An Act to Implement the Recommendations of the Stakeholder Group Convened by the Emergency Medical Services' Board on Financial Health of Ambulance Services
Maine Legislature, Session 131, LD 1602
Committee: Health Coverage, Insurance and Financial Services
Amends: 22 MRSA §8712, 24-A MRSA §4303-F, 32 MRSA §88

Legislative Document
No. 1602
S.P. 634
In Senate, April 11, 2023
An Act to Implement the Recommendations of the Stakeholder 
Group Convened by the Emergency Medical Services' Board on 
Financial Health of Ambulance Services
Reported by Senator BAILEY of York for the Joint Standing Committee on Health 
Coverage, Insurance and Financial Services pursuant to Joint Order 2023, S.P. 594.
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed pursuant to Joint Rule 218.
DAREK M. GRANT
Secretary of the Senate
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §8712, sub-§2, as amended by PL 2021, c. 423, Pt. A, §6, is 
further amended to read:
2.  Payments.  The organization shall create a publicly accessible interactive website 
that presents reports related to payments for services rendered by health care facilities and 
practitioners to residents of the State.  The services presented must include, but not be 
limited to, imaging, preventative health, radiology, surgical services, ambulance services, 
comparable health care services as defined in Title 24‑A, section 4318‑A, subsection 1, 
paragraph A and other services that are predominantly elective and may be provided to a 
large number of patients who do not have health insurance or are underinsured.  The 
website must also be constructed to display prices paid by individual commercial health 
insurance companies, 3rd-party administrators and, unless prohibited by federal law, 
governmental payors.  Beginning October 1, 2012, price information posted on the website 
must be posted semiannually and beginning October 1, 2022 must be posted annually, must 
display the date of posting and, when posted, must be current to within 12 months of the 
date of submission of the information.  Payment reports and price information posted on 
the website must include data submitted by payors with regard to all health care facilities 
and practitioners that provide comparable health care services as defined in Title 24‑A, 
section 4318‑A, subsection 1, paragraph A or services for which the organization reports 
data pertaining to the statewide average price pursuant to this subsection or Title 24‑A, 
section 4318‑B.  Upon notice made by a health care facility or practitioner that data posted 
by the organization pertaining to that facility or practitioner is inaccurate or incomplete, 
the organization shall remedy the inaccurate or incomplete data within the earlier of 30 
days of receipt of the notice and the next posting date.
Sec. 2.  24-A MRSA §4303-F, as enacted by PL 2021, c. 241, §3, is amended 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  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 less, 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 less, 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.
E.  A carrier may not require an ambulance service provider to obtain prior 
authorization before transporting an enrollee to a hospital, between hospitals or from a 
hospital to a nursing home or other health care facility.
This subsection is repealed December 31, 2023.
1-A.  Reimbursement for nontransport services.  When an ambulance services 
provider responds to a call for emergency services and an enrollee refuses transport to a 
hospital, a carrier shall reimburse that ambulance services provider for any services other 
than transport provided to an enrollee.  The reimbursement paid by a carrier must meet the 
requirements of subsection 1.
1-B.  Reimbursement for community paramedicine services.  A carrier shall 
reimburse an ambulance services provider for covered services delivered through 
community paramedicine in accordance with Title 32, section 84, subsection 4. The 
reimbursement paid by a carrier must meet the requirements of subsection 1. A carrier may 
require an ambulance service provider to obtain prior authorization before providing 
services delivered through community paramedicine.
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.
4.  Medical necessity.  A carrier shall consider the requirements of the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
related to medical necessity of ambulance services when establishing the carrier’s own 
policies and guidelines related to the medical necessity and reasonableness of covered 
services provided by ambulance service providers.
Sec. 3.  32 MRSA §88, sub-§2, ¶L, as enacted by PL 2021, c. 241, §5 and 
reallocated by RR 2021, c. 2, Pt. A, §113, is amended to read:
L.  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.  The cost and performance metrics for ambulance services adopted 
in rule must include, at a minimum, data on the volume of services provided per capita 
and per square mile of geographic area, the type of entity, the payer mix, the impact on 
length of stay in a health care facility due to lack of available ambulance transport, 
demographics on personnel and level of licensure, the number of vacancies and the 
number of volunteer hours dedicated to emergency medical services.  Rules adopted 
pursuant to this paragraph are routine technical rules pursuant to Title 5, chapter 375, 
subchapter 2‑A.
Sec. 4.  Appropriations and allocations.  The following appropriations and 
allocations are made.
PUBLIC SAFETY, DEPARTMENT OF
Emergency Medical Services 0485
Initiative: Provides appropriations for 2 Management Analyst I positions and related costs 
to collect and report cost and performance information related to emergency services.
GENERAL FUND
2023-24
2024-25
POSITIONS - LEGISLATIVE COUNT
2.000
2.000
Personal Services
$164,000
$169,248
All Other
$5,000
$5,000
__________
__________
GENERAL FUND TOTAL
$169,000
$174,248
SUMMARY
This bill proposes statutory changes based on recommendations included in the report 
made to the Joint Standing Committee on Health Coverage, Insurance and Financial 
Services by a stakeholder group convened by the Emergency Medical Services' Board on 
financial health of ambulance services.  The committee has not taken a position on the 
substance of this bill.  By reporting this bill out, the committee is not suggesting and does 
not intend to suggest that it agrees or disagrees with any aspect of this bill.  The committee 
is reporting out the bill for the sole purpose of having a bill printed 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 the proposals contained in the bill.
The bill makes the following changes. 
1.  It removes the repeal date related to the rate of reimbursement health insurance 
carriers are required to pay for covered emergency services provided by an ambulance 
service provider. 
2.  It removes the limitation that carriers are only required to reimburse for covered 
emergency services provided by an ambulance services provider. 
3.  It requires health insurance carriers to reimburse ambulance service providers for 
nontransporting services at the same reimbursement rates for covered emergency services.
4.  It prohibits health insurance carriers from requiring an ambulance services provider 
to obtain prior authorization before transporting an enrollee to a hospital, between hospitals 
or from a hospital to a nursing home or other health care facility and requires carriers to 
reimburse for those services. 
5.  It requires health insurance carriers to consider the requirements of the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
related to medical necessity when establishing the carrier’s own policies for medical 
necessity. 
6.  It requires carriers to reimburse ambulance services providers for covered services 
rendered through community paramedicine in accordance with the Maine Revised Statutes, 
Title 32, section 84, subsection 4. 
The bill also specifies the cost and performance metrics for the program for collecting 
and reporting cost and performance metrics related to emergency services that must be 
established by the Emergency Medical Services’ Board in rule and proposes to add 2 
positions to the Emergency Medical Services’ Board to facilitate that program. Finally, the 
bill proposes to require the Maine Health Data Organization to report information on 
payments for ambulance services on its publicly accessible website.