23-1468m Find Out What's Changing: Billing Members for Ground Ambulance Transportation
Date: 12/26/23
Assembly Bill 716 protects members from paying higher cost shares
Effective January 1, 2024, California Assembly Bill (AB) 716, Ground Medical Transportation, amends prior law and prohibits noncontracting providers from charging and balance billing members for ground ambulance services at a rate above that charged by contracting providers.
How this affects delegated PPGs
Noncontracted providers should avoid balance billing members for covered ground medical transportation. Claims that are participating physician group (PPG) risk should apply the member's in-network cost share, and the provider remittance advice and member explanation of benefits must reflect that the member is not responsible for charges beyond their in-network cost share.
Background
As of January 1, 2024, AB 716 deletes direct reimbursement requirements and prohibits noncontracting ground ambulance providers from balance billing or sending to collections an amount higher than the member’s in-network cost-sharing amount. The bill also disallows ground ambulance providers from billing an uninsured patient or self-pay patient an amount more than the established payment by Medi-Cal or Medicare fee-for-service amount, whichever is greater.1
Beginning January 1, 2024, Health Net and delegated PPGs must directly reimburse a noncontracting ground ambulance provider for covered ground ambulance services for the difference between the in-network cost-sharing amount and an amount outlined in the bill unless the Plan and the noncontracting ground ambulance provider have agreed otherwise.1
View the bill on the Legislature’s website.
1 Assembly Bill 716, Ground medical transportation.
This information applies to Participating Physician Groups (PPGs).