THE SENATE

S.B. NO.

1076

TWENTY-NINTH LEGISLATURE, 2017

S.D. 1

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO AIR AMBULANCE SERVICES.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. The legislature finds that patients are able to receive care in emergency situations at health care facilities that serve communities throughout the State. However, sometimes a patient may need to be transferred to another health care facility in order to receive continuing care or a higher level of care. Because of the unique geography of Hawaii, many of these patients must be transferred to another health care facility by air ambulance services. These transfers can be very costly, considering the specialized equipment and technology that is required.

While many patients are covered by their health benefits insurance for these services, there have been cases where patients are transported using an air ambulance service that does not contract with the covered patient's health insurance carrier. In a case where a non-contracted air ambulance service is used, the health carrier determines an appropriate payment for the air ambulance provider. The patient is then expected to cover the difference between what the provider charged and what the health carrier pays. This places the patient in the middle between the health carrier and the non-contracted air ambulance service when the non-contracted air ambulance service bills the patient for the difference. This practice is referred to as balance billing. Balance bills can cause a significant financial burden on patients. The legislature believes that transferring health care facilities should utilize air ambulance services that are covered by the person's health insurance carrier, except as otherwise permitted in this Act.

The purpose of this Act is to require all health care facilities, when transferring a patient to another health care facility via air ambulance for receiving continuing or higher level care, to first request transport services from an air ambulance that is contracted with the patient's health carrier. If the contracted air ambulance service is not available, then the transferring health care facility must notify the health carrier of the use of a non-contracted air ambulance service to transport the patient. Exceptions are made to ensure the safety of a patient if a contracted air ambulance service is not available in a reasonable amount of time based on the acuity of the patient's condition.

SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter within title 24 to be appropriately designated and to read as follows:

"Chapter

TRANSFERS UTILIZING

AIR AMBULANCE SERVICES PROVIDERS

   -1 Definitions. For purposes of this chapter:

"Air ambulance" means any privately or publicly owned fixed wing or rotor wing aircraft that is specially designed or constructed, equipped pursuant to section 11-72-29, Hawaii Administrative Rules, intended to be used for and maintained or operated for the transportation of patients with medical conditions who are unable to use other means of transportation.

"Contracted air ambulance service" means an air ambulance service that is contracted with a health carrier.

"Covered person" means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan, offered or administered by a person or entity, including an insurer governed by article 10A of chapter 431, mutual benefit society governed by article 1 of chapter 432, and health maintenance organization governed by chapter 432D.

"Facility" means a hospital licensed under section 321‑14.5.

"Health carrier" means the covered person's health plan, including an insurer governed by article 10A of chapter 431, a mutual benefit society governed by article 1 of chapter 432, and a health maintenance organization governed by chapter 432D.

"Non-contracted air ambulance service" means an air ambulance service that is not contracted with a health carrier.

"Receiving facility" means the facility to which the covered person is being transported.

"Transfer" means the transportation of a covered person, by air ambulance from the transferring facility to the receiving facility.

"Transferring facility" means the facility from which the covered person is being transported.

"Transferring physician" means the physician at the transferring facility who is responsible for the care of the covered person who is being transferred.

   -2 Contracted air ambulance service notification. Health carriers shall provide a list of all contracted air ambulance services in the area to facilities on an annual basis and as necessary to update changes in contracted air ambulance services. Health carriers shall also provide to facilities contact information for notification purposes if a non-contracted air ambulance service will be used to transport a covered person.

   -3 Utilizing contracted air ambulance services. Transferring facilities shall utilize an air ambulance service that contracts with the covered person's health carrier, except as provided in section    -4.

   -4 Transport by contracted air ambulance service not timely available. (a) If, in the opinion and medical judgment of the transferring physician:

(1) The health carrier's contracted air ambulance service's estimate of the covered person's pick up time at the transferring facility, as documented by the transferring facility in the covered person's medical record or in writing by the covered person's contracted air ambulance service, taking into consideration the timeframe for other forms of transportation such as the use of ground ambulance from the transferring facility to an airport, is too late considering the covered person's medical condition; or

(2) The transit time is not medically indicated for the covered person, taking into account the acuity of the covered person's medical condition,

the transferring facility shall notify the health carrier of the use of a non-contracted ambulance service.

(b) The receipt of the notification pursuant to subsection (a) shall not be considered an agreement by the health carrier or the transferring or receiving facility to pay the non-contracted ambulance service's charge as billed.

(c) If the health carrier acknowledges the use of a non-contracted ambulance service, this acknowledgment shall not be considered to be an agreement by the health carrier or the transferring or receiving facility to pay the non-contracted ambulance service's charge as billed."

SECTION 3. This Act shall take effect upon its approval and shall apply to all transfers occurring on or after the date of approval regardless of any existing arrangements that the transferring facility may have with an ambulance service.

SECTION 4. This Act shall take effect upon its approval.

 


 


 

Report Title:

Emergency Health Care; Air Ambulance Units; Balance Billing

 

Description:

Requires health care facilities to use transport services from an air ambulance that is contracted with the patient's health carrier when transferring the patient to another health care facility via air ambulance, except under certain conditions. Requires notification if a non-contracted air ambulance service is utilized. (SD1)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.