Updated December 20, 2023
Single final submission deadline: February 2, 2024
What is happening: The TDI recently finalized the rules that implement Texas Senate Bill 2476. These rules replace the proposed quarterly fee schedule reporting/submission timeline with a single, final reporting/submission due date of February 2, 2024.
What you need to do: If you have already completed your fee schedule submission, you do not need to take any action. You may continue to make changes to the fee schedule you have submitted until February 2, 2024. After this date, there will not be any subsequent opportunities to update the rate data.
If you have not submitted your fee schedule to the TDI portal yet, follow the steps outlined in this document to prepare and submit your fee schedules to the TDI portal by February 2, 2024. Additional information about SB 2476, including an FAQ section, can be found here: Emergency services billing data call.
Updated November 14, 2023
Why and how to submit your fee schedule to TDI
What is happening: As part of the preparation for the January 1, 2024, go live of Senate Bill 2476, Texas-based EMS providers should submit their fee schedule to the Texas Department of Insurance (TDI) portal.
The first submission deadline is December 15, 2023. While this is not the final fee schedule submission deadline, submitting your agency’s fee schedule by December 15, 2023, will guarantee that your fees are considered for the entire calendar year of 2024.
If failing to submit fees to TDI’s portal by December 15, 2023, there will be other opportunities to do so. Without a fee schedule, commercial insurance companies will pay the lesser of the charged fees or 325% of Medicare allowable rates.
What you need to do: Follow the steps in this document to prepare and submit fee schedules to TDI’s portal. The document includes resources if you have questions or need additional assistance.
Original post September 4, 2023
On September 1, Texas Senate Bill 2476, (S.B. No. 2476), signed by Texas Governor Greg Abbott on June 18, took effect. The bill affects reimbursement processes for Texas EMS agencies.
SB 2476 aims to amend current laws relating to consumer protections against specific medical and healthcare surprise billing. Changes outlined in the document will apply to emergency medical services provided on and after January 1, 2024.
What is happening?
Senate Bill 2476 eliminates balance billing out-of-network patients to all ground ambulance services. Therefore, health insurance organizations will be fully responsible for reimbursing EMS agencies. Patients can still receive bills for deductibles, copays, coinsurance, and when the service isn’t a covered benefit.
To accomplish this, EMS providers must submit a rate or fee schedule to Texas Department of Insurance (TDI)‘s portal. This data will determine the reimbursement that health insurance plans will pay for the EMS agency’s service. If a rate or fee schedule is not submitted to the TDI, the insurance provider will pay the lesser of the billed charge or 325% of the current Medicare rate.
EMS providers can increase fees annually, according to the Medicare Inflation Index, or 10% of the prior year’s rate. Health insurance organizations must pay the service provider by the 30th day after receiving a clean electronic claim.
Due to being a state law, the bill applies only to health insurance plans regulated by TDI. According to the Texas EMS Alliance, TDI plans represent approximately 20% of insured patients. Patients insured through the Employees Retirement System of Texas (ERS), Teacher Retirement System of Texas (TRS), or with insurance cards containing “TDI” or “DOI” are under TDI’s regulations.
The bill is set to expire on September 1, 2025, but can be amended or extended. Check the section-by-section bill analysis produced by the Senate Research Center of Health & Human Services for more information.
How can EMERGICON help?
EMERGICON has assembled a cross-functional task team focused on understanding the new regulations established by Senate Bill 2476. The group researches the bill’s components, updates internal processes, sends communications, and develops plans to help partner agencies prepare for the changes.
Additionally, EMERGICON can assist partner agencies in reviewing and reassessing the agency’s fee schedule prior to submission to TDI. Contact support@emergicon.com to arrange a meeting with the Client Services team.
Stay tuned to EMERGICON’s communication channels for more updates about Senate Bill 2476. If you have questions about SB 2476, contact our EMS & Client Hotline: 866-839-3671 | support@emergicon.com.