The principles developed by the Texas Legislature’s committee substitute for SB 2476 serve as a model for the U.S. Congress to utilize as it considers the future of EMS out-of-network billing at the federal level.
Austin, Texas – April 16, 2023 – Guided by the leadership of Sen. Judith Zaffirini, the Texas EMS Alliance (TEMSA) and Texas Association of Health Plans (TAHP) joined together to create a legislative solution that seeks to remove patients from the middle of out-of-network payment disputes while reimbursing Texas EMS agencies in an adequate manner to ensure that they can provide 911 service and facility-to-facility medical transports in Texas communities.
Under the principles developed by the stakeholders, the committee substitute for SB 2476 would prohibit the balance billing of patients for out-of-network services by ground EMS. Health plans would be directed to reimburse out-of-network ground EMS agencies at the rates set by local governmental entities. For communities that lack rates set by the local governmental entity, health plans would be directed to reimburse ground EMS agencies at 325 percent of Medicare. Sen. Zaffirini outlined these principles in the Senate committee hearing on April 12, 2023.
TEMSA President Brent Smith, chief executive officer of Hopkins County Hospital District, was invited by Sen. Zaffirini to testify on the bill at the hearing.
“I want to thank Senator Zaffirini and her staff, along with the Texas Association of Health Plans, for coming together to protect patients and Texas’s fragile EMS safety net,” Smith said. “The committee substitute language that we have been working on collaboratively ensures that local governments – which often help fund EMS operations – retain oversight and accountability. It has safeguards to contain health care spending, and it shields patients who are transported by ambulance from unexpected costs.”
About the Texas EMS Alliance
The Texas EMS Alliance was founded in 2014 to serve as the unified voice of Texas EMS agencies. Over 85 Texas EMS agencies representing both rural and urban 911 providers are TEMSA members.