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.
This Unofficial Version Includes Committee
Amendments Not Yet Adopted on Second Reading
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 ambulance services adopted by the
Page 2, Line 10political subdivision. A political subdivision or an ambulance
Page 2, Line 11service that chooses to submit its rates pursuant to this
Page 2, Line 12subsection (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;
Page 3, Line 13except that an ambulance service may charge a reduced rate to
Page 3, Line 14patients who are residents of or own real property within the political subdivision; and
Page 3, Line 15(IV) If the rates exceed three hundred twenty-five
Page 3, Line 16percent of the amount reimbursed under the "Health Insurance
Page 3, Line 17for the Aged Act", Title XVIII of the federal "Social Security
Page 3, Line 18Act", 42 U.S.C. sec. 1395 et seq., justified by a third-party cost analysis or publicly filed industry cost report.
Page 3, Line 19(2) (a) If a covered person receives covered services from
Page 3, Line 20an ambulance service that is out of network, the carrier shall
Page 3, Line 21reimburse the ambulance service at:
Page 4, Line 1(I) The rates established by the political subdivision in
Page 4, Line 2which the service originated, if the political subdivision or an
Page 4, Line 3ambulance service designated or contracted to provide
Page 4, Line 4ambulance services on behalf of the political subdivision
Page 4, Line 5submitted its rates to the division pursuant to subsection (1) of this section; or
Page 4, Line 6(II) The lesser of the ambulance service's billed charges
Page 4, Line 7or three hundred twenty-five percent of the amount reimbursed
Page 4, Line 8under the "Health Insurance for the Aged Act", Title XVIII of
Page 4, Line 9the federal "Social Security Act", 42 U.S.C. sec. 1395 et seq., if
Page 4, Line 10locally established rates for the ambulance service have not
Page 4, Line 11been submitted to the division pursuant to subsection (1) of this section.
Page 4, Line 12(b) (I) A carrier shall make payments required by
Page 4, Line 13subsection (2)(a) of this section, minus any coinsurance,
Page 4, Line 14deductible, or copayment for which a covered person is responsible, directly to the ambulance service.
Page 4, Line 15(II) At the time of the disposition of the claim, the carrier
Page 4, Line 16shall notify the ambulance service and the covered person of any required coinsurance, deductible, or copayment.
Page 4, Line 17(c) Payment made by a carrier in compliance with this
Page 4, Line 18subsection (2) is presumed to be payment in full for the
Page 4, Line 19ambulance services provided, except for any coinsurance,
Page 4, Line 20deductible, or copayment amount a covered person is required to pay.
Page 4, Line 21(d) This subsection (2) does not prohibit a carrier and an
Page 4, Line 22out-of-network ambulance service from voluntarily negotiating alternative reimbursement terms and rates.
Page 5, Line 1(3) An ambulance service that is out of network shall not
Page 5, Line 2directly or indirectly bill a covered person an outstanding
Page 5, Line 3balance for a covered service not paid for by a carrier, except
Page 5, Line 4for any coinsurance, deductible, or copayment amount required to be paid by the covered person.
Page 5, Line 5(4) An ambulance service that is out of network shall not
Page 5, Line 6willfully and knowingly submit rates that are false or not in
Page 5, Line 7compliance with subsection (1) of this section to the division if
Page 5, Line 8the ambulance service submits rates for ambulance services pursuant to subsection (1)(a) of this section.
Page 5, Line 9(5) A payment for any coinsurance, deductible, or
Page 5, Line 10copayment made by a covered person pursuant to subsection (3)
Page 5, Line 11of this section must be applied to the covered person's
Page 5, Line 12in-network deductibles and in-network out-of-pocket maximum
Page 5, Line 13amounts 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 14(6) The commissioner may adopt rules to implement and enforce this section.
Page 5, Line 15(7) As used in this section, unless the context otherwise requires:
Page 5, Line 16(a) "Ambulance service" has the meaning set forth in section 25-3.5-103 (3).
Page 5, Line 17(b) "Covered service" means a health-care service for
Page 5, Line 18which reimbursement is available under a covered person's
Page 5, Line 19health coverage plan contract or for which reimbursement
Page 5, Line 20would be available but for the application of contractual
Page 6, Line 1limitations such as deductibles, copayments, coinsurance,
Page 6, Line 2waiting periods, annual or lifetime maximums, frequency
Page 6, Line 3limitations, alternative benefit payments, or other contractual limitations.
Page 6, Line 4(c) "Political subdivision" means a governing subdivision
Page 6, Line 5of the state, including a statutory or home rule city, town, city
Page 6, Line 6and county, county, special district, or governmental emergency services provider.
Page 6, Line 7SECTION 2. Appropriation. (1) For the 2025-26 state fiscal
Page 6, Line 8year, $38,149 is appropriated to the department of regulatory agencies for
Page 6, Line 9use by the division of insurance. This appropriation is from the division
Page 6, Line 10of 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 6, Line 11(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 6, Line 12(b) $7,932 for operating expenses.
Page 6, Line 13SECTION 3. Act subject to petition - effective date -
Page 6, Line 14applicability. (1) This act takes effect at 12:01 a.m. on the day following
Page 6, Line 15the expiration of the ninety-day period after final adjournment of the
Page 6, Line 16general assembly; except that, if a referendum petition is filed pursuant
Page 6, Line 17to section 1 (3) of article V of the state constitution against this act or an
Page 6, Line 18item, section, or part of this act within such period, then the act, item,
Page 6, Line 19section, or part will not take effect unless approved by the people at the
Page 6, Line 20general election to be held in November 2026 and, in such case, will take
Page 6, Line 21effect on the date of the official declaration of the vote thereon by the governor.
Page 7, Line 1(2) This act applies to ambulance services provided on or after the applicable effective date of this act.