House Bill 25-1088 Reengrossed

A Bill for an Act

• Page 1, Line 101Concerning costs associated with the provision of ground

• Page 1, Line 102ambulance services, and, in connection therewith,

• Page 1, Line 103making an appropriation.

Bill Summary

(Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://leg.colorado.gov.)

For ground ambulance services (ambulance services), the bill:

• Allows a political subdivision or an ambulance service providing ambulance services on behalf of the political subdivision to submit to the division of insurance (division) the established rates for the ambulance services, if the rates meet specified conditions;
• Requires the division to publish reimbursement rates on the division's public-facing website;
• Establishes reimbursement rates for ambulance services that are out of network; and
• Prohibits an out-of-network ambulance service from billing an individual covered under a health insurance coverage plan (covered person) any outstanding balance for a covered service not paid for by an insurance carrier, except for any coinsurance, deductible, or copayment amount required to be paid by the covered person. If a covered person makes a payment for an out-of-network ambulance service, the payment must be applied to the covered person's in-network deductibles and in-network out-of-pocket maximum amounts.

• Page 2, Line 1Be it enacted by the General Assembly of the State of Colorado:

• Page 2, Line 2SECTION 1.  In Colorado Revised Statutes, add 10-16-170 as follows:

• Page 2, Line 310-16-170.  Ground ambulance service agencies - ambulance

• Page 2, Line 4services - billing rate database - out-of-network rates - rules -

• Page 2, Line 5definitions. (1) (a)  A political subdivision or an ambulance service

• Page 2, Line 6designated or contracted to provide ambulance services on

• Page 2, Line 7behalf of the political subdivision may submit to the division

• Page 2, Line 8annually, in the form and manner prescribed by the

• Page 2, Line 9commissioner, the rates for emergency ambulance services

• Page 2, Line 10adopted by the political subdivision. A political subdivision or an

• Page 2, Line 11ambulance service that chooses to submit its rates pursuant to

• Page 2, Line 12this subsection (1)(a) shall resubmit the rates to the division if the rates change.

• Page 2, Line 13(b)  The division shall publish rates submitted pursuant to

• Page 2, Line 14this subsection (1) annually on the division's public-facing

• Page 2, Line 15website.

• Page 3, Line 1(c)  The division shall continue to publish rates provided

• Page 3, Line 2by a political subdivision or an ambulance service in subsequent

• Page 3, Line 3years, including updated rates if the political subdivision or

• Page 3, Line 4ambulance service resubmits the rates to the division pursuant to subsection (1)(a) of this section due to a rate change.

• Page 3, Line 5(d)  A political subdivision or an ambulance service shall

• Page 3, Line 6ensure that rates submitted to the division pursuant to this subsection (1) are:

• Page 3, Line 7(I)  Reasonable considering the services provided and rationally calculated to offset the costs of providing services;

• Page 3, Line 8(II)  Legislatively adopted by the governing body of the

• Page 3, Line 9political subdivision or included in an ordinance, a resolution,

• Page 3, Line 10a public contract, or an adopted budget approved by the governing body;

• Page 3, Line 11(III)  Uniformly charged to all patients, regardless of the

• Page 3, Line 12patients' insurance type, insurance source, or insurance status; and

• Page 3, Line 13(IV)  If the rates exceed three hundred twenty-five

• Page 3, Line 14percent of the amount reimbursed under the "Health Insurance

• Page 3, Line 15for the Aged Act", Title XVIII of the federal "Social Security

• Page 3, Line 16Act", 42 U.S.C. sec. 1395 et seq., justified by a third-party cost analysis or publicly filed industry cost report.

