Senate Bill 2476 – What does it mean?

SB 2476

On September 1, Senate Bill 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 (OON) patients to all ground ambulance services. Therefore, health insurance organizations will be fully responsible for reimbursing EMS agencies. 

To accomplish this, EMS providers must submit a rate or fee schedule to the Texas Department of Insurance (TDI). 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 rates or 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 the Texas Department of Insurance. 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 your agency’s rate or fee schedule prior to submission to TDI. Contact 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 |