Note: This version of section effective until 1-1-2025. See also following version of this section, effective 1-1-2025.

     Sec. 8. (a) A health plan operator shall fairly negotiate rates and terms with any ambulance service provider willing to become a participating provider with respect to the health plan.

     (b) In negotiations under subsection (a), a health plan must consider all of the following:

(1) The ambulance service provider’s usual and customary rates.

(2) The ambulance service provider’s resources, and whether the ambulance service provider’s staff is available twenty-four (24) hours per day every day.

(3) The average wages and fuel costs in the geographical area in which the ambulance service provider operates.

(4) The number of times in which individuals covered by the health plan have sought ambulance service from the ambulance service provider but the ambulance service provider’s response was canceled or did not result in a transport.

(5) The local ordinances and state rules concerning staffing, response times, and equipment under which the ambulance service provider must operate.

(6) The types of requests for ambulance service for individuals covered by the health plan that the ambulance service provider generally receives, and the requesting party or agency by which those requests are generally made.

(7) The average reimbursement rate per level of service that the ambulance service provider generally receives as a nonparticipating provider.

(8) The specific:

(A) clinical and staff capabilities; and

(B) equipment resources;

that an ambulance service provider must have to adequately meet the needs of individuals covered by the health plan, such as for the transportation of covered individuals from one (1) hospital to another after traumatic injury.

(9) The average transport cost data reported to the office of the secretary of family and social services by governmental ambulance service providers located within the counties, and contiguous counties, that the nonparticipating ambulance service provider serves.

     (c) If negotiations between an ambulance service provider and a health plan operator under this section that occur after June 30, 2022, do not result in the ambulance service provider becoming a participating provider with respect to the health plan, each party shall provide to the department a written notice:

(1) reporting that negotiations between the ambulance service provider and the health plan operator did not result in the ambulance service provider becoming a participating provider with respect to the health plan; and

(2) stating the points on which agreement between the ambulance service provider and the health plan operator was necessary for the ambulance service provider to become a participating provider with respect to the health plan:

(A) that were discussed in the negotiations between the ambulance service provider and the health plan operator; but

(B) on which the ambulance service provider and the health plan operator did not reach agreement.

As added by P.L.170-2022, SEC.36. Amended by P.L.92-2023, SEC.1.