EMSAC ADVOCACY

Colorado first responders and consumer advocates have joined forces in support of bipartisan legislation that protects ambulance patients from unexpected balance bills

(Denver, January 22, 2025) Representative Karen McCormick, a veteran member of the House Health & Human Services Committee, introduced HB25-1088 to the Colorado General Assembly last week. Joining her as sponsors are the chairmen of the House and Senate Health & Human Services committees, Representative Kyle Brown and Senator Kyle Mullica. Senator Mark Baisley, vice chairman of Colorado’s Emergency Medical Services (EMS) System Sustainability Task Force, has also signed on as a bill sponsor.

Colorado’s existing balance billing law, passed in 2019, protects patients transported by private ambulance agencies from being “balance billed” if their insurance companies underpay claims for emergency transports. However, nearly 75% of Colorado ambulance services are public agencies operated by cities, special districts, and other political subdivisions – and thus aren’t covered by the existing law. Patients who are transferred to rehabilitation facilities after a hospital discharge or receive other non-emergency transports are also at risk of receiving balance bills.

HB25-1088 prohibits all ambulance agencies from balance billing patients for both emergency and non-emergency transports.

“Patients don’t have the option of choosing who their ambulance provider is in most cases,” said Isabel Cruz, Policy Director at the Colorado Consumer Health Initiative. “This bill is the next step in closing out-of-network billing gaps and protecting patients from surprise bills, preventing consumers from shouldering high costs. When patients are in their most vulnerable moments, their focus should be on their health—not navigating coverage loopholes or worrying about affording a bill."

The legislation aligns with recommendations that the federal Advisory Committee on Ground Ambulance and Patient Billing made to Congress in September 2024, including a requirement that insurance carriers pay the rates for ambulance service that are adopted by cities and other governing political subdivisions.

“Right now, for-profit insurance companies decide – on their own – how much of an ambulance bill to pay. That happens even when local elected officials set the ambulance billing rates, and it hurts patients, taxpayers, and the ability of Colorado ambulance agencies, especially those in rural communities, to sustain their vital operations,” said Sean Caffrey, chief executive officer of the Crested Butte Fire Protection District

“Ambulance agencies are funded almost exclusively through local taxes and revenues derived from insurance, Medicare, and Medicaid billing. When billing revenues go down, tax support must go up – or else the ambulance agency won’t have the resources to pay its medics, fill up the gas tanks, or buy medical supplies,” explained Caffrey.

Caffrey, a former president of the EMS Association of Colorado (EMSAC), serves on the state’s EMS System Sustainability Task Force. Created by Colorado’s General Assembly in 2022, the task force is charged with making recommendations on preserving, promoting, and expanding consumer access to ambulance service across the state. The task force recommended, in its Phase II report published last year, stronger state laws related to ambulance reimbursement, the payment of locally set rates, and balance billing.

Eight states have adopted laws like HB25-1088 over the past two years. Data shows no impact on insurance premiums. The Colorado bill includes unique safeguards, including a public database of rates adopted by political subdivisions and a requirement that rates be reasonable and rationally calculated to offset the costs, to promote accountability.

You can follow the progress of HB25-1088 here, and on the EMSAC Bill Tracker, here.