§ 23-79-2703 — Coverage for ambulance service to triage and transport enrollee to alternative destination or treat in place

(a) On and after January 1, 2024, a healthcare insurer that offers, issues, or renews a health benefit plan in this state shall provide coverage for: (1) An ambulance service to: (A) Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or (B) Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or (2) An encounter between an ambulance service and enrollee that results in no transport of the enrollee if: (A) The enrollee declines to be transported against medical advice; and (B) The ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint. (b) The coverage under this section: (1) Only includes ambulance service transportation to the treatment location; (2) Is subject to the initiation of ambulance service treatment as a result of a 911 call that is documented in the records of the ambulance service; (3) Is subject to health benefit plan deductibles or copayment requirements; (4) Does not diminish or limit benefits otherwise allowable under a health benefit plan, even if the billing claims for medical or behavioral health services overlap in time that is billed by the ambulance service also providing care; and (5) Is subject to any health benefit plan provisions that apply to other services covered by the health benefit plan. (c) The reimbursement rate for an ambulance service whose operators triage, treat, and transport an enrollee to an alternative destination, or triage, treat, and do not transport an enrollee if the enrollee declines to be transported against medical advice, if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint under this section shall be at least at the rate: (1) Contracted with a local government entity where the alternative destination is located; or (2) Established by the Workers' Compensation Commission under its schedule for emergency Advanced Life Support Level 1.

Legislative History

Added by Act 2023, No. 480,§ 2, eff. 8/1/2023.