Bill Text: DE SB207 | 2013-2014 | 147th General Assembly | Draft
Bill Title: An Act To Amend Title 18 Of The Delaware Code Relating To The Required Coverage For Volunteer Ambulance Company Services.
Spectrum: Slight Partisan Bill (Democrat 16-6)
Status: (Passed) 2014-09-24 - Signed by Governor [SB207 Detail]
Download: Delaware-2013-SB207-Draft.html
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SPONSOR: |
Sen. Ennis & Sen. Townsend & Rep. Carson & Rep. M. Smith |
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Sens. Sokola, Poore; Reps. Atkins, Baumbach, Gray, Heffernan, Jaques, J. Johnson, Q. Johnson, Kenton, Longhurst, Outten, Paradee, B. Short, D. Short, D.E. Williams, Wilson |
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DELAWARE STATE SENATE 147th GENERAL ASSEMBLY |
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SENATE BILL NO. 207 |
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AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO THE REQUIRED COVERAGE FOR VOLUNTEER AMBULANCE COMPANY SERVICES. |
Section 1. Amend Chapter 33, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3349A. Required coverage for volunteer ambulance company services.
(a) For the purpose of this section:
(1) "Ambulance run" means a volunteer ambulance company response to dispatched calls for service.
(2) "Basic life support (BLS)" shall have the same meaning as set forth in §9702 of Title 16.
(3) "Volunteer ambulance company" means a non-profit ambulance company that is certified by the State Fire Prevention Commission and is providing basic life support (BLS) services.
(b) Every individual health insurance policy, contract, certificate, or plan which is delivered or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization, or managed care organization shall include coverage of not less than the cost of every ambulance run and associated basic life support (BLS) services provided by a volunteer ambulance company, inclusive of an allowance for uncompensated service, whether in the form of:
(1) An allowable charge;
(2) Through 100% payment; or
(3) Any combination of the foregoing.
(c) In the event that the volunteer ambulance company and the health insurer, health service corporation, health maintenance organization, or managed care organization cannot agree upon the allowable charge or the amount of payment to be made for an ambulance run and associated basic life support (BLS) services, then the volunteer ambulance company shall be entitled to those charges and rates allowed by the Insurance Commissioner or the Commissioner's designee following an arbitration of the dispute.
(1) The Insurance Commissioner shall adopt regulations concerning the arbitration of such disputes.
(2) The Insurance Commissioner shall establish a schedule of fees for arbitration. The nonprevailing party at arbitration shall reimburse the Commissioner for the expenses related to the arbitration process. Funds paid to the Insurance Commissioner under this subsection shall be placed in the arbitration fund and shall be used exclusively for the payment of appointed arbitrators. The Insurance Commissioner may, in the Commissioner's discretion, impose a schedule of maximum fees that can be charged by an arbitrator for a given type of arbitration.
(d) Prior to the determination by the Insurance Commissioner, or the Commissioner's designee, of the allowable charge or the amount of payment to be made for an ambulance run and associated basic life support (BLS) services, the health insurer, health service corporation, health maintenance organization, or managed care organization will pay directly to the volunteer ambulance company the charge assessed by the volunteer ambulance company for the run and basic life support (BLS) services provided, which shall not be subject to reimbursement after the Commissioner's determination.The Insurance Commissioner is authorized to adopt regulations concerning the provisions of this subsection.
(e) Nothing in this section shall prevent the operation of policy provisions involving deductibles or copayments.
(f) This section shall apply to all policies, contracts, certificates, or plans issued, renewed, modified, altered, amended, or reissued on or after July 1, 2014.
Section 2. Amend Chapter 35, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3565A. Required coverage for volunteer ambulance company services.
(a) For the purpose of this section:
(1) "Ambulance run" means a volunteer ambulance company response to dispatched calls for service.
(2) "Basic life support (BLS)" shall have the same meaning as set forth in §9702 of Title 16.
(3) "Volunteer ambulance company" means a non-profit ambulance company that is certified by the State Fire Prevention Commission and is providing basic life support (BLS) services.
(b) Every individual health insurance policy, contract, certificate, or plan which is delivered or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization, or managed care organization shall include coverage of not less than the cost of every ambulance run and associated basic life support (BLS) services provided by a volunteer ambulance company, inclusive of an allowance for uncompensated service, whether in the form of:
(1) An allowable charge;
(2) Through 100% payment; or
(3) Any combination of the foregoing.
(c) In the event that the volunteer ambulance company and the health insurer, health service corporation, health maintenance organization, or managed care organization cannot agree upon the allowable charge or the amount of payment to be made for an ambulance run and associated basic life support (BLS) services, then the volunteer ambulance company shall be entitled to those charges and rates allowed by the Insurance Commissioner or the Commissioner's designee following an arbitration of the dispute.
(1) The Insurance Commissioner shall adopt regulations concerning the arbitration of such disputes.
(2) The Insurance Commissioner shall establish a schedule of fees for arbitration. The nonprevailing party at arbitration shall reimburse the Commissioner for the expenses related to the arbitration process. Funds paid to the Insurance Commissioner under this subsection shall be placed in the arbitration fund and shall be used exclusively for the payment of appointed arbitrators. The Insurance Commissioner may, in the Commissioner's discretion, impose a schedule of maximum fees that can be charged by an arbitrator for a given type of arbitration.
(d) Prior to the determination by the Insurance Commissioner, or the Commissioner's designee, of the allowable charge or the amount of payment to be made for an ambulance run and associated basic life support (BLS) services, the health insurer, health service corporation, health maintenance organization, or managed care organization will pay directly to the volunteer ambulance company the charge assessed by the volunteer ambulance company for the run and basic life support (BLS) services provided, which shall not be subject to reimbursement after the Commissioner's determination.The Insurance Commissioner is authorized to adopt regulations concerning the provisions of this subsection.
(e) Nothing in this section shall prevent the operation of policy provisions involving deductibles or copayments.
(f) This section shall apply to all policies, contracts, certificates, or plans issued, renewed, modified, altered, amended, or reissued on or after July 1, 2014.
SYNOPSIS
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In 1999, House Bill 332 established new response time goals and certification standards for the delivery of basic life support and emergency medical services.In order to meet the new standards, volunteer ambulance companies needed to hire paid EMTs and ambulance attendants to ensure the availability of sufficient numbers of trained, certified staff on a 24 hour, 7 days a week basis to meet the new response time goals.The authors of House Bill 332 recognized that compliance with the new goals and standards would impose additional expense on the volunteer ambulance companies, however, neither House Bill 332 nor any subsequent legislation has addressed the funding sources for basic life support ambulance service in Delaware.Increased costs, without corresponding increases in revenue, have eroded the financial stability of volunteer ambulance companies.In 2012, 40 of Delaware's 55 volunteer ambulance companies reported they are now conducting ambulance/EMS operations at a loss. In 2013, House Bill 215 established the Ambulance and EMS Task Force ("Task Force").In February 2014, the Task Force issued its report on the state of funding of ambulance and EMS services in Delaware and noted, "By some accounts, the public may begin to see diminished ambulance service in as little as 8 to 12 months, if steps are not taken promptly to meet the funding need."The Task Force made 9 findings and 13 recommendations aimed at addressing this issue. This bill would implement one of the Task Force's recommendations to improve the funding of basic life support ambulance services in Delaware by ensuring that health insurers, health service corporations, health maintenance organizations, or managed care organizations do not set their allowable charges below the costs incurred by the volunteer ambulance companies in providing an ambulance run and basic life support services. |
Author:Sen. Ennis
