An Act to prohibit certain billing practices by ambulance service providers and establish reimbursement standards for out-of-network emergency medical services.

Be it enacted by the Legislature of the State of South Dakota:

Section 1. That § 58-17-63 be AMENDED:

58-17-63. For the purposes of §§ 58-17-64, sections 2 to 5 inclusive, of this Act, §§ 58-18-63, 58-38-36, and 58-40-33, a health benefit plan is any hospital or medical policy or certificate, hospital or medical service plan, or health maintenance organization subscriber contract. The term does not include specified disease, hospital indemnity, fixed indemnity, fixed duration of one year or less, accident‑only, credit, dental, vision, medicare supplement, long‑term care, or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, or automobile medical payment insurance.

Section 2. That a NEW SECTION be added to chapter 58-17:

Terms used in this Act mean:

(1) "Ambulance service," any ground ambulance service licensed pursuant to chapter 34-11;

(2) "Emergency medical services," ambulance transportation and prehospital emergency medical care provided to a patient;

(3) "Out-of-network provider," an ambulance service provider that does not have a direct or contractual agreement with the patient’s health benefit plan.

Section 3. That a NEW SECTION be added to chapter 58-17:

An ambulance service provider may not bill, attempt to collect from, or otherwise seek reimbursement from a patient for emergency medical services rendered on an out-of-network basis, except for any coinsurance, copayment, or deductible amount, required under the terms of the patient’s health benefit plan.

Section 4. That a NEW SECTION be added to chapter 58-17:

A health benefit plan must reimburse an out-of-network ambulance service provider for emergency medical services at a rate not less than the rate established, adopted, or recognized by the political subdivision from which the transport originated.

If no local rate has been established, adopted, or recognized, the reimbursement must be the lesser of:

(1) The provider’s billed charge; or

(2) Two hundred seventy-five percent of the medicare allowable rate for the same service.

A health benefit plan shall provide the reimbursement for emergency medical services rendered on an out-of-network basis directly to the ambulance service provider in accordance with the provisions set forth in chapter 58-12, unless otherwise agreed to in writing by the plan and the provider.

Section 5. That a NEW SECTION be added to chapter 58-17:

Each ambulance service provider and health benefit plan shall furnish to a patient a clear and concise explanation of benefits and a statement of any amount owed by the patient.

With the exception of non-covered services, a patient is not liable for any amount charged, beyond the applicable coinsurance, copayment, or deductible, required by the patient's health benefit plan for emergency ambulance services.

Section 6. That a NEW SECTION be added to chapter 58-17:

Sections 2 to 5, inclusive, of this Act do not apply to a self-funded employer health plan, medicaid, medicare, or any other federally regulated program.