Health plans would pay a set rate for emergency ambulance care

State rules or protocols would identify facilities that can receive ambulance patients. The rules cover facilities that receive patients transported by ambulance. The authorized facility types would include facilities for patients during suspected behavioral health or substance use crises.

Responders would have a procedure to contact local crisis teams for help before transport. Emergency medical responders could contact a local co-responder program, mobile crisis team, or medical mobile crisis team. The procedure applies during suspected behavioral health or substance use disorder patient contacts and is for crisis deescalation, assessment, and referral.

Medical assistance coverage for ambulance services would be limited to medically necessary treatment and, when needed, transport to specified destinations. This provision concerns eligible medical assistance recipients. When needed, transport may be to the recipient's home, the nearest facility, a nonhospital drug and alcohol detoxification or rehabilitation facility, or a receiving facility.

Specified health plans would pay the emergency services payment amount for EMS treatment and, when needed, transport to a receiving facility. This applies to insurers, medical assistance managed care plans, and Children's Health Insurance Program managed care plans. The EMS agency must provide treatment in response to an actual or reported emergency. Any needed transport must be to a receiving facility. Patient copayments, coinsurance, or deductibles may apply.