HB245 would require Kentucky health benefit plans to cover emergency ground ambulance services, including services provided by out-of-network ground ambulance providers. The bill treats ambulance transport requested by a first responder, another health care practitioner, or through a 911 answering point as medically necessary and bars insurers from issuing adverse determinations for those services. It also limits patient cost sharing for out-of-network emergency ground ambulance services so that it cannot exceed the cost sharing that would apply in-network.
The bill establishes a reimbursement framework for out-of-network ground ambulance providers. In general, insurers would have to pay the local emergency ground ambulance service rate set by the relevant local governing authority; if no local rate exists, reimbursement would be the lesser of 400% of the Medicare amount for the same service or the provider’s billed charges. Insurers would have to pay claims or issue written notice within 30 days, and providers could not balance bill patients beyond applicable cost sharing once the insurer pays in accordance with the statute. The bill also amends Kentucky’s health insurance code and the state employee health insurance statute to incorporate this new ambulance coverage requirement for fully insured and self-insured plans issued or renewed on or after January 1, 2026.
The bill’s broader legal impact is to add a new, specific mandate to Kentucky insurance law and to make that mandate controlling over conflicting laws. It also updates the state employee health plan statute so public employee coverage must comply with the new ambulance coverage rules. Because the bill applies to plans issued or renewed after January 1, 2026, it would affect commercial health insurers, self-insured plans, public employee plans, ambulance providers, local governments that set ambulance rates, and covered patients who use emergency ground ambulance services.
The overall sentiment reflected in the available record is neutral to supportive in concept, but there is no committee transcript or vote history provided to show formal debate, amendments, or opposition. The bill’s structure suggests an effort to address surprise billing and payment disputes in emergency ambulance care while preserving patient protections. At the same time, the reimbursement formula and the use of local government rates or a Medicare-based cap indicate likely concerns about insurer costs, provider payment adequacy, and how local rate-setting interacts with private coverage.
The main points of contention likely center on reimbursement levels, the role of local government-set ambulance rates, and whether the 400% of Medicare fallback is sufficient for providers. Insurers may object to mandatory coverage and direct payment requirements, while ambulance providers may argue that the payment standard is too low or too dependent on local rate structures. Patients and consumer advocates would likely support the ban on balance billing and the limits on cost sharing, while local governments and providers may focus on how the bill affects emergency service funding and existing contracts.
HB245 would create a new insurance mandate in Kentucky requiring coverage and direct reimbursement rules for emergency ground ambulance services, including out-of-network services, and would prohibit balance billing beyond applicable cost sharing. It amends KRS Chapter 304 and KRS 18A.225 so the new requirements apply to most health benefit plans and to public employee health coverage, with an effective date for plans issued or renewed on or after January 1, 2026.
No committee discussion or recorded votes were provided, so there is no direct evidence of formal support or opposition in the legislative record supplied. Based on the bill text, the measure appears designed to protect patients from surprise ambulance bills and standardize payment rules, which suggests a generally consumer-protective intent. At the same time, the reimbursement provisions indicate potential concern from insurers and ambulance providers over cost and payment adequacy.
The likely areas of contention are the reimbursement formula, the use of local emergency ground ambulance service rates, and the fallback cap of 400% of Medicare. Insurers may argue the mandate increases costs and limits claims review, while ground ambulance providers may argue the payment standard is insufficient or uneven across jurisdictions. Local governments could also be affected because their rate-setting or contracted rates become the benchmark for payment in many cases.