An Act to Implement the Recommendations of the Stakeholder Group Convened by the Emergency Medical Services' Board on Fmanc1al Health of Ambulance Services
Maine Legislature, Session 131, LD 1602
Committee Amendment CA_A_S338 (Senate)
Amends: 24-A MRSA §4303-F

COMMITTEE AMENDMENT " rl " to S P 634, L D 1602, "An Act to Implement 
the Recommendations of the Stakeholder Group Convened by the Emergency Medical 
Services' Board on Fmanc1al Health of Ambulance Services" 
Amend the bill by stnkmg out all of section 2 and msertmg the followmg 
'Sec. 2. 24-A MRSA §4303-F, as enacted by PL 2021, c 241, §3, 1s amended to 
read 
§4303-F Reimbursement for ambulance services and part1C1pation of ambulance 
service providers m carrier networks 
1. Reimbursement for ambulance services. Ua-tll Deeemher 31, 2023, with With 
respect to a bill for covered emergene:y services rendered by an ambulance service provider, 
a earner shall rermburse the ambulance service provider or enrollee, as applicable, as 
follows 
A If the ambulance service provider part1c1pates m the earner's network, the earner 
shall rermburse at the ambulance service provider's rate or 200% of the Medicare rate 
for that service, whichever 1s less, plus any adjustment requ1red by paragraph C 
B If the ambulance service provider 1s an out-of-network provider, the earner shall 
reimburse at the ambulance service provider's rate or 180% of the Medicare rate for 
that service, whichever 1s less, plus any adjustment requ1red by paragraph C 
C 
If the ambulance service provider 1s located m a rural or super rural area as 
designated by the federal Department of Health and Human Services, Centers for 
Medicare and Med1ca1d Services and ehg1ble for additional Medicare rermbursement 
for services that were provided to a Medicare enrollee, the earner shall mcrease the 
rermbursement to that ambulance service provider m the same amount as the add1t10nal 
Medicare reimbursement 
D If, on the effective date ofth1s subsection, an ambulance service provider's charge 
for ambulance services 1s below 200% of the Medicare rate for that service, the 
COMMITTEE AMENDMENT 
COMMITIEEAMENDMENT"A "to SP 634,LD 1602 {5·3?J5) 
ambulance service provider may not mcrease the charge for that service by more than 
5% annually 
E 
A earner may not requrre an ambulance service provider to obtam pnor 
authorization before transportmg an enrollee to a hospital, between hospitals or from a 
hospital to a nursmg home, hospice care fac1hty or other health care fac1hty, as defmed 
m Title 22, sect10n 328, subsect10n 8 
Thrn s:a-eseet10a is repealed Deeember .J 1, 2023 
N otw1thstandmg this subsect10n, a earner 1s not regurred to re1mburse an ambulance service 
provider at the re1mbursement rates regurred m this subsection for covered services 
delivered through commumty paramed1cme m accordance with Title 32, sect10n 84, 
subsection 4 and a earner may regurre an ambulance service provider to obtam pnor 
authonzat10n before prov1dmg services through commumty paramed1cme 
1-A. Reimbursement for nontransport services With respect to a health plan with 
an effective date on or after January 1, 2024, when an ambulance service provider responds 
to a call for emergency services and an enrollee refuses transport to a hospital, a earner 
shall re1mburse that ambulance service provider for any services other than transport 
provided to the enrollee as follows 
A If the ambulance service provider part1c10ates m the earner's network, the earner 
shall re1mburse the ambulance service provider at the ambulance service provider's rate 
or 200% of the average of the Medicare rate for basic hfe support services and the 
Medicare rate for advanced hfe support services, whichever 1s less, plus any admstment 
requrred by paragraph C 
B If the ambulance service provider 1s an out-of-network provider, the earner shall 
reimburse the ambulance service provider at the ambulance service provider's rate or 
180% of the average of the Medicare rate for basic hfe support services and the 
