate, unless the 
carrier and out-of-network provider agree otherwise. rate required by section 4303-F;
This paragraph is repealed October 1, 2021;
Sec. 2.  24-A MRSA §4303-C, sub-§2, ¶E, as enacted by PL 2019, c. 668, §2, is 
amended to read:
E.  If an out-of-network provider disagrees with a carrier's payment amount for a 
surprise bill for emergency services or for covered emergency services as determined 
in accordance with paragraph B or paragraph D, the carrier and the out-of-network 
provider have 30 calendar days to negotiate an agreement on the payment amount in 
good faith.  If the carrier and the out-of-network provider do not reach agreement on 
the payment amount within 30 calendar days, the out-of-network provider may submit 
a dispute regarding the payment and receive another payment from the carrier 
determined in accordance with the dispute resolution process in section 4303‑E, 
including any payment made pursuant to section 4303‑E, subsection 1, paragraph G; 
and
Sec. 3.  24-A MRSA §4303-F is enacted to read:
§4303-F.  Reimbursement for ambulance services and participation of ambulance 
service providers in carrier networks
1.  Reimbursement for ambulance services.  Until December 31, 2023, with respect 
to a bill for covered emergency services rendered by an ambulance service provider, a 
carrier shall reimburse the ambulance service provider or enrollee, as applicable, as 
follows.
A.  If the ambulance service provider participates in the carrier's network, the carrier 
shall reimburse at the ambulance service provider's rate or 200% of the Medicare rate 
for that service, whichever is greater, plus any adjustment required by paragraph C.
B.  If the ambulance service provider is an out-of-network provider, the carrier shall 
reimburse at the ambulance service provider's rate or 180% of the Medicare rate for 
that service, whichever is greater, plus any adjustment required by paragraph C.
C.  If the ambulance service provider is located in a rural or super rural area as 
designated by the federal Department of Health and Human Services, Centers for 
Medicare and Medicaid Services and eligible for additional Medicare reimbursement 
for services that were provided to a Medicare enrollee, the carrier shall increase the 
reimbursement to that ambulance service provider in the same amount as the additional 
Medicare reimbursement.
D.  If, on the effective date of this subsection, an ambulance service provider's charge 
for ambulance services is below 200% of the Medicare rate for that service, the 
ambulance service provider may not increase the charge for that service by more than 
5% annually.
This subsection is repealed December 31, 2023.
2.  Network participation; standard contract.  A carrier shall offer a standard 
contract to all ambulance service providers willing to participate in the carrier's provider 
network with the following provisions:
A.  The reimbursement rate paid for ambulance services conforms to the requirements 
of subsection 1. 
This paragraph is repealed December 31, 2023;
B.  The contract term is for a minimum of 24 months;
C.  The contract may be terminated as long as the party seeking to terminate the contract 
provides at least 180 days' prior notice; and
D.  The contract provides that an ambulance service provider has a minimum of 120 
days to submit a claim.
3.  Exemption.  This section does not apply to air ambulance services.
Sec. 4.  32 MRSA §86, sub-§1, as amended by PL 2015, c. 82, §5, is further 
amended to read:
1.  Ambulance services and nontransporting medical services to be licensed.  Every 
ambulance service and nontransporting emergency medical service must be licensed, 
operate in accordance with the rules adopted and protocols developed for services under 
this chapter and carry the equipment called for in those rules.  The board shall adopt rules 
and protocols to evaluate the need for any new ambulance service in this State before 
granting a license under this subsection, including rules that provide an appeal process for 
any decision made by the board. Rules adopted pursuant to this subsection are routine 
technical rules pursuant to Title 5, chapter 375, subchapter 2-A.
Sec. 5.  32 MRSA §88, sub-§2, ¶K is enacted to read:
K.  The board shall establish by rule a program for collecting and reporting cost and 
performance metrics related to emergency medical treatment services, including 
ambulance services.  Rules adopted pursuant to this paragraph are routine technical 
rules pursuant to Title 5, chapter 375, subchapter 2-A.
Sec. 6.  Review of financial health and costs of ambulance service providers 
and the delivery of services by ambulance service providers.  The Emergency 
Medical Services' Board shall convene a stakeholder group, including representatives of 
the Maine Ambulance Association, municipal and private ambulance services, health 
insurance carriers and the Department of Professional and Financial Regulation, Bureau of 
Insurance, to review issues related to financial health and costs of ambulance service 
providers and the delivery of services by ambulance service providers in this State, 
including issues related to the medical necessity and reasonableness of ambulance services.  
The stakeholder group shall consider and develop financial and cost reporting standards 
and other metrics related to the delivery and quality of ambulance services to measure and 
evaluate ambulance services in this State. The Emergency Medical Services' Board shall 
submit a report on the results of its review, including any recommendations, to the joint 
standing committee of the Legislature having jurisdiction over health coverage, insurance 
and financial services matters no later than February 1, 2023.  The joint standing committee 
may report out a bill based on the report to the First Regular Session of the 131st 
Legislature.
SUMMARY
This bill is reported out by the Joint Standing Committee on Health Coverage, 
Insurance and Financial Services pursuant to Public Law 2019, chapter 668, section 5.  The 
bill implements recommendations related to reimbursement rates and contracting for 
ambulance services made by a stakeholder group convened by the Emergency Medical 
Services' Board.
The bill does the following.
1.  It requires insurance carriers to reimburse ambulance service providers rendering 
covered emergency services based on a certain percentage of Medicare reimbursement 
rates.  The bill states that ambulance service providers participating in an insurance carrier's 
network will be reimbursed at the ambulance service provider's rate or 200% of the 
Medicare rate for that service, whichever is greater.  For out-of-network providers, the 
reimbursement rate is 180% of the Medicare rate.  The bill also permits carriers to add an 
adjustment to increase reimbursement for providers in rural areas.  The laws governing 
those requirements are repealed December 31, 2023.
2.  It requires insurance carriers to offer a standard contract to ambulance service 
providers with certain minimum requirements related to the length of the contract, the 
ability to terminate the contract and the time period in which ambulance service providers 
may submit claims for payment.
3.  It requires the Emergency Medical Services' Board to adopt rules and protocols to 
evaluate the need for any new ambulance service in this State before granting a license.
4.  It requires the Emergency Medical Services' Board to establish by rule a program 
for collecting and reporting cost and performance metrics related to emergency services, 
including ambulance services.
5.  It directs the Emergency Medical Services' Board to convene a stakeholder group 
to review issues related to financial health and costs of ambulance service providers and 
the delivery of services by ambulance service providers in this State.  The stakeholder 
group is required to report to the joint standing committee of the Legislature having 
jurisdiction over health coverage, insurance and financial services matters no later than 
February 1, 2023.
The Joint Standing Committee on Health Coverage, Insurance and Financial Services 
is reporting the bill out for the sole purpose of turning the recommendations into a printed 
bill that can be referred to the committee for an appropriate public hearing and subsequent 
processing in the normal course.  The committee is taking this action to ensure clarity and 
transparency in the legislative review of this bill.