MaineProposed amendment sets ambulance payment rules for Maine health plans
A proposed replacement would require health insurers to reimburse covered emergency care given at the scene, including overdose-reversing medicine, for plans issued or renewed from 2027.
What it does
The proposed replacement describes covered emergency care at the scene as reimbursable, even if the patient is not taken to a facility. It includes overdose-reversing medicine and bars duplicate payment for one emergency request.
The proposed replacement sets insurer payments by comparing provider charges with a percentage of Medicare's rate. The printed figures are paired, so it is unclear which percentages would apply; eligible rural providers would get an added amount.
Insurers would not require prior approval for listed ground ambulance trips or urgent hospital trips by nonprofit air ambulance providers.
Argument forEmergency crews could be paid for care at the scene, including overdose-reversing medicine, even when they do not take the patient to a facility.
Argument againstIf ambulance and nontransporting crews answer the same emergency request, an insurer might not pay both, leaving one provider without reimbursement for its response.
More detail
The proposed replacement would require insurers to reimburse covered emergency care given at the scene, including overdose-reversing medicine. This applies to covered services from ambulance services and nontransporting emergency medical service providers, whether or not the patient is taken to another facility. Insurers would not have to reimburse twice when ambulance and nontransporting emergency crews respond to the same request. It would apply to health policies and contracts issued, continued, or renewed in Maine on or after January 1, 2027.
The proposed replacement sets insurer reimbursement using each provider's rate or a percentage of Medicare's rate, whichever is lower. This applies to covered ambulance and nontransporting emergency medical services, whether the provider is in or out of the insurer's network. The text shows paired percentages: 200% and 300% for in-network providers, and 180% and 280% for out-of-network providers. Missing amendment formatting makes it unclear which figures apply. Eligible rural and super rural providers would receive an added amount equal to the extra Medicare reimbursement for the service. It would apply to health policies and contracts issued, continued, or renewed in Maine on or after January 1, 2027.
The proposed replacement would bar insurers from requiring prior approval for specified ambulance transports. This applies to ground ambulance providers and nonprofit air ambulance providers. For ground ambulances, the trips are to a hospital, between hospitals, or from a hospital to a nursing home, hospice, or other defined health care facility. For air ambulances, the provider must be a nonprofit and the trip must be to or between hospitals for urgent care. It would apply to health policies and contracts issued, continued, or renewed in Maine on or after January 1, 2027.
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Where it stands
- Introduced
- Passed 1st Chamber
- Became Law
- Died
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Apr 29Died in Possession of the Senate when the Legislature adjourned Sine Die and was PLACED IN THE LEGISLATIVE FILES. (DEAD)Died
- Apr 6On motion by Senator ROTUNDO of Androscoggin PLACED ON THE SPECIAL APPROPRIATIONS TABLE pending PASSAGE TO BE ENACTED, in concurrence.
- Apr 6Sent for concurrence. ORDERED SENT FORTHWITH.
- Apr 6PASSED TO BE ENACTED.Became Law
- Apr 2In concurrence. ORDERED SENT FORTHWITH.
- Apr 2The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (S-595).Minor
- Apr 2Under suspension of the rules, the Bill was given its SECOND READING without REFERENCE to the Committee on Bills in the Second Reading.
- Apr 2Committee Amendment "A" (S-595) was READ and ADOPTED.Minor
- Apr 2The Bill was READ ONCE.Minor
- Apr 2On motion of Representative MATHIESON of Kittery, REPORT A Ought to Pass as Amended was ACCEPTED.
- Apr 2Reports READ.
- Apr 2Sent down for concurrence.
- Apr 2Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED by Committee Amendment "A" (S-595)Minor
- Apr 2Committee Amendment "A" (S-595) READ and ADOPTED.Minor
- Apr 2READ ONCE.Minor
- Apr 2On motion by Senator BAILEY of York the Report A Ought to Pass as Amended by Committee Amendment "A" (S-595) Report ACCEPTED.
- Apr 2Reports READ.
- Mar 27Reported Out - OTP-AM/ONTP/OTP-AM
- Jan 21Voted - Divided Report
- Jan 21Work Session Held
- Jan 14Work Session Held - TABLED
- 2025
- Jun 25CARRIED OVER, in the same posture, to any special or regular session of the 132nd Legislature, pursuant to Joint Order SP 800.
- May 19Carry Over Approved
- May 16Carry Over Requested
- May 15Work Session Held - TABLED
- May 8Work Session Held - TABLED
- Apr 8In concurrence. ORDERED SENT FORTHWITH.
- Apr 8The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.Minor
- Apr 8Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES suggested and ordered printed REFERENCE to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES Ordered sent down forthwith for concurrenceIntroduced
Healthcare