entity — Default rate — Payment. A. A local governmental entity, or ambulance service provider operating on its behalf, may annually submit to the Insurance Department, in the form and manner prescribed by the Insurance Commissioner, the ambulance service rates set or approved, whether in contract or ordinance, by the local governmental entity. B. By January 1, 2026, the Department shall establish and maintain on its public website a database listing all submitted rates. C. The minimum allowable reimbursement rate under any health care benefit plan issued by a health care insurer to an out-of- network ambulance service provider for providing covered ambulance services shall be the rates set or approved, whether in contract or ordinance on May 1, 2025, submitted by a local governmental entity in the jurisdiction in which the covered ambulance services originate, or ambulance service provider operating on its behalf, as provided in subsection A of this section, if the local governmental entity has submitted such rates. D. In absence of the rates provided in subsection A of this section, the rate shall be the lesser of: 1. Three hundred twenty-five percent (325%) of the current published rate for ambulance services as established by the Centers for Medicare and Medicaid Services under Title XVIII of the Social Security Act for the same services provided in the same geographic area; or 2. The ambulance service provider’s billed charges. E. Payment made in compliance with this section shall be considered payment in full for the covered ambulance services provided, except for any copayment, coinsurance, deductible, and other cost-sharing feature amounts required to be paid by the enrollee. An ambulance service provider is prohibited from billing the enrollee for any additional amounts for the paid covered ambulance services in excess of what the health care insurer pays. F. All copayments, coinsurance, deductible, and other cost- sharing feature amounts applicable to amounts calculated in accordance with subsection A of this section shall not exceed the in-network copayment, coinsurance, deductible, and other cost- sharing features for the covered ambulance services received by the enrollee. G. In administering and paying claims, a health care insurer shall comply with Section 1219 of this title. H. The Department shall review the data from the database and submit a report by January 1, 2027, to the Governor, the President Pro Tempore of the Oklahoma State Senate, and the Speaker of the Oklahoma House of Representatives. The rates provided for in subsections C and D of this section shall cease to remain in effect unless the rates are modified by the Oklahoma Legislature prior to December 31, 2027.
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