SPONSOR:

Rep. Carson & Rep. M. Smith & Sen. Ennis & Sen. Hall-Long

 

Reps. Q. Johnson, Spiegelman, Walker

 

HOUSE OF REPRESENTATIVES

147th GENERAL ASSEMBLY

 

HOUSE BILL NO. 149

 

 

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO PAYMENT FOR EMERGENCY MEDICAL SERVICES.

 


BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

 


Section 1. Amend Chapter 33, Title 18 of the Delaware Code by inserting a new Section 3367 as shown by underlining as follows:

3367. Payment for Emergency Medical Services.

(a) As used in this section:

(i) "Volunteer fire company" shall mean the duly organized volunteer fire companies in the State of Delaware.

(ii) "Emergency medical services provider agency" shall have the same definition set forth in 9802 of Title 16.

(iii) "Basic life support" shall have the same definition set forth in 9702 of Title 16.

(iv) "Ambulance" shall have the same definition set forth in 9702 of Title 16.

(b) No individual health insurance policy, contract, certificate or plan, delivered or issued for delivery in this State by any insurer, health service corporation, or health maintenance organization, shall contain any provision that prohibits or precludes assignment by or on behalf of a covered person to any volunteer fire company or other emergency medical services provider agency certified by the Delaware State Fire Prevention Commission, of the right to receive payment or reimbursement for covered emergency medical services, including but not limited to basic life support, ambulance service, oxygen and supplies.

(c) When a volunteer fire company or other emergency medical services provider agency certified by the Delaware State Fire Prevention Commission renders covered emergency medical services, including but not limited to basic life support and ambulance service, any payment or reimbursement made by an insurer, health service corporation or health maintenance organization for such covered emergency medical services shall be paid directly to the volunteer fire company or other certified emergency medical services provider agency, or their designee, without regard to whether a contract exists between the volunteer fire company or certified emergency medical services provider agency and the insurer, health service corporation or health maintenance organization, and otherwise without regard to whether the volunteer fire company or emergency medical services provider agency is a part of any network maintained by the insurer, health service corporation or health maintenance organization.

(d) The limitations on balance billing provided in 3348 of this title shall not apply to billing for emergency medical services within the scope of this Section provided by volunteer fire companies or emergency medical services provider agencies certified by the Delaware State Fire Prevention Commission.

(e) This section shall apply to all policies, contracts, certificates or plans issued, renewed, modified, altered, amended or reissued on or after July 1, 2013.

Section 2. Amend Chapter 35, Title 18 of the Delaware Code by adding thereto a new Section 3571H as shown by underlining as follows:

3571H. Payment for Emergency Medical Services.

(a) As used in this section:

(i) "Volunteer fire company" shall mean the duly organized volunteer fire companies in the State of Delaware.

(ii) "Emergency medical services provider agency" shall have the same definition set forth in 9802 of Title 16.

(iii) "Basic life support" shall have the same definition set forth in 9702 of Title 16.

(iv) "Ambulance" shall have the same definition set forth in 9702 of Title 16.

(b) No group or blanket health insurance policy, contract, certificate or plan, delivered or issued for delivery in this State by any insurer, health service corporation, or health maintenance organization, shall contain any provision that prohibits or precludes assignment by or on behalf of a covered person to any volunteer fire company or other emergency medical services provider agency certified by the Delaware State Fire Prevention Commission, of the right to receive payment or reimbursement for covered emergency medical services, including but not limited to basic life support, ambulance service, oxygen and supplies.

(c) When a volunteer fire company or other emergency medical services provider agency certified by the Delaware State Fire Prevention Commission renders covered emergency medical services, including but not limited to basic life support and ambulance service, any payment or reimbursement made by an insurer, health service corporation or health maintenance organization for such covered emergency medical services shall be paid directly to the volunteer fire company or other certified emergency medical services provider agency, or their designee, without regard to whether a contract exists between the volunteer fire company or certified emergency medical services provider agency and the insurer, health service corporation or health maintenance organization, and otherwise without regard to whether the volunteer fire company or emergency medical services provider agency is a part of any network maintained by the insurer, health service corporation or health maintenance organization.

(d) The limitations on balance billing provided in 3348 of this title shall not apply to billing for emergency medical services within the scope of this Section provided by volunteer fire companies or emergency medical services provider agencies certified by the Delaware State Fire Prevention Commission.

(e) This section shall apply to all policies, contracts, certificates or plans issued, renewed, modified, altered, amended or reissued on or after July 1, 2013.


SYNOPSIS

Currently, some health insurers refuse to pay Delaware Volunteer Fire Companies and other emergency medical service ("EMS") providers directly for ambulance service and related supplies unless the Fire Company (or other EMS provider) has agreed to accept contract reimbursement rates that can be below the costs actually incurred by the Fire Companies and EMS providers in providing the service. This Act would prohibit insurers from refusing to pay the Fire Companies and other EMS providers directly, for covered ambulance and other emergency medical services, and would require direct payment of the provider regardless of whether the Fire Company or other EMS provider is under contract with the insurer, or otherwise in the insurer's network. This requirement would apply only in the case of volunteer fire companies and other EMS providers that have been certified as EMS provider agencies by the State Fire Prevention Commission. This Act also clarifies that the restriction on "balance billing" contained at 3348 of Title 18 (relating to referrals out of network) does not apply to certified volunteer fire companies and EMS service providers.