An Act to Require Reimbursement of Fees for Treatm:nJ Rendered by Public and Private Ambulance Services,,
Maine Legislature, Session 131, LD 1832
Committee Amendment CA_A_H826 (House)
Amends: 24-A MRSA §4303-C, 24-A MRSA §4303-F

COMMITTEE AMENDMENT" J'.l,, to H.P. 1164, L.D. 1832, "An Act to Require 
Reimbursement of Fees for Treatm:nJ Rendered by Public and Private Ambulance 
Services,, 
Amend the bill by striking out the title and substituting the following: 
'An Act to Continue the Study of Community Paramedicine and to Make Changes 
Related to Health Insurance Coverage and Prior Authorization Requirements for 
Certain Ambulance Service Providers' 
Amend the bill by striking out the emergency preamble, 
Amend the bill by striking out eve1ything after the enacting clause and inserting the 
following: 
'Sec. 1. 24-A MRSA §4303-C, sub-§2, ~' as amended by PL 2021, c. 222, §1, 
is further amended to read: 
B. Except as provided for ambulance services in paragraph I} D-1. unless the carrier 
and out-of-network provider agree otherwise, a carrier shall reimburse the out-of. 
network provider or enrollee, as applicable. for health care services rendered at the 
greater of: 
(1) The caJTier's median network rate paid for that health care service by a similar 
provider in the geographic area where the service was provided; and 
(2) The median network rate paid by all carriers for that health care service by a 
similar provider in the geographic area where the service was provided as 
determined by the all-payer claims database maintained by the Maine Health Data 
Organization or, if Maine Health Data Organization claims data is insufficient or 
otherwise inapplicable, another independent medical claims database specified by 
the superintendent; 
Sec. 2. 24-A MRSA §4303-C, sub-§2, ~-1 is enacted to read: 
COMMITTEE AMENDMENT 
~oe:, 
COMMITIEEAMENDMENT"A "to HJ'. 1164,L.D. 1832 
D-1. Unless the ca11·ier 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 rate applicable to the out-of-network provider pursuant to 
section 4303-F. 
Sec. 3, 24-A MRSA §4303-F, sub-§1, ~' as enacted by PL 2023, c. 468, §2, is 
amended to read: 
E. A carrier may not require oo a ground ambulance service provider to obtain prior 
authorization before transporting an enrollee to a hospital, between hospitals or from a 
hospital to a nursing home, hospice care facility or other health care facility, as defined 
in Title 22, section 328, subsection 8. A carrier may not require an air ambulance 
service provider to obtain prior authorization before transpo1ting an enrollee to a 
hospital or between hospitals for urgent care. 
Sec. 4. 24-A MRSA §4303-F, sub-§3, as enacted by PL 2021, c. 241, §3, is 
amended to read: 
3. Exemption, +his Except as provided in subsection I, paragraph E, this section does 
not apply to air ambulance services. 
Sec, 5. Authority to report out legislation. Based on recommendations from 
stakeholders after further study, the joint standing committee of the Legislature having 
jurisdiction over health coverage, insurance and financial services matters may report out 
legislation to the 132nd Legislature in 2025 related to reimbursement by health insurance 
carriers for health care services provided by community paramedicine personnel as 
described in the Maine Revised Statutes, Title 32, section 84, subsection 4.' 
Amend the bill by relettering or renumbering any nonconsecutive Patt letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill and changes the title. The amendment enacts a 
prnvision enacted by the !30th Legislature and repealed October I, 2021 that clarifies the 
reimbursement rate to be paid to out-of-network ambulance service providers for covered 
emergency services. The amendment prohibits a health insurance carrier from requiring 
an air ambulance service provider to obtain prior authorization before transp01ting an 
enrollee to a hospital or between hospitals for urgent care. The amendment also authorizes 
the joint standing committee of the Legislature having jurisdiction over health coverage, 
insurance and financial services matters to report out, after futther study, legislation to tlte 
132nd Legislature in 2025 related to reimbursement by health insurance carriers for health 
care services provided by community paramedicine persomtel. 
COMMITTEE AMENDMENT