• Page 3, Line 17(2) (a)  If a covered person receives covered services that

• Page 3, Line 18are emergency ambulance services from an ambulance service

• Page 3, Line 19that is out of network, the carrier shall reimburse the ambulance service at:

• Page 3, Line 20(I)  The rates established by the political subdivision in

• Page 4, Line 1which the service originated, if the political subdivision or an

• Page 4, Line 2ambulance service designated or contracted to provide

• Page 4, Line 3ambulance services on behalf of the political subdivision

• Page 4, Line 4submitted its rates to the division pursuant to subsection (1) of this section; or

• Page 4, Line 5(II)  The lesser of the ambulance service's billed charges

• Page 4, Line 6or three hundred twenty-five percent of the amount reimbursed

• Page 4, Line 7under the "Health Insurance for the Aged Act", Title XVIII of

• Page 4, Line 8the federal "Social Security Act", 42 U.S.C. sec. 1395 et seq., if

• Page 4, Line 9locally established rates for the ambulance service have not

• Page 4, Line 10been submitted to the division pursuant to subsection (1) of this section.

• Page 4, Line 11(b)  If a covered person receives a covered service that is

• Page 4, Line 12a nonemergency ambulance service from an ambulance service

• Page 4, Line 13that is out of network, the carrier shall reimburse the

• Page 4, Line 14ambulance service at the lesser of the ambulance service's

• Page 4, Line 15billed charges or three hundred twenty-five percent of the

• Page 4, Line 16amount reimbursed under the "Health Insurance for the Aged

• Page 4, Line 17Act", Title XVIII of the federal "Social Security Act", 42 U.S.C. sec. 1395 et seq.

• Page 4, Line 18(c) (I)  A carrier shall make payments required by

• Page 4, Line 19subsection (2)(a) of this section, minus any coinsurance,

• Page 4, Line 20deductible, or copayment for which a covered person is responsible, directly to the ambulance service.

• Page 4, Line 21(II)  At the time of the disposition of the claim, the carrier

• Page 4, Line 22shall notify the ambulance service and the covered person of

• Page 4, Line 23any required coinsurance, deductible, or copayment.

• Page 5, Line 1(d)  Payment made by a carrier in compliance with this

• Page 5, Line 2subsection (2) is presumed to be payment in full for the

• Page 5, Line 3ambulance services provided, except for any coinsurance,

• Page 5, Line 4deductible, or copayment amount a covered person is required to pay.

• Page 5, Line 5(e)  This subsection (2) does not prohibit a carrier and an

• Page 5, Line 6out-of-network ambulance service from voluntarily negotiating alternative reimbursement terms and rates.

• Page 5, Line 7(3)  An ambulance service that is out of network shall not

• Page 5, Line 8directly or indirectly bill a covered person an outstanding

• Page 5, Line 9balance for a covered service not paid for by a carrier, except

• Page 5, Line 10for any coinsurance, deductible, or copayment amount required to be paid by the covered person.

• Page 5, Line 11(4)  An ambulance service that is out of network shall not

• Page 5, Line 12willfully and knowingly submit rates that are false or not in

• Page 5, Line 13compliance with subsection (1) of this section to the division if

• Page 5, Line 14the ambulance service submits rates for ambulance services pursuant to subsection (1)(a) of this section.

• Page 5, Line 15(5)  A payment for any coinsurance, deductible, or

• Page 5, Line 16copayment made by a covered person pursuant to subsection (3)

• Page 5, Line 17of this section must be applied to the covered person's

• Page 5, Line 18in-network deductibles and in-network out-of-pocket maximum

• Page 5, Line 19amounts and in the same manner as if the cost-sharing payments were made to an in-network provider or an in-network facility.

• Page 5, Line 20(6)  The commissioner may adopt rules to implement and enforce this section.

• Page 5, Line 21(7)  As used in this section, unless the context otherwise requires:

• Page 6, Line 1(a)  "Ambulance service" has the meaning set forth in section 25-3.5-103 (3).

• Page 6, Line 2(b)  "Covered service" means a health-care service for

• Page 6, Line 3which reimbursement is available under a covered person's

• Page 6, Line 4health coverage plan contract or for which reimbursement

• Page 6, Line 5would be available but for the application of contractual

• Page 6, Line 6limitations such as deductibles, copayments, coinsurance,

• Page 6, Line 7waiting periods, annual or lifetime maximums, frequency

• Page 6, Line 8limitations, alternative benefit payments, or other contractual limitations.

