| (a) Consistent with Insurance Code §38.006, concerning
Emergency Medical Services Provider Balance Billing Rate Database,
this section applies to:
(1) a political subdivision that sets, controls, or
regulates a rate charged for a health care service, supply, or transport
provided by an emergency medical services (EMS) provider, other than
an air ambulance; and
(2) an EMS provider or its designee that provides a
health care service, supply, or transport on behalf of a political
subdivision that sets, controls, or regulates a rate.
(b) A political subdivision or EMS provider subject
to this section may not issue a bill for a health care service, supply,
or transport that exceeds the amount of the rate set, controlled,
or regulated by the political subdivision.
(c) A political subdivision that chooses to submit
data to the Texas Department of Insurance (TDI) under this section
must submit data using the data submission method available at www.tdi.texas.gov
and must include at a minimum:
(1) the political subdivision's name and contact information;
(2) if known, the National Provider Identification
(NPI) number of each EMS provider that provides a health care service,
supply, or transport that is subject to rates set, controlled, or
regulated by the political subdivision;
(3) each ZIP code that is subject to the rates set,
controlled, or regulated by the political subdivision; and
(4) the applicable billing code, code type, and dollar
amount for each health care service, supply, or transport rate that
is set, controlled, or regulated by the political subdivision.
(d) The data submission deadline for a political subdivision
that chooses to submit data is 30 days after the date this section
becomes effective.
(e) TDI will publish data reported by a political subdivision
no later than 10 business days after the data reporting deadline specified
in subsection (d) of this section.
(f) A claim submitted by an EMS provider or its designee
for a health care service, supply, or transport provided on behalf
of a political subdivision must include the ZIP code in which the
health care service, supply, or transport originated.
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