Relating to consumer protections against certain medical and health care billing by emergency medical services providers.
Summary
SB 916 revises Texas law governing emergency medical services billing and related consumer protections. The bill extends the expiration date of several existing Insurance Code provisions from September 1, 2025 to September 1, 2027, thereby continuing the current framework for ambulance and EMS rate-setting and billing oversight for two additional years.
The bill also changes the enforcement authority of the Texas Department of State Health Services. Under the amended Health and Safety Code, the department may revoke, suspend, or refuse to renew an EMS provider’s license or certificate if it confirms the provider intentionally submitted incorrect information required under Insurance Code Section 38.006 or engaged in a pattern of violations of several Insurance Code billing provisions. In addition, the bill standardizes rate-adjustment language across multiple insurance-related sections so that political subdivisions may annually adjust submitted rates by no more than the lesser of the Medicare Ambulance Inflation Factor or 10 percent of the provider’s prior-year rates. The bill applies only to EMS provided on or after September 1, 2025.
Impact
SB 916 affects the Insurance Code and Health and Safety Code by extending and refining the state’s ambulance billing and reimbursement rules. It preserves the existing rate-adjustment structure for EMS providers, insurers, health maintenance organizations, and public benefit plans, while giving the Department of State Health Services an added licensing enforcement tool against providers that submit false information or repeatedly violate billing requirements. The practical effect is to maintain current consumer protections and payment limits for ambulance services while keeping the statutory framework in place through 2027.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the Senate unanimously, 30-0, and the House overwhelmingly, 144-0 with two members present not voting. The absence of committee transcript debate suggests the measure was largely noncontroversial and treated as a continuation and clarification of existing consumer protection and billing rules rather than a major policy shift.
Contention
No significant points of contention are evident in the available record. The main policy choices in the bill are the extension of sunset dates, the preservation of the Medicare Ambulance Inflation Factor/10 percent cap for annual rate increases, and the addition of license sanctions for intentional misinformation or repeated billing violations. Any potential concern would likely come from EMS providers or insurers affected by the rate limits and enforcement provisions, but the voting record indicates no organized legislative resistance.
Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers
Ground ambulance services; to prohibit balance billing and set minimum reimbursement rates by health care insurers to emergency medical service providers
Requires the executive office of health and human services to increase Medicaid payment rates for primary care services furnished by primary care providers to be commensurate with Medicare rates.