• Page 6, Line 9(c)  "Emergency ambulance service" means an immediate

• Page 6, Line 10ambulance response at the time service is requested that results

• Page 6, Line 11in an assessment, treatment, or transport of a patient by an ambulance service.

• Page 6, Line 12(d)  "Nonemergency ambulance service" means the

• Page 6, Line 13transport of a patient by an ambulance service, including the

• Page 6, Line 14provision of medically necessary supplies and services, that

• Page 6, Line 15meets the medical necessity requirements under 42 CFR 410.40(e), as that section existed on July 1, 2025.

• Page 6, Line 16(e)  "Political subdivision" means a governing subdivision

• Page 6, Line 17of the state, including a statutory or home rule city, town, city

• Page 6, Line 18and county, county, special district, or governmental emergency services provider.

• Page 6, Line 19SECTION 2.  In Colorado Revised Statutes, 10-16-704, repeal (5.5)(d)(II) as follows:

• Page 6, Line 2010-16-704.  Network adequacy - required disclosures - balance

• Page 7, Line 1billing - rules - legislative declaration - definitions.

• Page 7, Line 2(5.5) (d) (II) (A)  The commissioner shall promulgate rules to identify and

• Page 7, Line 3implement a payment methodology that applies to service agencies

• Page 7, Line 4described in subsection (5.5)(d)(I) of this section, except for service agencies that are publicly funded fire agencies.

• Page 7, Line 5(B)  The commissioner shall make the payment methodology

• Page 7, Line 6available to the public on the division's website. The rules must be

• Page 7, Line 7equitable to service agencies and carriers; hold consumers harmless

• Page 7, Line 8except for any applicable coinsurance, deductible, or copayment amounts;

• Page 7, Line 9and be based on a cost-based model that includes direct payment to service agencies as described in subsection (5.5)(d)(I) of this section.

• Page 7, Line 10(C)  The division may contract with a neutral third-party that has

• Page 7, Line 11no financial interest in providers, emergency service providers, or carriers

• Page 7, Line 12to conduct the analysis to identify and implement the payment methodology.

• Page 7, Line 13SECTION 3.  In Colorado Revised Statutes, 12-30-112, amend (5) as follows:

• Page 7, Line 1412-30-112.  Health-care providers - required disclosures -

• Page 7, Line 15balance billing - deceptive trade practice - rules - definitions. (5)  This

• Page 7, Line 16section does not apply to service agencies, as defined in section 25-3.5-103 (11.5). that are publicly funded fire agencies.

• Page 7, Line 17SECTION 4.  Appropriation. (1)  For the 2025-26 state fiscal

• Page 7, Line 18year, $38,149 is appropriated to the department of regulatory agencies for

• Page 7, Line 19use by the division of insurance. This appropriation is from the division

• Page 7, Line 20of insurance cash fund created in section 10-1-103 (3)(a)(I), C.R.S. To implement this act, the division may use this appropriation as follows:

• Page 7, Line 21(a)  $30,217 for personal services, which amount is based on an assumption that the division will require an additional 0.4 FTE; and

• Page 8, Line 1(b)  $7,932 for operating expenses.

• Page 8, Line 2SECTION 5.  Act subject to petition - effective date -

• Page 8, Line 3applicability. (1)  This act takes effect at 12:01 a.m. on the day following

• Page 8, Line 4the expiration of the ninety-day period after final adjournment of the

• Page 8, Line 5general assembly; except that, if a referendum petition is filed pursuant

• Page 8, Line 6to section 1 (3) of article V of the state constitution against this act or an

• Page 8, Line 7item, section, or part of this act within such period, then the act, item,

• Page 8, Line 8section, or part will not take effect unless approved by the people at the

• Page 8, Line 9general election to be held in November 2026 and, in such case, will take

• Page 8, Line 10effect on the date of the official declaration of the vote thereon by the governor.

• Page 8, Line 11(2)  This act applies to ambulance services provided on or after the applicable effective date of this act.