HOUSE DOCKET, NO. FILED ON: 7/11/2013
HOUSE . . . . . . . . . . . . . . . No. 3557
The Commonwealth of Massachusetts
In the Year Two Thousand Thirteen
An Act relative to reimbursement for ambulance services.
Whereas, The deferred operation of this act would tend to defeat its purpose, which is to establish forthwith reimbursement for ambulance services, therefore, it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter 176D of the General Laws is hereby amended by inserting after section 3B the following section:-
Section 3C. (a) As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:-
“Ambulance service provider”, a person or entity licensed by the department of public health pursuant to section 6 of chapter 111C to establish or maintain an ambulance service.
“Emergency ambulance services”, emergency services that an ambulance service provider is authorized to render pursuant to its ambulance service license when a condition or situation in which an individual has a need for immediate medical attention, or where the potential for such need is perceived by the individual, a bystander or an emergency medical services provider.
“Insurance policy” and “insurance contract”, a contract of insurance, motor vehicle insurance, indemnity, medical or hospital service, dental or optometric, suretyship or annuity issued, proposed for issuance or intended for issuance by any insurer.
“Insured”, an individual entitled to ambulance services benefits pursuant to an insurance policy or insurance contract.
“Insurer”, a person, as defined in section 1 of chapter 176D; any health maintenance organization, as defined in section 1 of chapter 176G; a non-profit hospital service corporation organized pursuant to chapter 176A; any organization, as defined in section 1 of chapter 176I, that participates in a preferred provider arrangement, as defined in said section 1 of said chapter 176I; any carrier offering a small group health insurance plan pursuant to chapter 176J; any company, as defined in section 1 of chapter 175; any employee benefit trust; any self-insurance plan; and any company possessing a certificate, as defined in section 34A of chapter 90, and authorized to issue a policy of motor vehicle liability insurance pursuant to section 113A of chapter 175 that provides insurance for the expense of medical coverage.
(b) Notwithstanding the provisions of any general or special law to the contrary, in any instance in which an ambulance service provider that provides an emergency ambulance service to an insured is not an ambulance service provider under contract to the insurer maintaining or providing the insured’s insurance policy or insurance contract, the insurer maintaining or providing such insurance policy or insurance contract shall pay the ambulance service provider directly and promptly for the emergency ambulance service rendered to the insured. Notwithstanding any prohibition against an insured’s assigning benefits under the insured’s insurance policy or insurance contract, such payment shall be made to the ambulance service provider; provided that the insured executes an assignment of benefits to the ambulance service provider. In the event that an insured is either incapable or unable as a practical matter to execute an assignment of benefits under an insurance policy or insurance contract pursuant to which an assignment of benefits is not prohibited, or in connection with an insurance policy or insurance contract that contains a prohibition against any such assignment of benefits, such payment shall be made to the ambulance service provider regardless of any such incapacity or inability. An ambulance service provider shall not be considered to have been paid for an emergency ambulance service rendered to an insured if the insurer makes payment for the emergency ambulance service to the insured. An ambulance service provider shall have a right of action against an insurer that fails to make a payment to it pursuant to this subsection.
(c) Payment to an ambulance service provider pursuant to subsection (b) shall be at a rate equal to the rate established by the municipality where the patient was transported from.
(d) An ambulance service provider receiving payment for an ambulance service in accordance with subsections (b) and (c) shall be deemed to have been paid in full for the ambulance service provided to the insured, and shall have no further right or recourse to further bill the insured for said ambulance service with the exception of coinsurance, co-payments or deductibles for which the insured is responsible under the insured’s insurance policy or insurance contract.
(e) No term or provision of this section shall be construed as limiting or adversely affecting an insured’s right to receive benefits under any insurance policy or insurance contract providing insurance coverage for ambulance services. No term or provision of this section shall create an entitlement on behalf of an insured to coverage for ambulance services if the insured’s insurance policy or insurance contract provides no coverage for ambulance services.