AUSTIN — The Texas EMS Alliance and Texas Ambulance Association endorsed key recommendations in an extensive report that the federal advisory committee on Ground Ambulance and Patient Billing (GAPB) delivered to Congress on September 4, 2024.

The federal government’s No Surprises Act, which took effect in 2022, required the Secretaries of Health and Human Services, Labor and the Treasury to create the GAPB advisory committee. Ground ambulance leaders, consumer protection advocates, state regulators, insurance executives and other stakeholders selected to serve on the committee were charged with providing policy recommendations to protect patients from balance billing and improve transparency regarding insurance coverage and ambulance charges. 

Many of the recommendations align with protections already afforded to Texans with state-regulated commercial health plans. SB 2476 by Senator Judith Zaffirini, which was passed by the Texas Legislature in 2023 and took effect January 1, 2024, prohibits ground ambulance agencies from balance billing and requires insurance companies to pay fair, locally set rates after their beneficiaries receive service. The law, which promotes rate transparency and was modeled by Oklahoma, Washington, and other states over the past two years, is set to expire on September 1, 2025.

“We are grateful to Senator Zaffirini for her pioneering leadership and to the Texas Association of Health Plans for their collaborative work on SB 2476,” said Butch Oberhoff, President of the Texas EMS Alliance.  “This landmark measure secured important protections for Texans with state-regulated plans and ensures fair reimbursement for the ambulance agencies that serve as a critical part of our state’s health care safety net,”

“The federal advisory committee’s recommendations acknowledge – just like SB 2476 does – that ground ambulance service is funded, designed and directed at the local government level. We urge the 2025 Texas Legislature to extend SB 2476 protections beyond the September 2025 sunset, and we compel Congress to follow Texas’ lead by protecting patients who have federally regulated insurance,” said Texas Ambulance Association President Brett Coghlan. 

A few of the recommendations from the GAPB report that were supported by all or a majority of committee members included:

• Ground ambulance patients demand a unique solution and should not be rolled into the existing No Surprises Act framework.
• Balance billing for out-of-network ground ambulance services should be prohibited.
• There should be minimum required payments for out-of-network ground ambulance service based on amounts specified in state balance billing laws or locally set rates.
• More transparency is needed regarding rates charged by ground ambulance providers.  
• Insurance companies should pay ambulance providers promptly and directly for services. In some states, insurers send a check to patients, which is an inefficient, confusing system.

The advisory committee’s full report, Report on Prevention of Out-of-Network Ground Ambulance Emergency Service Balance Billing, can be found on the committee’s website: https://www.cms.gov/medicare/regulations-guidance/advisory-committees/advisory-committee-ground-ambulance-and-patient-billing-gapb.

Click here to learn more about out-of-network billing under Texas law for ground ambulance.

###

The Texas EMS Alliance was founded in 2014 to serve as the unified voice of Texas EMS agencies. Over 85 public, fire-based, private, non-profit and hospital-based Texas EMS agencies providing 9-1-1 service to rural and urban Texas communities represent TEMSA. Learn more at txemsa.com.

Founded in 1981, the Texas Ambulance Association pioneered the development of modern EMS in Texas. The contributions of its dedicated and diverse membership continue to contribute to this mission. Learn more at txamb.com.