Medicare rate for advanced hfe support services, whichever 1s less, plus any admstment 
regurred by paragraph C 
C 
If the ambulance service provider 1s located m a rural or super rural area as 
designated by the federal Department of Health and Human Services, Centers for 
Medicare and Med1ca1d Services and ehg1ble for add1t1onal Medicare re1mbursement 
for services that were provided to a Medicare enrollee, the earner shall mcrease the 
re1mbursement to that ambulance service provider m the same amount as the additional 
Medicare re1mbursement 
D If, on the effective date of this subsection, an ambulance service provider's rate for 
ambulance services 1s below 200% of the average of the Medicare rate for basic hfe 
sugport and advanced hfe suggort services, the ambulance service provider may not 
mcrease the rate for that service by more than 5% annually 
2. Network part1c1pation, standard contract. A earner shall offer a standard 
contract to all ambulance service providers w1llmg to part1c1pate m the earner's provider 
network with the followmg prov1s1ons 
A The re1mbursement rate paid for ambulance services conforms to the requrrements 
of subsection 1-~ 
This paragraph is repealed Deeember .J 1, 2Q2.J, 
COMMITTEE AMENDMENT 
~o<o 
COMMITTEE AMENDMENT" It" to s p 634, L D 1602 { S · 33f) 
B The contract term 1s for a mlillmum of 24 months, 
C The contract may be tennmated as long as the party seekmg to tennmate the contract 
provides at least 180 days' pnor notice, and 
D The contract provides that an ambulance service provider has a mmimum of 120 
days to submit a claim 
3. Exemption. This sect10n does not apply to arr ambulance services 
Medical necessity. A earner shall consider the regurrements of the federal 
Department of Health and Human Services, Centers for Medicare and Med1ca1d Services 
related to medical necessity of ambulance services when estabhshmg the earner's own 
pohc1es and gmdelmes related to the medical necessity and reasonableness of covered 
services provided by ambulance service providers ' 
Amend the bill by relettermg or renumbermg any nonconsecutive Part letter or section 
number to read consecutively 
SUMMARY 
This amendment specifies the rate at which camers are requrred to reimburse 
ambulance service providers for nontransport services The amendment removes the 
provis10n m the bill requmng earners to reimburse ambulance service providers for 
covered services delivered through commumty paramedicme m accordance with the Mame 
Revised Statutes, Title 32, sect10n 84, subsect10n 4 and provides that, 1f a camer provides 
coverage for commumty paramed1cme, the earner 1s not reqmred to reimburse an 
ambulance service provider at the reimbursement rates requrred m the bill The amendment 
also adds a cross-reference to a defm1t10n of "health care fac1hty" as 1t relates to pnor 
authonzation for transport service of an ambulance service provider 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved 06/12/23 feae.. 
LD 1602 
LR2467(02) 
An Act to Implement the Recommendations of the Stakeholder Group Convened by the Emergency 
Medical SerVIces' Board on Fmancial Health of Ambulance SerVIces 
Fiscal Note for Bill as Amended by Committee Amendment 'lf' ( 5 . 33t) 
Comnnttee: Health Coverage, Insurance and Fmancial Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
J FY 2023-24 
FY 2024-25 
$169,000 
$174,248 
$169,000 
$174,248 
ProJ ections 
FY 2025-26 
$179,663 
$179,663 
Pro1ections 
FY 2026-27 
$185,253 
The bill mcludes General Fund appropnat10ns of $169,000 m fiscal year 2023-24 and $174,248 m fiscal year 2024-25 
to the Department of Pubhc Safety for 2 Management Analyst I pos1t10ns and related costs to collect and report cost 
and perfonnance mfonnatlon related to emergency services 
Additional costs to the Mame Health Data Orgamzatlon to mclude data on ambulance services m reports related to 
payments for services rendered by health care fac1ht1es and pract1t1oners are expected to be mmor and can be absorbed 
w1thm ex1stmg budgeted resources 
LR2467(02) - F1~cal Note - P:::iP-e- 1 of 1