Oklahoma § 36-6050.3 - Minimum reimbursement rate set by local governmental

§ 36-6050.3. Minimum reimbursement rate set by local governmental

entity — Default rate — Payment.

A. A local governmental entity, or ambulance service provider

operating on its behalf, may annually submit to the Insurance

Department, in the form and manner prescribed by the Insurance

Commissioner, the ambulance service rates set or approved, whether

in contract or ordinance, by the local governmental entity.

B. By January 1, 2026, the Department shall establish and

maintain on its public website a database listing all submitted

rates.

Oklahoma Statutes - Title 36. Insurance

C. The minimum allowable reimbursement rate under any health

care benefit plan issued by a health care insurer to an out-ofnetwork ambulance service provider for providing covered ambulance

services shall be the rates set or approved, whether in contract or

ordinance on May 1, 2025, submitted by a local governmental entity

in the jurisdiction in which the covered ambulance services

originate, or ambulance service provider operating on its behalf, as

provided in subsection A of this section, if the local governmental

entity has submitted such rates.

D. In absence of the rates provided in subsection A of this

section, the rate shall be the lesser of:

1. Three hundred twenty-five percent (325%) of the current

published rate for ambulance services as established by the Centers

for Medicare and Medicaid Services under Title XVIII of the Social

Security Act for the same services provided in the same geographic

area; or

2. The ambulance service provider’s billed charges.

E. Payment made in compliance with this section shall be

considered payment in full for the covered ambulance services

provided, except for any copayment, coinsurance, deductible, and

other cost-sharing feature amounts required to be paid by the

enrollee. An ambulance service provider is prohibited from billing

the enrollee for any additional amounts for the paid covered

ambulance services in excess of what the health care insurer pays.

F. All copayments, coinsurance, deductible, and other costsharing feature amounts applicable to amounts calculated in

accordance with subsection A of this section shall not exceed the

in-network copayment, coinsurance, deductible, and other costsharing features for the covered ambulance services received by the

enrollee.

G. In administering and paying claims, a health care insurer

shall comply with Section 1219 of this title.

H. The Department shall review the data from the database and

submit a report by January 1, 2027, to the Governor, the President

Pro Tempore of the Oklahoma State Senate, and the Speaker of the

Oklahoma House of Representatives. The rates provided for in

subsections C and D of this section shall cease to remain in effect

unless the rates are modified by the Oklahoma Legislature prior to

December 31, 2027.

Added by Laws 2024, c. 356, § 3, eff. Jan. 1, 2025. Amended by Laws

2025, c. 424, § 1, eff. Jan. 1, 2026.