SB916

SB916 extends specified out-of-network ground-ambulance billing protections and the state’s local-rate database to September 1, 2027, changes who may make annual rate adjustments, and adds licensing enforcement. The affected provisions would otherwise have expired September 1, 2025. These are protections for covered services, supplies and related transport under the listed health-plan laws—not free ambulance service for everyone, and not an air-ambulance rule. Final sections 1–8.

The continued rules limit a protected patient’s bill to applicable plan copayments, coinsurance and deductibles based on the amount initially determined payable or the amount modified through the plan’s internal appeal process. Payment to the provider uses a local-government rate submitted to the Texas Department of Insurance when one exists for the place where the service, or transport if provided, originated. Without a submitted rate, the rule is the lesser of the billed charge or 325% of the current Medicare rate, including applicable extenders and modifiers. SB916 does not create that existing payment formula or waive patient cost-sharing. HMO provision; Insurer provision; Rate database.

The six extended provisions cover health maintenance organizations, preferred- and exclusive-provider insurance arrangements within Chapter 1301, Chapter 1275 plans, and the specified state-employee and public-school employee/retiree managed-care programs. Chapter 1275 includes nonprofit agricultural plans, employer self-funded plans whose sponsors elect the chapter for the relevant plan year, and postsecondary-institution plans under Chapter 1683; that last category comes from a separate 2025 scope amendment, not SB916. Do not assume every self-funded or uninsured patient is covered. Each extended payment section expressly excludes air ambulances. Chapter 1301 itself excludes the child health plan and Medicaid managed-care programs. Chapter 1301 scope. Chapter 1275 payment rule; Chapter 1275 scope as of September 2025; State group program; School retiree program; School employee program.

Instead of requiring the insurer or plan administrator to increase a payment each plan year, SB916 allows the political subdivision to adjust its submitted rate annually. The adjustment may not exceed the lesser of the Medicare Ambulance Inflation Factor or 10% of the provider’s previous-calendar-year rates. This is a limit on the specified submitted-rate adjustment, not a guarantee of a 10% increase or a universal cap on every ambulance charge. Parallel amendments in sections 3–8.

The Department of State Health Services may revoke, suspend or refuse to renew a provider’s license or certificate if it confirms intentional submission of incorrect information required under the rate-database law, or a pattern of violations of one of the six listed billing provisions. This applies even to a directly government-operated provider and is additional to other permitted actions or penalties. It is discretionary authority after confirmation, not automatic revocation for any disputed bill. Signed June 20, 2025, the act took effect September 1, 2025 and applies its changes only to emergency medical services provided on or after that date. Earlier services follow the former law. Sections 1, 9 and 10; History.