MISSISSIPPI LEGISLATURE
2025 Regular Session
To: Public Health and Human Services; Insurance
By: Representative Carpenter
AN ACT TO AMEND SECTION 83-9-371, MISSISSIPPI CODE OF 1972, TO AUTHORIZE THE USE OF TELEMEDICINE WHEN TREATING OR ASSESSING AN ENROLLEE IN PLACE; TO AMEND SECTION 83-9-373, MISSISSIPPI CODE OF 1972, TO REVISE THE MINIMUM ALLOWABLE REIMBURSEMENT RATE FOR AN OUT-OF-NETWORK AMBULANCE SERVICE PROVIDER WHEN THE REIMBURSEMENT RATES HAVE NOT BEEN CONTRACTED FOR; TO REQUIRE THE DEPARTMENT OF INSURANCE TO PUBLISH THE CONTRACTED RATES; TO PROVIDE WHAT SHALL BE INCLUDED IN AN EXPLANATION OF BENEFITS DOCUMENT REGARDING THE AMBULANCE SERVICE PROVIDER'S CHARGES FOR CERTAIN PURPOSES; TO PROVIDE THAT AN AMBULANCE SERVICE PROVIDER SHALL BE PAID IN ACCORDANCE WITH THE ASSIGNMENT OF BENEFITS; TO REQUIRE THE COMMISSIONER OF INSURANCE TO ENFORCE; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 83-9-371, Mississippi Code of 1972, is amended as follows:
83-9-371. (1) This section shall be known and may be cited as the "Mississippi Triage, Treat and Transport to Alternative Destination Act."
(2) As used in this section, the following terms shall be defined as provided in this subsection:
(a) "911 call" means a communication made on behalf of an enrollee indicating that the enrollee may need emergency medical services;
(b) (i) "Alternative destination" means a lower-acuity facility that provides medical services, including, without
limitation:
1. A federally qualified health center;
2. An urgent care center;
3. A physician's office or medical clinic, as chosen by the patient; and
4. A behavioral or mental health care facility, including, without limitation, a crisis stabilization unit and a diversion center.
(ii) "Alternative destination" does not include a:
1. Critical access hospital;
2. Dialysis center;
3. Hospital;
4. Private residence; or
5. Skilled nursing facility.
(c) "Ambulance service provider" means a person or entity that provides ambulance transportation and emergency medical services to a patient for which a permit is required under Section 41-59-9;
(d) "Enrollee" means an individual who is covered by any health benefit plan; and
(e) "Health benefit plan" means any such policy as defined by Section 83-63-3.
(3) Coverage for ambulance
service to assess, triage and transport an enrollee to an alterative
destination or treat in place. On and after July 1, * * * 2025, any health benefit plan
shall provide coverage for:
(a) An ambulance service to:
(i) Treat or assess an enrollee in place, and such treatment or assessment may be made with the use of telemedicine as defined in Section 83-9-351; or
(ii) Triage or triage and transport an enrollee to an alterative destination; or
(b) An encounter between an ambulance service and enrollee that results without transport of the enrollee.
(4) The coverage required under this section:
(a) 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;
(b) Is subject to deductibles or co-payment requirements of the health benefit plan;
(c) 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 provider that is also providing care; and
(d) Is subject to any provisions of the health benefit plan that apply to other services covered by the health benefit plan.
(6) This section shall
apply to all contracts described in this section that are entered into or
renewed on or after July 1, * * * 2025.
SECTION 2. Section 83-9-373, Mississippi Code of 1972, is amended as follows:
83-9-373. (1) (a) The minimum allowable reimbursement rate under any policy of accident and sickness insurance as defined by Section 83-9-1 to an out-of-network ambulance service provider for all covered services shall be the rates contracted between an ambulance service provider and a county, municipality or special purpose district or authority, or otherwise approved or established by ordinance or regulation enacted by any such county, municipality or special purpose district or authority in which the covered healthcare services originated. The Department of Insurance shall publish such rates on its website within ten (10) days of the ambulance service provider and a county, municipality or special purpose district or authority executing a contract that establishes the rates, or within ten (10) days of the approval or establishment of an ordinance or regulation enacted by the county, municipality or special purpose district or authority that establishes the rates.
(b) In the absence of
rates provided in subsection (a), the minimum allowable reimbursement rate to
an out-of-network ambulance service provider shall be the * * * lesser of:
(i) * * *
Two hundred fifty percent (250%) of the reimbursement allowed by
Medicare for the respective services originating in the respective geographic
area; or
(ii) The ambulance service provider's billed charges; provided, however, that if the rates described in subparagraph (i) of this paragraph (b) are the lesser rates, whether or not the payor pays such lesser rates, the ambulance service provider's billed charges shall be included in the explanation of benefits documenting the allowed payment amount and shall be deemed to be the amount of payment allowed for each service for purposes of the emergency ambulance services provisions of Section 43-13-117.
(2) A payment made under this section shall be considered payment in full for the covered services provided, except for any copayment, coinsurance, deductible and other cost-sharing feature amounts required to be paid by the enrollee.
(3) For purposes of this section, the term "ambulance service provider" means a person or entity that provides ambulance transportation and emergency medical services to a patient for which a permit is required under Section 41-59-9.
(4) The ambulance service provider shall be paid in accordance with the assignment of benefits as provided in law, and the Commissioner of Insurance shall enforce the provisions of this section.
( * * *5) This section shall stand repealed
on June 30, 2028.
SECTION 3. This act shall take effect and be in force from and after its passage, and shall stand repealed one day before passage.