Illinois Legislative Victory: Ground Ambulance Coverage Legislation Awaits Governor's Signature
In a landmark move for healthcare in Illinois, a critical piece of legislation concerning ground ambulance coverage has cleared both the House and Senate unanimously and is now awaiting the signature of Governor J.B. Pritzker. This bill is seen not only as a win for patients but also for first responders who have long struggled with reimbursement issues from insurance companies.
The proposed law, known as House Bill 2785, aims to shield patients from the undue financial burden of unexpectedly high ambulance service costs when insurance doesn't cover them fully.
The bill's main provisions include:
1. Coverage for Emergency Services: Insurers are required to provide coverage for all urgent and emergency ground ambulance services that are ordered within a 12-hour window.
2. Cost Limitation for Patients: Patient costs are capped at the lower of an Emergency Room visit copayment or 10% of the recognized amount for the services provided, thus minimizing out-of-pocket expenses.
3. Prohibition on Balance Billing: The legislation bans balance billing for ground ambulance services when providers accept a designated fair payment amount, preventing patients from receiving surprise bills.
4. Fair Payment Mandate: Insurers must reimburse ambulance service providers by offering the lesser of negotiated rates, 85% of billed charges, or the average gross charge from the previous year.
5. Support for First Responders: The bill aims to help first responders, municipalities, and fire protection districts secure fair training reimbursement for 911 transports from commercial insurance plans, refreshing much-needed resources for life-saving operations without placing an additional burden on taxpayers.
According to Kim Godden, President of the Illinois State Ambulance Association's Board of Directors, this legislation provides vital consumer protections following federal recommendations. It alleviates the anxiety faced by patients who, during vulnerable moments, should not be stressed about costs when seeking emergency medical help. Godden states, "By ensuring adequate reimbursement for ambulance services, we are securing a sustainable framework that maintains operational integrity and supports our first responders."
Andrew Thornton, Treasurer of the Illinois State Ambulance Association, emphasized the significance of this legislation, especially in rural areas where ground ambulance services serve as a primary health care resource. He highlighted that no patient should face billing concerns or make unnecessary cost-based decisions while confronting emergencies.
Senator Ram Villivalam (D-Chicago), who sponsored the bill, expressed pride in the legislation's potential to prevent unexpected bills for insured residents needing immediate care. He stated, "When someone calls an ambulance, their priority should be receiving help, not worrying about how to cover the costs. This bill will eliminate the worry that comes with seeking assistance during critical times." Rep. Marty Moylan (D-Des Plaines), who also supported the bill, recognized the urgent need for fair reimbursement scenarios for EMS and stated this law would provide essential support to municipalities and responders, ensuring they receive the necessary compensation without penalizing patients.
This legislation aligns with federal initiatives set by the No Surprises Act, which addresses balance billing in other emergency care settings but previously left ground ambulance services unprotected. The recent action by Illinois lawmakers is a proactive approach, encouraged at the federal level, that aims to create an equitable landscape for ambulance providers and patients alike.
As this bill heads to Governor Pritzker's desk, its passage could markedly alter the patient experience in Illinois, granting peace of mind in the critical moments when swift actions may not only save lives but also now protect patients from financial strain. Once signed into law, the effective date is set for January 1, 2027, allowing time for the involved parties to prepare for its implementation, ensuring a smoother transition toward improved ambulance services coverage across the board.
The proposed law, known as House Bill 2785, aims to shield patients from the undue financial burden of unexpectedly high ambulance service costs when insurance doesn't cover them fully.
Key Provisions of the Legislation
The bill's main provisions include:
1. Coverage for Emergency Services: Insurers are required to provide coverage for all urgent and emergency ground ambulance services that are ordered within a 12-hour window.
2. Cost Limitation for Patients: Patient costs are capped at the lower of an Emergency Room visit copayment or 10% of the recognized amount for the services provided, thus minimizing out-of-pocket expenses.
3. Prohibition on Balance Billing: The legislation bans balance billing for ground ambulance services when providers accept a designated fair payment amount, preventing patients from receiving surprise bills.
4. Fair Payment Mandate: Insurers must reimburse ambulance service providers by offering the lesser of negotiated rates, 85% of billed charges, or the average gross charge from the previous year.
5. Support for First Responders: The bill aims to help first responders, municipalities, and fire protection districts secure fair training reimbursement for 911 transports from commercial insurance plans, refreshing much-needed resources for life-saving operations without placing an additional burden on taxpayers.
Importance of this Legislation
According to Kim Godden, President of the Illinois State Ambulance Association's Board of Directors, this legislation provides vital consumer protections following federal recommendations. It alleviates the anxiety faced by patients who, during vulnerable moments, should not be stressed about costs when seeking emergency medical help. Godden states, "By ensuring adequate reimbursement for ambulance services, we are securing a sustainable framework that maintains operational integrity and supports our first responders."
Andrew Thornton, Treasurer of the Illinois State Ambulance Association, emphasized the significance of this legislation, especially in rural areas where ground ambulance services serve as a primary health care resource. He highlighted that no patient should face billing concerns or make unnecessary cost-based decisions while confronting emergencies.
Legislative Support
Senator Ram Villivalam (D-Chicago), who sponsored the bill, expressed pride in the legislation's potential to prevent unexpected bills for insured residents needing immediate care. He stated, "When someone calls an ambulance, their priority should be receiving help, not worrying about how to cover the costs. This bill will eliminate the worry that comes with seeking assistance during critical times." Rep. Marty Moylan (D-Des Plaines), who also supported the bill, recognized the urgent need for fair reimbursement scenarios for EMS and stated this law would provide essential support to municipalities and responders, ensuring they receive the necessary compensation without penalizing patients.
The Path Ahead
This legislation aligns with federal initiatives set by the No Surprises Act, which addresses balance billing in other emergency care settings but previously left ground ambulance services unprotected. The recent action by Illinois lawmakers is a proactive approach, encouraged at the federal level, that aims to create an equitable landscape for ambulance providers and patients alike.
As this bill heads to Governor Pritzker's desk, its passage could markedly alter the patient experience in Illinois, granting peace of mind in the critical moments when swift actions may not only save lives but also now protect patients from financial strain. Once signed into law, the effective date is set for January 1, 2027, allowing time for the involved parties to prepare for its implementation, ensuring a smoother transition toward improved ambulance services coverage across the board.
Topics Policy & Public Interest）
【About Using Articles】
You can freely use the title and article content by linking to the page where the article is posted.
※ Images cannot be used.
【About Links】
Links are free to use.